PATHOLOGY LAB

Section 15
Diseases of the Central Nervous System
• 10 month old
• History:
• 1 week PTA:
• cough and fever
• Given counter medication  slight relief
• Irritability few days later
• Increased sleeping time
• Loss of appetite
• Few hrs PTA:
• Difficulty to arouse
• Jerky movements of extremities

CASE 1. ACUTE MENINGITIS

• Physical Exam
• Harsh breath sounds
• Neck rigidity
• Lab findings:
• CSF: cloudy fluid with numerous neutrophils
• Culture: (+) H. influenzae
• Gross:
• Brain stem and cerebellum: Covered with a thick
layer of cream white exudates
• Microscopic:
• Numerous neutrophils in subarachnoid space and
around blood vessels

CASE 1. ACUTE MENINGITIS

 Meninges

Subarachnoid
space

Neutrophils and
Inflammatory cells

CASE 1. ACUTE MENINGITIS

• 45 year old female
• History
• On and off tolerable facial pain for 3 years with
nasal congestion and rhinorrhea
• anosmia for 2 weeks
• Endoscopy
• Bulging mass in the ethmoid area
• Microscopic:
• Mixture of spindle cells and epithelial cells
arranged in whorls (or small nodules)
• Few psammoma bodies at the center of the
whorls

CASE 2. MENINGIOMA
Epithelial
cells in
whorls

Psammoma
bodies

CASE 2. MENINGIOMA
• 52 year old male
• CC: seizure attack
• Course:
• Several seizure attacks for a month
• Comatose
• Hooked to a ventilator
• CT scan
• Large contrast enhancing tumor along the
right cerebral hemisphere

CASE 3. GLIOBLASTOMA
• Gross:
• Solid firm whte and soft yellow areas infiltrating
normal brain tissue
• Microscopic:
• Pleomorphic glial cells
• Occasional large bizarre giant tumor cells
• Proliferation of endothelial cells in blood vessels
• Malignant tumor cells crowded along the edges of
necrotic areas (Pseudopalisading necrosis)

CASE 3. GLIOBLASTOMA
 Blood vessels

Pleomorphic
Giant cells

CASE 3. GLIOBLASTOMA
• 40 year old male
• CC: On and off headaches of increasing severity
for the past few months
• With weakness in the right upper extremities
• CT scan and MRI:
• Mass involving the left temporal love
• Gross:
• Poorly defined gray tumor infiltrating the
brain substance
• Soft gelatinous area in cut sections

CASE 4. ASTROCYTOMA
• Microscopic:
• Mild to moderate increase in the number of glial
cell nuclei
• Variable nuclear pleomorphism
• Intervening network of fine, GFAP positive
astrocytic cell processes
• Fibrillary background

CASE 4. ASTROCYTOMA
Fibrillary
background

Pleomorphic
Glial cells

CASE 4. ASTROCYTOMA