Diagnostic Neuropathology: Volume 1

327 Pages·1988·17.36 MB·English

by  K. L. Gupta

Diagnostic Neuropathology
Volume 1
Diagnostic
Neuropathology
DVOLUMEI
Editors
Julio H. Garcia, M.D.
The University of Alabama at Birmingham, U.S.A.
Julio Escalona-Zapata, M.D.
Universidad Complutense de Madrid, Spain
Uriel Sandbank, M.D.
University of Tel-Aviv, Israel
Springer-Verlag Berlin Heidelberg GmbH
Copyright © 1988 Springer-Verlag Berlin Heidelberg
Originally published by Springer-Verlag Berlin Heidelberg New York in 1988
Softcover reprint of the hardcover 1s t edition 1988
All rights reserved. No part of this book may be reproduced
or transmitted in any form or any means, electronic or
mechanical, including photocopying, recording, or any
other information storage and retrieval system, without
permission in writing from the Publisher.
Library of Congress Catalog Card Number: 88-080148
Manufactured in the United States of America
ISBN 978-3-662-11470-4 ISBN 978-3-662-11468-1 (eBook)
DOI 10.1007/978-3-662-11468-1
Contents
Contributors
1
Preoperative Imaging Studies in Neurosurgery 1
K. L. Gupta, E. R. Duvall, J. J. Vitek, and J. H. Garcia
INTRODUCTION 1
SKULL 2
Size and Configuration of the Skull 2
Thickness and Texture of Bones 2
Cranial Sutures 4
Vascular Grooves and Channels 4
Sella Turcica 4
Calcification 5
COMPUTED TOMOGRAPHY 5
Cranial CT Scan Technique 9
Congenital and Developmental Disorders 12
Hydrocephalus 12
Inflammatory Diseases 13
Abscesses 13
Metastatic Tumors 14
Primary Brain Tumors 14
Cerebellopontine Angle Lesions 14
Brain Stem Gliomas and Fourth Ventricle Ependymomas 17
Third Ventricle Lesions 19
Choroid Plexus Papillomas 19
Meningioma 19
Subarachnoid Hemorrhage 20
Arteriovenous Malformations 20
v
vi Contents
CT Findings in Brain Infarction 20
Intracerebral Hemorrhage 27
Spine 29
MYELOGRAPHY 30
Techniques of Myelography 30
Myelographic Complications 30
Hydrosyringomyelia 31
Ependymoma of the Cauda Equina 33
Meningiomas 34
Schwannomas 34
Arteriovenous Malformations 35
Herniation of Spinal Discs 35
Metastatic Disease 35
CEREBRAL ANGIOGRAPHY 35
Patient Preparation and Technique of Cerebral Angiography 36
Complications of Cerebral Angiography 38
Indications for Cerebral Angiography 39
Angiography of Various Tumors 39
Meningiomas 40
Astrocytomas 40
Glioblastomas 40
Hemangioblastomas 42
Subarachnoid Hemorrhage and Aneurysms 42
Angiomatous Malformations 44
NUCLEAR MAGNETIC RESONANCE 44
REFERENCES 47
2
The Neurosurgical Biopsy 49
J. M. Bonnin
INTRODUCTION 49
INDICATIONS FOR NEUROSURGICAL BIOPSIES 50
PLANNING 50
RAPID DIAGNOSIS VERSUS ROUTINE TISSUE PROCESSING 51
SMEAR TECHNIQUE VERSUS FROZEN SECTION 51
FROZEN SECTIONS OF PREVIOUSLY UNFIXED TISSUES 51
THE SMEAR TECHNIQUE 52
PROCESSING A NEUROSURGICAL BIOPSY 56
FIXATIVES IN NEUROSURGICAL PATHOLOGY 56
STAINING 57
The Nissl Method 57
Stains for Neurofibrils and Axons 57
Staining for Glial Fibrils 58
Myelin Staining 59
Staining for Neutral Lipids 60
Demonstration of Connective Tissue Fibers 60
Other Stains 60
IMMUNOHISTOCHEMISTRY 61
Glial Fibrillary Acidic (GFA) Protein 61
S-loo Protein 63
Neurofilaments (NF) Proteins 63
Neuron-Specific Enolase (NSE) 63
Vimentin, Desmin, and Cytokeratins 63
AIpha-fetoprotein and Human Chorionic Gonadotropin 65
Contents vii
Other Markers tor CNS Tumors 65
Special Viral Antisera 65
TISSUE CULTURE 65
SPECIAL STUDIES REQUIRED IN SOME TYPES OF NEUROSURGICAL BIOPSIES 66
Dementias 66
Lymphoreticular Processes in the CNS 67
Blood Clots from Intracerebral Hematomas 67
CNS Abscesses and Other Infectious Processes 67
Pituitary Adenomas 68
REFERENCES 69
3
Tumors of the Central Nervous System (I) 73
U. Sandbank, J. H. Garcia, J. Escalona-Zapata, and J. M. Bonnin
INTRODUCTION 73
TUMOR CLASSIFICATION 74
EPIDEMIOLOGY OF BRAIN TUMORS 76
TUMORS OF THE ORBIT AND NASAL CAVITY 77
Intraocular Tumors 77
Retrobulbar Tumors That Cause Unilateral Exophthalmus 82
Nasal Tumors of Neural Derivation 88
BENIGN TUMORS OF THE SKULL 89
Hemangioma 89
Giant-cell Tumor (Osteoclastoma) 89
Meningioma 89
MALIGNANT TUMORS OF THE SKULL 90
Chordoma 90
Metastatic Tumors to the Skull 90
Lymphoma 91
Osteosarcoma 91
Multiple Myeloma 92
Fibrosarcoma and Ewing's Tumor 92
CONDITIONS SIMULATING CALVARIAL NEOPLASMS 92
Fibrous Dysplasia 92
Aneurysmal Bone Cyst 92
Epidermoid Cysts 93
Histiocytosis X 93
Paget's Disease of Bone 95
MENINGEAL AND EXTRAPARENCHYMAL TUMORS 96
Meningiomas 96
Meningeal Infiltration by Lymphoma, Leukemia, Plasmacytoma 110
Meningeal XanthomatosislHand-Schueller-Christian Disease 114
Carcinoma 114
Cysts 115
Lipoma 115
Angiomas and Angiomatous Malformations 116
Gliomatous Infiltration of Meninges 116
Primary Leptomeningeal Melanosis 117
TUMORS OF THE PINEAL REGION 117
Germ Cell Tumors 118
Pinealomas 121
Glial Neoplasms and Other Tumors 121
Cysts 121
REFERENCES 122
viii Contents
4
Tumors of the Central Nervous System (II) 127
J. H. Garcia, and J. Escalona-Zapata
INTRODUCTION 127
Location of the Tumor 128
Tumor Markers 131
SUPRATENTORIAL TUMORS 132
Primary Tumors of the Cerebral Hemispheres 132
Astrocytomas and Glioblastoma Multiforme 132
Astroblastoma 150
Oligodendrogliomas 153
Ependymomas 158
Intraventricular Meningiomas 165
Embryonal Neuroepithelial Tumors 165
Gangliogliomas (Ganglioneuromas) 171
Lymphomas of the Brain 172
Primary Cerebral Sarcomas 177
Vascular Neoplasms and Malformations 177
Intracranial Lipomas 182
Cysts 182
Tumors of the Third Ventricle 182
Metastatic (Secondary) Tumors of the Cerebral Hemispheres 186
Granulomas and other Localized Inflammatory Conditions in the Brain Parenchyma 196
TUMORS OF THE SELLA TURCICA AND PARASELLAR REGION 198
Nonneoplastic Pathology of the Adenohypophysis 199
Neoplasms in the Sella Turcica 200
POSTERIOR FOSSA TUMORS 217
Tumors of the Cerebellum 218
Tumors of the Cerebellopontine Angle 232
Tumors of the Fourth Ventricle 242
Other Posterior Fossa Tumors 248
TUMORS OF THE SPINE AND SPINAL CORD 253
Extramedullary Spinal Tumors 254
Intramedullary Spinal Tumors 274
Cauda Equina Tumors 280
FINE-NEEDLE ASPIRATION IN THE DIAGNOSIS OF BRAIN TUMORS 286
Astrocytomas and Related Tumors 288
Astrocytomas of the Cerebral Hemispheres 288
Glioblastoma Multiforme 292
Subependymal Giant-Cell Astrocytoma 292
Oligodendroglioma 292
Ependymoma 296
Medulloblastoma 296
Choroid Plexus Papilloma 296
Schwannoma 296
Meningiomas 299
Intracranial Metastases 299
Craniopharyngioma 299
Tumors of the Pineal Region 303
REFERENCES 304
Contributors
Jose M. Bonnin, M.D. of Anatomic Pathology/
Former Assistant Professor of Neuropathology
Pathology University of Alabama at
University of Alabama at Birmingham
Birmingham Birmingham, AL 35294, USA
Birmingham, AL 35294, USA
K. L. Gupta, M.D.
E. R. Duvall, M.D. Assistant Professor
Associate Professor Department of Radiology
Department of Radiology University of Alabama at
University of Alabama at Birmingham
Birmingham Birmingham, AL 35294, USA
Birmingham, AL 35294, USA
Uriel Sandbank, M.D.
J. Escalona-Zapata, M.D. Professor of Pathology, Tel-Aviv
Professor of Pathology, University
Universidad Complutense. Director, Anatomic Pathology,
Madrid Beilinson Hospital
Director, Institute of Anatomic 49100 Petah Tiqva, Israel
Pathology
Hospital General "Gregorio J. J. Vitek, M.D.
Maraft6n" Professor and Director,
Madrid 28007, Spain Neuroradiology
Department of Radiology
Julio H. Garcia, M.D. University of Alabama at
Professor of Pathology and Birmingham
Neurology Director, Division Birmingham, AL 35294, USA
ix
PREFACE
Diagnosis is the process by which the nature of a disease is established. The histologic
evaluation is what ultimately determines the nature of the disease process in situations
requiring excision of a tissue sample to establish the diagnosis.
Pathologists are responsible for the interpretation of tissue samples removed for the
purpose of establishing a diagnosis. This textbook has been conceived and arranged in
a manner that facilitates the task of arriving at a diagnosis through the evaluation of
tissues removed from patients afflicted with neurological complaints. The portion of the
diagnostic work-up that is purely "clinical", such as the history of the disease and the
results of the physical examination are entirely beyond the scope of this textbook.
Moreover, in current medical practice, it is frequent to deal with patients in whom the
medical history consists of only a single complaint, such as visual difficulties, without
significant abnormalities in the rest of the physical evaluation.
In such patients, imaging studies are of paramount importance for the purpose of
localizing the approximate site of the lesion. Having established that there is, as an
example, a mass or tumor in the suprasellar region which, in the judgement of the
neurologist, is responsible for the visual disturbances, it remains for the surgeon to
resect an appropriate sample of the mass and for the pathologist to "make the diagnosis."
This process can be considerably facilitated if the pathologist is well informed on: a) the
lesions most commonly found at each location, and b) the gross and histologic features
most frequently associated with each type of lesion.
The material included in this textbook has been prepared with these thoughts in
mind. Extensive descriptions of disease processes, which are available in most of the
references cited, have been omitted in favor of relatively detailed descriptions and abundant
illustrations of the histologic abnormalities that, as a group, constitute a diagnostic entity.
Because most pathologists rely primarily on evaluation of histologic preparations stained
with hematoxylin and eosin (H&E), most illustrations included in the book were obtained
from preparations stained by this method.
xi