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Chordoma
Chordoma
Malignant tumor w/ notochordal differentiation
histology: physaliphorous cells (containing intracellular mucin)
high recurrence rate
CT - well-circumscribed; lytic, irregular intratumoral calcifications, ± enhancement
MRI - T1 - isointense; T2: hyperintense; T1C: hetero- enh. w/ honeycomb
radioresistant; Tx → Qx en bloc
Frozen section pitfalls
Frozen section pitfalls
dDx LGG/nml/reactive tissue is challenging
mts vs. glioma - 👍 on frozen
astro vs. ODG: artifact → miss Dx; “fried egg” (artifact of formalin fix) NOT present on frozen
glioma grading: sampling bias → undergrading; ± overgrading
radionecrosis vs. GBM: both my be present
lymphoma vs. SCLC: may resemble on frozen
Supratentorial SOL w/ seizures
Supratentorial SOL w/ seizures
Common first Sx
1st sz in pts >20 y/o → aggressively r/o SOL
if imaging ⊖ → should repeat later
Arachnoid cysts
Arachnoid cysts
congenital; arise from splitting of arachnoid membrane; ♂>♀
fluid is identical to CSF; not communicate w/ vent. or SS
two types: simple (meningothelial cells [arachnoid] → CSF secretion); complex (neuroglia, ependyma & other)
⊕ EMA, ⊖ CEA
Imaging: bone remodeling; CSF on CT/MRI; ± septations;
if incidental fi in adults → single f/u in 6–8 m (r/o ↑ size) if aSx
Tx: Qx if Sx
Galassi classification for middle fossa Arachnoid cysts
Galassi classification for middle fossa Arachnoid cysts
Type I: (MC)
Small, biconvex, in ant. temp. tip.
No mass effect.
Communicates w/ SS on cisternogram (WS-CTC)
± aSx; Tx: observation; Qx if Sx;
Type II:
prox. & intermed. seg. of Sylvian fissure.
open insula → rectangular shape
Partial communication on WS-CTC.
Type III:
entire Sylvian fissure.
MLS.
± bony expansion
minimal communication on WS-CTC.
Feature
Feature
Skin lesions
Tumors
Other features
NF1
NF1
Café au lait spots, freckles, neurofibromas
Optic gliomas, schwannomas, meningiomas
Learning disabilities, endocrine abnormalities, Dural ectasia
NF2
NF2
No skin lesions
Vestibular schwannomas, meningiomas, ependymomas
Hearing loss, mental retardation
Karnofsky Performance Scale (KPS)
Karnofsky Performance Scale (KPS)
10, 20, 30, Sick and Weary, 40, 50, Needing Help Quickly, 60, 70, Mostly Healthy, 80, 90, Perfectly Fine, 100, Divine.
WHO performance score (ECOG)
WHO performance score (ECOG)
ranges 0 - 5
0 - healthy; 5 is dead
Gerstmann’s syndrome
Gerstmann’s syndrome
dominant parietal lobe lesion
agraphia w/o alexia (can't write but can read)
left-right confusion
digit agnosia (can't identify finger by name
acalculia
Mnemonic: "A Lefty Digits Calculator"
Sindou grading
Sindou grading
Grading of meningioma invasion to SSS
Type I - attachment to lat. wall of sinus.
Type II - invasion of lat. recess.
Type III - invasion of lat. wall.
Type IV - invasion of lat. wall & roof.
Type V - total sinus occlusion, contral. wall spared.
Type VI - total sinus occlusion, invasion of all walls.
Verocay bodies
Verocay bodies
stacked arrangements of elongated palisading nuclei alternating w/ anuclear zones containing cell processes
These Verocay bodies are typically found in the more densely packed Antoni A regions, rather than in the loose or microcystic Antoni B areas.
Schwannomas
Pseudopalisades
Pseudopalisades
Pseudopalisading necrosis in a GBM characterized by a garlandlike arrangement of hypercellular tumor nuclei (arrows) lining up around irregular foci of tumor necrosis (n) containing pyknotic nuclei (arrowheads). Note tumor vessel (v).
GBM
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