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 (near-drowning, 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 Abscessresult 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. Gliomas  derived from glial cells : astrocytomas,

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

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 contrast-enhancing 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.