Pattern Recognition in Practical Surgical Neuropathology

PATTERN RECOGNITION IN SURGICAL
NEUROPATHOLOGY
Arie Perry, M.D.
Director, Neuropathology Division
DISCLOSURES
• The lecturer will be utilizing portions of
two commercial products in his talks
− Textbook by A Perry and D Brat entitled
“Practical Surgical Neuropathology”
− CD by A Perry entitled “Neuropathology
Songs”
• The lecturer receives royalties from the
sales of these two products
PATTERN RECOGNITION IMPERSONATORS

Beware: Look-alikes
and Mimics

CLINICAL AND RADIOLOGICAL
PATTERNS
• Location
• Location
• Location
• Patient Age
• Radiology
• Histologic Patterns
Real estate analogy
≠ ≠
≠

PATTERNS: EXAMPLE CASE
• 48-yo F with a 7 year history of seizures
and a non-enhancing R temporo-parietal
mass that has been closely followed with
serial imaging
• Recent imaging demonstrated tumor
growth and new foci of contrast
enhancement, prompting surgery
MRI
T2 FLAIR T1-GAD

WHICH PATTERN(S)?
• Parenchymal Infiltrate with Hypercellularity
• Solid Mass (Pure)
• Solid and Infiltrative Process
• Vasculocentric Process
• Extra-axial Mass
• Meningeal Infiltrate
• Destructive/Necrotic Process
• Subtle Pathology or Near Normal Biopsy
WHICH PATTERN(S)?
• Parenchymal Infiltrate with Hypercellularity
• Solid Mass (Pure)
• Solid and Infiltrative Process
• Vasculocentric Process
• Extra-axial Mass
• Meningeal Infiltrate
• Destructive/Necrotic Process
• Subtle Pathology or Near Normal Biopsy

*IDH1-R132H+ (70-80%)
GFAP SYN

FISH STUDIES
1p32
1q42
19p13
19q13
Neu-N IDH1-R132H
DX: ANAPLASTIC
OLIGODENDROGLIOMA,
WHO GRADE III

AO GBM-SC OLIGODENDROGLIOMA (II or III)
• Age 30-40 years
• Corticotropism / seizures common
• Cerebral, especially frontal lobe
• Slow progression
• Survival ~10 years for grade II, 2-5
years for grade III
• 5-25% of diffuse gliomas
OLIGODENDROGLIOMA OLIGODENDROGLIOMA
GFAP

Medical Education: CD
Recording
• Neuropathology songs
• Common disorders
• 2 nd Year medical
students
• Memorization aid
• Fun way to learn!
www.neuropathsongs.com
iTunes or amazon.com

Full Arrangements: Chris Bergmann – RFJ Music
Oligodendroglioma
Music to Ave Maria by F. Schubert, Lyrics by Arie Perry, MD
O----ligodendroglio-oh-oh-ma, diffuse cerebral tumor of adults
Invading cortex, causing epilepsy; on imaging, often you are calcified
And although, you tend to progress over time, for long periods your
fine
You're famous for your rounded nuclei,
Clear haloes look like honeycombs or fried eggs
With branching chicken wire capillaries, and perineuronal satellitosis
O----ligodendroglio-oh-oh-ma, genetically, you are quite unique
With 1p and 19q deletions, from translocation with loss of one
derivative
Represents a genetically favorable set, when FISH criteria are met
Anaplastic cases grow more rapidly, assigned a W.H.O. grade III
With microvascular proliferation, or increased mitotic activity
O----ligodendroglio-oh-oh-ma