NEUROPATHOLOGY

FK UISU

The right hemisphere exhibits a large

collection of blood in the subdural space,
owing to rupture of the bridging veins.

Ischemia
Globally decreased oxygenation of the
brain caused by hypoxia (neardrowning, carbon-monoxide poisoning,
suffocation) or generalized decreased
blood flow (cardiac arrest, external
hemorrhage) may lead to diffuse
(global) ischemia of the brain.

Patients with global hypoxia (ischemia) may develop laminar

cortical necrosis, necrosis of the hippocampus and cerebellar
Purkinje neurons, and watershed infarcts of the cerebrum.

CNS INFECTIONS

ACUTE FOCAL SUPPURATIVE

Cerebral abscesses
Local (mastoiditis, sinusitis)
Hematogenous (tooth extraction, sepsis)
Staph, Strep
Often fibrous capsule, liquid center
Subdural empyema (in sinusitis)
Extradural abscess
(in osteomyelitis)

Cerebral Abscessresult of cerebritis

Originate when bloodborne microorganisms
lodge within the capillary network of the
cortex.
These organisms incite an acute
inflammatory reaction (cerebritis), with
neutrophil influx, edema, and liquefactive
necrosis. The components of the abscess
consist of inflammation, gliosis, and fibrosis.
Expansion of the abscess may result in
compression of blood vessels, leading to
ischemia or mass effect.

 10 17/100.000 Tumor CNS

intracranial
1 2/ 100.000 intraspinal
1/2 3/4 Primer, >> metastase
Ada 3 keunikan CNS
1. Histologi benign low mitotic rate, cellular
uniformity, and slow growth poor
prognosismay infiltrate large regions of
the brain
2. the ability to surgically resect infiltrating glial
neoplasms without compromising
neurologic function is limited
3. the anatomic site of the neoplasm

The four major classes of brain tumors are :

1. Gliomas derived from glial cells : astrocytomas,
oligodendrogliomas, and ependymomas.

2. Neuronal tumors
A. Ganglion Cell Tumors
B. Other Tumors with Glial and Neuronal
Components
C. Tumors with Only Neuronal Elements

3. Poorly differentiated neoplasms

A. Medulloblastoma
B. Atypical Teratoid/Rhabdoid Tumor (AT/RT)
4.

Meningiomas

1. GLIOMAS derived from glial cells

Astrocytoma
Oligodendrogliomas
Ependymomas.

Astrocytoma
astrocytes astrocytoma, glioblastoma,
pilocytic astrocytoma, and pleomorphic
xanthoastrocytoma
about 80% of adult primary brain tumors
WHO astrocytoma (grade II/IV), anaplastic
astrocytoma (III/IV), and glioblastoma (IV/IV)

Well-differentiated astrocytoma. A, The right frontal tumor

has expanded gyri, which led to flattening (arrows). B,
Expanded white matter of the left cerebral hemisphere and
thickened corpus callosum and fornices.

Computed tomographic (CT) scan of a large tumor in the

cerebral hemisphere showing signal enhancement with
contrast material and pronounced peritumoral edema. B,
Glioblastoma multiforme appearing as a necrotic,
hemorrhagic, infiltrating mass.

Glioblastoma. Foci of necrosis with

pseudopalisading of malignant nuclei

Pilocytic astrocytomas other types by their

pathologic appearance and relatively benign behavior.
They typically occur in children and young adults and are
usually located in the cerebellum but may also appear in
the floor and walls of the third ventricle, the optic nerves,
and occasionally the cerebral hemispheres.

These tumors grow very slowly, are considered as

WHO grade I/IV,
Pilocytic astrocytoma in the
cerebellum with a nodule of tumor in
a cyst

Pleomorphic
Xanthoastrocytoma

most often relatively superficially in the

temporal lobe of children and young adults
This is usually a low-grade tumor (WHO grade
II/IV), with a survival rate estimated at 80% at 5
years.
The degree of nuclear atypia can be extreme
and may suggest a high-grade astrocytoma, but
the presence of abundant reticulin
deposits, relative circumscription, and chronic
inflammatory cell infiltrates along with an
absence of necrosis and mitotic activity will
redirect the pathologist toward the diagnosis

Glioblastoma multiforme. A. A coronal section of the brain shows a

necrotic, hemorrhagic, expansile mass in the right hemisphere. B.
Another area exhibits tumor necrosis, which is surrounded by
pseudopalisaded tumor cells. C. A characteristic feature of glioblastoma
multiforme is endothelial proliferation (arrows).

Oligodendroglioma
5% to 15% of gliomas and are most common in the
fourth and fifth decades
mostly in the cerebral hemispheres.
macroscopic are well-circumscribed, gelatinous, gray
masses, often with cysts, focal hemorrhage, and
calcification
microscopic cells with spherical nuclei containing
finely granular chromatin (similar to normal
oligodendrocytes) surrounded by a clear halo of
cytoplasm.
WHO grade II/IV lesions.
Anaplastic oligodendrogliomas (WHO grade III/IV)
are characterized by increased cell density, with nuclear
anaplasia, increased mitotic activity, and necrosis

Ependymoma
most often arise from ventricular system, including
the oft-obliterated central canal of the spinal cord.
5% to 10% of the primary brain tumors
In adults, the spinal cord is their most common location
microscopic cells with regular, round to oval nuclei
with abundant granular chromatin. Between the nuclei,
there is a variably dense fibrillary background. Tumor
cells may form gland-like round or elongated structures
(rosettes, canals)
GFAP expression is found in most ependymomas.
WHO grade II/IV lesions
anaplastic ependymomas occur with increased cell
density, high mitotic rates, areas of necrosis, and
less evident ependymal differentiation. These lesions
are more aggressive (WHO grade III/IV).

Ependymoma. A,
Tumor growing into
the fourth ventricle,
distorting,
compressing, and
infiltrating surrounding
structures. B,
Microscopic
appearance of
ependymoma.

3. POORLY DIFFERENTIATED
NEOPLASMS

Medulloblastoma
20% of the brain tumors in children are
located in the midline of the cerebellum
Dewasa lateral of the cerebellum
microscopic sheets of anaplastic cells.
Individual tumor cells are small, with little
cytoplasm and hyperchromatic nuclei
that are frequently elongated or crescent
shaped. Mitoses are abundant, and
markers of cellular proliferation, such as
Ki-67,

Medulloblastoma. A, CT scan showing a contrastenhancing midline lesion in the posterior fossa. B, Sagittal
section of brain showing medulloblastoma destroying the
superior midline cerebellum. C, Microscopic appearance of
medulloblastoma.

 Atypical Teratoid/Rhabdoid
Tumor (AT/RT)
highly malignant tumor of young children
The histologic component of rhabdoid
cells, resembling those of a
rhabdomyosarcoma, is the defining
characteristic of the lesion.
Mitotic activity is extremely prominent.
found in the posterior fossa
These are highly aggressive tumors of the
very young, nearly all tumors occurring
before the age of 5 and most patients
living less than a year after diagnosis

4. MENINGIOMAS
Meningiomas are predominantly benign tumors of
adults, usually attached to the dura, that arise from
the meningothelial cell of the arachnoid
grade I/IV by the WHO classification
PAS-positive
Atypical meningiomas (WHO grade II/IV) are lesions
with a higher rate of recurrence and more aggressive
local growth that may require therapy in addition to
surgery. The diagnostic criteria a mitotic index of
four or more mitoses per 10 high power fields or three
or more of the atypical features
Certain histologic patterns (clear cell and chordoid) are
also considered to be grade II/IV because of their more
aggressive behavior

A, Parasagittal multilobular meningioma

attached to the dura with compression of
underlying brain

B, Meningioma with a whorled pattern of

cell growth and psammoma bodies.

SELAMAT
BELAJAR