brain biopsy frozen section/touch prep. brain biopsy for suspected neoplasm is it abnormal? is it...
TRANSCRIPT
Brain Biopsy
Frozen Section/Touch Prep
Brain Biopsy for Suspected Neoplasm
• Is it Abnormal?
• Is it Neoplastic?
• What Type of Neoplasm is it?
• What is the Neoplasm’s Grade?
Brain Biopsy for Suspected Neoplasm
• Is it Abnormal? Yes
• Is it Neoplastic? Yes
• What Type of Neoplasm is it?
• What is the Neoplasm’s Grade?
TOUCH PREP-GLIOBLASTOMA MULTIFORME
TOUCH PREP-CNS LYMPHOMA
TOUCH PREP-PRESENT CASE
TOUCH PREP-PRESENT CASE
H&E
EBER
CD20
Ki67
Diagnosis:
Malignant Lymphoma, High Grade,
Diffuse Large B Cell Type,
EBV positive
CNS Lymphomas
• Primary CNS Lymphoma– Immunosuppressed Patients– Immunocompetent Patients
• Secondary CNS Lymphoma– 10% of systemic non-Hodgkin’s lymphomas
involve CNS– Leptomeninges, epidural space are favored
locations
Primary CNS Lymphoma
• Immunosuppressed Host– AIDS, s/p transplant, inherited immunodeficiency
– 95% EBV positive
– Median survival=1 year
• Immunocompetent Host– Usually >60 years old
– 10% EBV positive
– Median survival=3 years
Primary CNS Lymphoma• Epidemiology
– Incidence increased 10X worldwide due to AIDS• Clinical
– 10% of patients have a history of another cancer– Respond dramatically to corticosteroids
• “ghost tumor”, “sentinel lesion”• Radiology
– Often homogeneously enhancing, periventricular• Pathology
– Most Diffuse Large B Cell Lymphoma– Hodgkins lymphoma=rare
• Treatment– Gross total resection not indicated– Biopsy for diagnosis followed by chemotherapy
Quandary
• There are no B lymphocytes normally in the CNS
• How do you get Primary B cell lymphomas in CNS?
Primary CNS Lymphoma: Possible Etiologies
• B cell transformed elsewhere in body that develops adhesion molecules specific for CNS endothelium
• Systemic lymphoma that is eradicated by immune system but is protected in CNS
• Clonal B cell neoplasm arising in polyclonal intracerebral inflammatory response
Argani’s rule of tumor pathology
Stuff happens