Practical Surgical Neuropathology: A Diagnostic Approach E-Book

A Volume in the Pattern Recognition Series

Arie Perry, Daniel J. Brat

• Publisher: Elsevier
• Year: 2017
• ISBN:
  9780323508667
• Edition: 2
• Topic: Medicine
• Subtopic: Pathology

Part of the in-depth and practical Pattern Recognition series, Practical Surgical Neuropathology, 2nd Edition, by Drs. Arie Perry and Daniel J. Brat, helps you arrive at an accurate CNS diagnosis by using a pattern-based approach. Leading diagnosticians in neuropathology guide you from a histological (and/or clinical, radiologic, and molecular) pattern, through the appropriate work-up, around the pitfalls, and to the best diagnosis. Almost 2, 000 high-quality illustrations capture key neuropathological patterns for a full range of common and rare conditions, and a "visual index" at the beginning of the book directs you to the exact location of in-depth diagnostic guidance.

• Instructive algorithms provide detailed guidance based on 8 major (scanning magnification) patterns and 20 minor (high magnification) patterns – helping you narrow the range of diagnostic possibilities.
• A user-friendly design color-codes patterns to specific entities, and key points are summarized in tables, charts, and graphs so you can quickly and easily find what you are looking for.

• Sweeping content updates keep you at the forefront of recent findings regarding gliomas, embryonal neoplasms, meningiomas, pituitary region and pineal tumors, epilepsy pathology, peripheral nerve sheath tumors, neurodegenerative disorders, tumor predisposition syndromes, and much more.

Improved pattern call-outs are now linked directly within the chapter, reinforcing the patterns for more efficient and complete understanding.

1

Neuropathology Patterns and Introduction

Arie Perry MD, Daniel J. Brat MD, PhD

CNS Tumor Classification Schemes and Additional “Neuropathology Patterns” 1

Electron Microscopy 3

Immunohistochemistry 3

Glial Markers 3

Neuronal Markers 3

Epithelial and Meningothelial Markers 15

Proliferation Markers 15

Molecular Diagnostics and Surrogate Molecular Immunostains 15

CNS Tumor Classification Schemes and Additional “Neuropathology Patterns”

The first comprehensive classification of nervous system tumors, formulated by Percival Bailey and Harvey Cushing in 1926, was founded on presumed parallels between embryologic and neoplastic cells.¹ In large part, this histogenetic “cell of origin” model still forms the basis for today's nomenclature, although much of the terminology has changed considerably. Renewed interest in the role of developmental pathways in tumorigenesis has led to more recent studies focusing on cancer stem cells and progenitor cells,^2–6 as well as in disease-defining driver mutations.^7–11 In 1949, as a means of enhancing the clinical utility of tumor classification, Kernohan contributed a tumor grading system focusing on correlations with patient prognosis.¹² As progress was made over time, Russell and Rubinstein continued to modify and update the Bailey and Cushing system from the 1960s through the 1980s. Nonetheless, considerable variability in diagnostic practice existed on both sides of the Atlantic Ocean. In order to enhance consistency, an experts' consensus scheme known as the World Health Organization (WHO) classification scheme was first completed in 1979 and then revised in 1993, 2000, 2007, and 2016.^13,14 This latter scheme is now the most widely utilized by neuropathologists for tumor typing and grading.

The 2016 WHO “blue book” currently lists over 100 types of nervous system tumors and their variants.¹³ It also departs from prior editions in being the first to integrate molecular criteria into the definitions of many adult and pediatric tumor types.^13,14 This level of complexity can be daunting; therefore, an organized approach or algorithm is required. As a first step, consideration of clinical and radiologic characteristics is a critical way to narrow the differential diagnosis, often to a few fairly common entities. In fact, the combination of patient age and neuroimaging features (including tumor location) provides some of the most powerful diagnostic clues before any tissue is even sampled or examined under the microscope. For example, the differential varies considerably for supratentorial versus infratentorial, pediatric versus adult, and enhancing versus nonenhancing tumors. The most common diagnostic considerations are therefore summarized by age, location, and imaging features in Table 1.1, with each specific entity discussed in greater detail in subsequent chapters. Also, for a much more detailed background on the use of neuroimaging, the reader is referred to Chapter 4, while the more recent approach of using classic molecular patterns/profiles as a diagnostic aid is summarized in a c...