Course:Introduction to Neuropathology
Course Neuropathology is a online collection of images and descriptions of specimens used for teaching medical students and residents.
This page is divided into following courses:
- Basic neuropathology - preclinical medical education
- Molecular neuropathology - ideal for bachelor of molecular medicine or oncology
- Advanced neuropathology - clinical medical education
Basic neuropathology
Day one
Meningioma
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Picture 5
This H&E stain displays parts of a moderately cellular tumor growing with ovoid elongated nuclei (Pictures 1+2). There are no clear-cut cell borders discernible in light microscopy. This interveawing is called a syncytium. WHO Grading of the tumour is dependent of the mitotic activity (Picture 3) or histological hallmarks such as prominent nucleoli, high nuclear to cytoplasmic ratio, CNS infiltation etc.. Focal nuclear clearing (Nuclear pseudoinclusions, Picture 4+5) are typical cut phenomenon. The round calcified inclusions (Psammoma bodies) are characteristic for a meningioma.
- See also: Virtual slide (Meningioma I, HE, usz.ch)
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Astrocytoma
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This specimen contains fragments of a diffusely growing tumor with only slight inclreased cell density and focally microcysts withing the neuropil background (Picture 1). Although many of the astrocytic tumour cells look quite similiar there is increased pleomorphism, mostly larger and a more dense chromatin. There are no mitoses seen in this tumour (Picture 2). The tumour borders are not clear, there is just a decrease of cell density a the tumor infiltration zone. In this area one is not always sure which cells are still neoplastic and which cells are normal or reactive astrocytes of the normal brain (Picture 3).
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Glioblastoma
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Already at low magnification extraordinary pleomorphism is evident in the cellular tumour (Picture 1). Major hallmark are extensive line-shaped necroses. Tumour cells bordering these necrotic centers are arranged in a pseudopalisading fashion (Picture 2). In addition the glioblastoma harbors neoagniogenesis with vascular proliferations of enlarged endothelial in several layers (Picture 3). The tumour cells are quite pleomorphic, somitimes round, sometimes polygonal. Plenty of mitoses are seen (Picture 4). The tumour cells show slender, elongated cytoplasmic processes, in part still resting on a neuropil-like (fibrillary) background that resembles normal CNS tissue (Picture 5).
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Oligodendroglioma
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The sample consists mainly of tumour particles that show extensive calcifications which are already visible at low magnification (Picture 1). The tumour cells show perinuclear halos - a fixation artefact seen typically in oligodendrogliomas (Picture 2). This "fried-egg" appearance at higher cell density results in the so called "honeycomb" appearance. Oligodendrogliomas usually have monomprhic round nuclei with scant chromatin. Between the tumour cells delicate capillaries are present. In contrast to astrocytomas the tumor border is more pronounced, the infiltrative pattern is less evident (Picture 4). In absence of necrosis and almost no mitotic activity this tumour corresponds to WHO Grade II.
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Day two
Purulent meningitis
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This autopsy specimen from cerebral hemisphere shows diffuse clouding of the arachnoidea and pia mater by a dense cellular infiltrate as seen in this low magnification (Picture 1). In higher magnification the infiltrate consists mainly of neutrophil granulocytes (Picture 2). Because the granulocytes are also seen along capillaries in the Virchow-Robin space, we consider this a meningoencephalitis (Picture 3).
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Tuberculous meningitis
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This autopsy specimen was sampled in coronar section from the optic chiasm and displays numerous granulomas (Picture 1). In the brain parenchyma mutlifocal smaller infiltrates consisting of lymphocytes and monocytes. The adjacent astrocytes show reactive changes with broadly swollen, pink cytoplasm ("gemistocytes", Picture 2). The granulomas are surronded by lymphocytes and in between so called epitheloid cells with chromatin-dense, elongated, sole-like nuclei and occassionally Langhans giant cells (Picture 3). The center of the granuloma is often necrotic, such "caeseating necroses" are typical for tuberculous meningitis (Picture 4).
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Molecular neuropathology
Coming soon.
Adavanced neuropathology
Coming soon.