Pattern Recognition in Practical Surgical Neuropathology
Pattern Recognition in Practical Surgical Neuropathology
Pattern Recognition in Practical Surgical Neuropathology
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PATTERN RECOGNITION IN SURGICAL<br />
NEUROPATHOLOGY<br />
Arie Perry, M.D.<br />
Director, <strong>Neuropathology</strong> Division<br />
DISCLOSURES<br />
• The lecturer will be utiliz<strong>in</strong>g portions of<br />
two commercial products <strong>in</strong> his talks<br />
− Textbook by A Perry and D Brat entitled<br />
“<strong>Practical</strong> <strong>Surgical</strong> <strong>Neuropathology</strong>”<br />
− CD by A Perry entitled “<strong>Neuropathology</strong><br />
Songs”<br />
• The lecturer receives royalties from the<br />
sales of these two products<br />
PATTERN RECOGNITION IMPERSONATORS
Beware: Look-alikes<br />
and Mimics
CLINICAL AND RADIOLOGICAL<br />
PATTERNS<br />
• Location<br />
• Location<br />
• Location<br />
• Patient Age<br />
• Radiology<br />
• Histologic <strong>Pattern</strong>s<br />
Real estate analogy<br />
≠ ≠<br />
≠
PATTERNS: EXAMPLE CASE<br />
• 48-yo F with a 7 year history of seizures<br />
and a non-enhanc<strong>in</strong>g R temporo-parietal<br />
mass that has been closely followed with<br />
serial imag<strong>in</strong>g<br />
• Recent imag<strong>in</strong>g demonstrated tumor<br />
growth and new foci of contrast<br />
enhancement, prompt<strong>in</strong>g surgery<br />
MRI<br />
T2 FLAIR T1-GAD
WHICH PATTERN(S)?<br />
• Parenchymal Infiltrate with Hypercellularity<br />
• Solid Mass (Pure)<br />
• Solid and Infiltrative Process<br />
• Vasculocentric Process<br />
• Extra-axial Mass<br />
• Men<strong>in</strong>geal Infiltrate<br />
• Destructive/Necrotic Process<br />
• Subtle Pathology or Near Normal Biopsy<br />
WHICH PATTERN(S)?<br />
• Parenchymal Infiltrate with Hypercellularity<br />
• Solid Mass (Pure)<br />
• Solid and Infiltrative Process<br />
• Vasculocentric Process<br />
• Extra-axial Mass<br />
• Men<strong>in</strong>geal Infiltrate<br />
• Destructive/Necrotic Process<br />
• Subtle Pathology or Near Normal Biopsy
*IDH1-R132H+ (70-80%)<br />
GFAP SYN
FISH STUDIES<br />
1p32<br />
1q42<br />
19p13<br />
19q13<br />
Neu-N IDH1-R132H<br />
DX: ANAPLASTIC<br />
OLIGODENDROGLIOMA,<br />
WHO GRADE III
AO GBM-SC OLIGODENDROGLIOMA (II or III)<br />
• Age 30-40 years<br />
• Corticotropism / seizures common<br />
• Cerebral, especially frontal lobe<br />
• Slow progression<br />
• Survival ~10 years for grade II, 2-5<br />
years for grade III<br />
• 5-25% of diffuse gliomas<br />
OLIGODENDROGLIOMA OLIGODENDROGLIOMA<br />
GFAP
Medical Education: CD<br />
Record<strong>in</strong>g<br />
• <strong>Neuropathology</strong> songs<br />
• Common disorders<br />
• 2 nd Year medical<br />
students<br />
• Memorization aid<br />
• Fun way to learn!<br />
www.neuropathsongs.com<br />
iTunes or amazon.com
Full Arrangements: Chris Bergmann – RFJ Music<br />
Oligodendroglioma<br />
Music to Ave Maria by F. Schubert, Lyrics by Arie Perry, MD<br />
O----ligodendroglio-oh-oh-ma, diffuse cerebral tumor of adults<br />
Invad<strong>in</strong>g cortex, caus<strong>in</strong>g epilepsy; on imag<strong>in</strong>g, often you are calcified<br />
And although, you tend to progress over time, for long periods your<br />
f<strong>in</strong>e<br />
You're famous for your rounded nuclei,<br />
Clear haloes look like honeycombs or fried eggs<br />
With branch<strong>in</strong>g chicken wire capillaries, and per<strong>in</strong>euronal satellitosis<br />
O----ligodendroglio-oh-oh-ma, genetically, you are quite unique<br />
With 1p and 19q deletions, from translocation with loss of one<br />
derivative<br />
Represents a genetically favorable set, when FISH criteria are met<br />
Anaplastic cases grow more rapidly, assigned a W.H.O. grade III<br />
With microvascular proliferation, or <strong>in</strong>creased mitotic activity<br />
O----ligodendroglio-oh-oh-ma