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8/13/2019 A case for discussion (Part 2)
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A case for !!?Prof. Gamal Dawood
(Part 2)
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IMMUNOHISTOCHEMISTRY
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SNF.
Note positivity in three locations:
In neurpil (tissue located between the cell bodies of neoplastic cells);
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SNF.
Note positivity in three locations:
Occasionally in structures suggestive of pseudorosettes of Homer Wright;
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SNF.
Note positivity in three locations:
In the cytoplasm of some cells.
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SNF.
Homer Wright pseudorosettes
These structures are characteristic of tumors of neuronal lineage
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NeuN nuclear antigen
Advanced stages of neuronal maturation, immunolabeling is shared by many
central neurocytomas and attests to their well-differentiated nature.
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NSE.
Strong cytoplasmic positivity in part of cells, compatible with neuronal differentiation.
However, NSE (neuron-specific enolase) is, in reality, little specific, being positive also in
gliomas, as oligodendrogliomas and ependymomas.
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NSE.
Strong cytoplasmic positivity in part of cells, compatible with neuronal differentiation.
However, NSE (neuron-specific enolase) is, in reality, little specific, being positive also in
gliomas, as oligodendrogliomas and ependymomas.
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CGR.
It is observed focally in the cytoplasm.
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CGR.
It is observed focally in the cytoplasm.
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Cromogranin
Dot positivity in standard. In this case, the positivity is denoted in only a small rounded
area of cytoplasm.
It is assumed that the marking occurs in the Golgi apparatus, where the protein is being
modified after synthesis in the endoplasmic reticulum.
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Cromogranin
Dot positivity in standard. In this case, the positivity is denoted in only a small rounded
area of cytoplasm.
It is assumed that the marking occurs in the Golgi apparatus, where the protein is being
modified after synthesis in the endoplasmic reticulum.
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NF.
Negative throughout the sample. The negativity indicates that neoplastic cells,
although showing neuronal differentiation, as evidenced by the reactivity to NFC and
CGR, are in an intermediate stage. Only cells with advanced degree of differentiation
into neurons tend to be positive for neurofilament.
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Small group of astrocytes interpreted as reactive to the presence of
the tumor (non neoplastic). Have more abundant cytoplasm, with
aspect of gemistocytic astrocytes, denser and afforestation.
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GFAP.
The great majority of cells positive for GFAP are small, with short
extensions or simplified, making it unlikely that are pre-existing cells.
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GFAP
Positive cells, apparently belonging to tumor, at least in the majority.
In addition, there are fine cellular extensions attending between negative
cells.
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GFAP.
Positivity in pseudorosettes.Homer Wright pseudorosettes in this case are densely
populated by prolongations GFAP-positive, so astrocytes, make
this tumor
Astrocytic differentiation in tumor cells had been observed inseveral cases but positive GFAP filaments in pseudorosettes
never had found. Usually, these structures are positive for
neuronal markers, especially synaptophysin, but not to a glial
marker. This suggests that in intimate coexistence of rosettesthere may be an extension of two cell lines, as in normal
nervous tissue.
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GFAP. Positivity in perivascular astrocytic extensions. Small vessels in the tumor are often
surrounded by positive GFAP cellular extensions.
As in normal nervous tissue there is intimate relationship between the prolongations of
astrocytes with vessels, apparently these small primitive cells, but with incipient astrocytic
differentiation, reproduce a morpho-physiological patternof adult astrocytes.
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GFAP. Positivity in perivascular astrocytic extensions. Small vessels in the tumor are often
surrounded by positive GFAP cellular extensions.
As in normal nervous tissue there is intimate relationship between the prolongations of
astrocytes with vessels, apparently these small primitive cells, but with incipient astrocytic
differentiation, reproduce a morpho-physiological patternof adult astrocytes.
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VIM.
neoplastic cells with suspected astrocytic differentiation, as
already seen with GFAP
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VIM.
neoplastic cells with suspected astrocytic differentiation, as
already seen with GFAP
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VIM.
neoplastic cells with suspected astrocytic differentiation, as
already seen with GFAP
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.
The results with vimentin virtually reproduce with GFAP. There are marking a
portion of the small tumor cells, and of pseudorosettes of Homer Wright. The
vessels are always positive for vimentin, since this intermediate filament is
present on endothelial cells.
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.
The results with vimentin virtually reproduce with GFAP. There are marking a
portion of the small tumor cells, and of pseudorosettes of Homer Wright. The
vessels are always positive for vimentin, since this intermediate filament is
present on endothelial cells.
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VIM.
As neurons do not express this marker, the positivity for vimentin is further evidence of
astrocytic differentiation i.e. divergent differentiation in a primitive cell tumor.
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S-100.
Fuzzy Positivity, but highlighting cells that, by their extensions, suggest
astrocytic differentiation as already discussed above for GFAP and VIM
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S-100.
Fuzzy Positivity, but highlighting cells that, by their extensions, suggest
astrocytic differentiation as already discussed above for GFAP and VIM
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CD34.
This quality is excellent for demonstrating the rich vascularization. The vast network of
capillaries regularly spaced and very thin walls stands out against the tumor tissue.
There is no endothelial proliferation.
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CD34.
Positive in endothelial cells. Distributed capillary network
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CD34.
Positive in endothelial cells. Distributed capillary network
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Ki-67.
The number of cores marked was valued at around 3%, a visual estimate of multiple
fields, without counting. The photos were made in the richer areas. Mitoses are
difficult to find, even with this method.
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Ki-67.
The number of cores marked was valued at around 3%, a visual estimate of multiple
fields, without counting. The photos were made in the richer areas. Mitoses are
difficult to find, even with this method.
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Differential Diagnosis
The main differential diagnoses are : Central Neurocytoma
Oligodendroglioma: Neurocytic neoplasms are further (and mostefficiently) distinguished by a neuronal immunophenotype that includesdiffuse matrix labeling for synaptophysin and, in many instances,widespread immunoreactivity for the neuronal nuclear antigen (NeuN).This is not to dismiss evidence that oligodendrogliomas occasionallyexercise a potential for neuronal differentiation.
Chromosome 1p/19q co-deletions, a common feature of histologicallytypical oligodendrogliomas are not harbored by central neurocytomas orclear cell ependymomas
Oligodendroglioma GFAP Vimentin
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NSE Synaptophysin
Unfortunately, there does not exist at present an immunocytochemical reagent that
consistently and specifically identifies neoplastic cells as oligodendroglial. Immunolabeling
for S-100 protein, membranous Leu7 (CD57) reactivity, and cytoplasmic expression of
carbonic anhydrase Cand MAP-2 are characteristic but shared by other tumor types.
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Ependymoma
Pineocytoma
Dnet (dysembryoplasic neuroepitelial tumor):
It is a benign, mixed glial-neuronal cortical
neoplasm of children and young adults
GFAPEpendymoma
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EMAVimentin
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SynaptophysinGFAPVimentin
Central Neurocytoma
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Central Neurocytoma