“There are forces in life working for you and against you. One must distinguish the beneficial

forces from the malevolent ones and choose correctly between

them” - Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.

Quick Pathology Review

Shashidhar Venkatesh MurthyA/Prof.& Head of PathologySchool of Medicine & Dentistry James Cook University Australia.

Pathology of CNS Tumors & Meningitis

CPC 35 – CNS- Seizure – Tumours, meningitis

Major CLI:• Increased intracranial pressure – Pathogenesis &

pathology. Pathology of common CNS tumours. • Astrocytoma – grades, clinical types, presentation &

complications. • Pathology & Microbiology of Meningitis – common types

* Bacterial, Viral & TB.

Minor CLI:• Epilepsy, types, clinical features & Pathogenesis.• Toxic meningitis – Kernicterus.• Meningitis other types – viral, fungal (Cryptococcus),

carcinomatous etc.

Look for good in others… no one is without faults and everyone has some good

qualities!

BK.

A. B. C. D. E.

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A 36y woman with 18month history of progressively increasing headaches which increases with her menstrual cycle. Her daughter is also concerned with her recent memory problem and emotional outbursts. Image shows MRI of her head. What is the most likely diagnosis?

A. Briefly discuss origin & pathogenesis of this condition?

B. List 3 gross and Microscopic feature of this disease?

C. What is the relation to menstrual cycle.

A. ACA infarct.

B. Glioblastoma multiforme.

C. Frontotemporal dementia.

D. Brain Metastases.

E. Meningioma.

A. B. C. D. E.

0% 0% 0%0%0%

A 3 year old boy with a history of headaches and morning vomiting for 10 days presents to the ER after a bad episode of vomiting. He is afebrile. The diagnostic studies might include all of the following Except

A. Briefly discuss complications of spinal tap?

B. List 3 laboratory features of CSF in infective types of meningitis?

C. Briefly discuss locations and clinical features of brain herniation?

A. Fundoscopy.

B. CSF examination.

C. GI Endoscopy.

D. MRI.

E. Haemogram/FBC.

A. B. C. D. E.

0% 0% 0%0%0%

A 56 year old woman has a grand mal seizure. Her CSF values reveal a high protein, normal glucose and a normal WBC counts, culture was negatie. A large right cerebral mass is resected and has the microscopic appearance shown. What is the most likely diagnosis?

A. Briefly discuss origin & pathogenesis of this condition?

B. List 3 gross and Microscopic feature of this disease?

C. Briefly discuss prognosis of this condition?

A. Cerebral infarct.

B. Fungal Abscess.

C. Glioblastoma multiforme.

D. Brain Metastases.

E. Meningioma.

52y, F, morning headache 1year, mood changes: Specimen of brain. ? diagnosis

A. B. C. D. E.

0% 0% 0%0%0%

A. Glioblastoma multiforme.

B. Astrocytoma grade 2.

C. Meningioma.

D. Ependymoma.

E. Metastases.

52y, Fem, Menstrual headache: ? diagnosis

1 2 3 4 5

0% 0% 0%0%0%

1. Glioblastoma m.

2. Astrocytoma

3. Metastases

4. Medulloblastoma

5. Meningioma

52y, Fem, Headache, seizure 4 weeks. ? diagnosis

A. B. C. D. E.

20% 20% 20%20%20%

A. AV malformation.

B. Glioblastoma

C. Astrocytoma

D. Meningioma

E. ACA Stroke

52y, F, parasagittal tum attached to falx: ? diagnosis

A. B. C. D. E.

0% 0% 0%0%0%

A. Glioblastoma m.

B. Astrocytoma

C. Meningioma

D. Ependymoma

E. Medulloblastoma

Commonest primary CNS tumor in Adults ?

A. B. C. D. E.

0% 0% 0%0%0%

A. Glioblastoma multiforme

B. Lowgrade Astrocytoma

C. Meningioma

D. Ependymoma

E. Medulloblastoma

60y smoker, chronic bronchitis complains of difficulty walking. PE: stiff, expressionless face. A resting tremor of his fingers (pill rolling). Image shows his brain stem . Diagnosis ?

A. B. C. D. E.

0% 0% 0%0%0%

A. Alzheimers disease

B. Lacunar infarcts

C. Picks disease

D. Parkinsons disease

E. Durett hemorrhages

55y Female. Died following car crash. Coroners autopsy Image shows Brain stem- What is the likely cause of death?

A. B. C. D. E.

0% 0% 0%0%0%

A. Herniation of cerebral tonsil

B. Intracerebral hemorrhage.

C. Subdural hemotoma

D. Subarachnoid hemorrhage.

E. Glioblastoma multiforme.

56y, F Rapidly growing parietal lobe tumor:? diagnosis

1 2 3 4 5

0% 0% 0%0%0%

A. Glioblastoma m.

B. Astrocytoma

C. Meningioma

D. Ependymoma

E. Medulloblastoma

49y, M, CNS tumor: ? diagnosis

1 2 3 4 5

0% 0% 0%0%0%

A. Metastases

B. Astrocytoma sy.

C. Meningiomatosis

D. Neurofibromatosis

E. Lipomatosis

54y woman dies 48 hours after suffering severe head injuries in an automobile accident. Just before her death, her left pupil becomes fixed and dilated. An inferior view of the patient's

brain at autopsy is shown. Most likely cause of death?

A. B. C. D. E.

0% 0% 0%0%0%

A. Diffuse axonal shearing

B. Laminar necrosis

C. Thrombosis of sagittal sinus

D. Transtentorial herniation

E. Watershed infarct

1 2 3 4 5

20% 20% 20%20%20%

48y male, headache 2months, Frontal lobe well demarcated mass lesion. Most likely diagnosis?

A. Glioblastoma multiforme.

B. Astrocytoma Lowgrade

C. Meningioma

D. Ependymoma

E. Medulloblastoma

A. B. C. D. E. F.

0% 0% 0%0%0%0%

A 49y man with a 3 month history of worsening headaches, vomiting and blurring vision has a seizure. Image shows MRI of her head. He undergoes surgical debulking followed by radiation and chemotherapy. What is the most likely diagnosis?

A. Briefly discuss origin & pathogenesis of this condition?

B. List 3 gross and Microscopic feature of this disease?

C. Briefly discuss prognosis of this condition?

A. ACA infarct.

B. Meningioma

C. Glioblastoma multiforme.

D. Frontotemporal dementia.

E. Brain Metastases.

F. .

A. B. C. D. E.

0% 0% 0%0%0%

A 49y man presents with rapidly progressive decline in mental function over 4 weeks. He has clumsiness of motor movements, difficulty eating or walking. Impaired attention span, memory, and judgement. Image shows microscopic appearance of his cerebrum. What is the most likely diagnosis?

A. Briefly discuss origin & pathogenesis of this condition?

B. List 3 gross and Microscopic feature of this disease?

C. Briefly discuss prognosis of this condition?

A. ACA infarct.

B. Viral Meningitis.

C. Creutzfeldt-Jakob disease

D. Pick’s disease.

E. Spongiform encephalopathy.

A. B. C. D. E.

0% 0% 0%0%0%

A 19y female develops sore throat, 3 days later presents with severe headache, neck rigidity. CSF examination reveals High protein, low sugar with plenty of neutrophils. Image shows appearance of CSF Gram stain. What is the most likely diagnosis?

A. Briefly discuss origin & pathogenesis of this condition?

B. List 3 gross and Microscopic feature seen in her cerebrum?

C. Differentiate CSF findings in different types of meningitis?

A. Tuberculous meningitis.

B. Viral Meningitis.

C. Candida meningitis.

D. Streptococcal meningitis.

E. Neisseria meningitidis.

A. B. C. D. E.

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A 61 year old woman with a 8 month history of worsening headaches develops new unilateral anosmia. She has also developed obsessive anxiety about her health and her children safety with no apparent reason. A left subfrontal 3 cm discrete mass is resected. Image shows it’s histopathological appearance. What is the most likely diagnosis?

A. Briefly discuss origin & pathogenesis of this condition?

B. List 3 gross and Microscopic feature of this disease?

C. Briefly discuss prognosis of this condition?

A. Olfactory Neuroblastoma.

B. Lowgrade Glioma.

C. Brain Metastases.

D. Meningioma.

E. Glioblastoma multiforme.

A. B. C. D. E.

0% 0% 0%0%0%

A 8 year old girl presents with severe headache, abnormal gait & MRI reveals third and lateral ventricular enlargement. Image shows gross specimen showing likely gross features. What is the most likely diagnosis?

A. Briefly describe pathological features seen in the image?

B. Explain the symptoms? What is the prognosis?

C. List two microscopic features?

A. Medulloblastoma

B. Pilocytic astrocytoma.

C. Neuroblastoma.

D. Retinoblastoma metastases.

E. Ruptured AV malformation.

A. B. C. D. E.

0% 0% 0%0%0%

A 31 year old man with no significant past medical history has a sudden new-onset grand mal seizure. No Diabetes, he is normotensive. Image shows the angiogram of his left internal carotid artery. What is the most likely diagnosis?

A. Briefly discuss origin & pathogenesis of this condition?

B. List 3 clinical features of this disease?

C. Briefly discuss prognosis of this condition?

A. Berry aneurysm.

B. Vascular malformation.

C. AV fistula in MCA.

D. Atherosclerosis of MCA.

E. Fusiform aneurysm.

A. B. C. D. E.

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A 51 year old previously healthy woman with a sudden severe headache has the vertebral artery angiogram shown. What is the most likely diagnosis?

A. Briefly discuss origin & pathogenesis of this condition?

B. List 3 complications of this condition? How common is this?

C. Briefly discuss prognosis of this condition?

A. AV malformation.

B. Fusiform aneurysm.

C. AV fistula in MCA.

D. Atherosclerosis of MCA.

E. Berry aneurysm.

A. B. C. D. E.

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A 86 year old man with a 7 year history of progressive withdrawal and apathy is found on formal examination to have severe short term memory loss and is unoriented to place or time. The image shows brain appearance similar to his. What is the most likely diagnosis?

A. Briefly describe pathological features seen in the image?

B. Explain the symptoms? What is the prognosis?

C. List three microscopic features?

A. Parkinson’s disease

B. Alzheimer’s disease

C. Astrocytome low grade.

D. Vascular dementia.

E. Pick’s disease

A. B. C. D. E.

0% 0% 0%0%0%

A 68 year old woman with a 4 year history of progressive withdrawal, irritable, irresponsible with speech difficulties. The image shows brain appearance similar to her. What is the most likely diagnosis?

A. Briefly describe pathological features seen in the image?

B. Explain the symptoms? What is the prognosis?

C. List two microscopic features?

A. Parkinson’s disease

B. Alzheimer’s disease

C. Astrocytome low grade.

D. Vascular dementia.

E. Pick’s disease

A. B. C. D. E.

0% 0% 0%0%0%

A 4 year old boy presents with a wide based gait and truncal ataxia. MRI reveals thisrd and lateral ventricular enlargement, along with the lesion shown. What is the most likely diagnosis?

A. Briefly describe pathological features seen in the image?

B. Explain the symptoms? What is the prognosis?

C. List two microscopic features?

A. Medulloblastoma

B. Pilocytic astrocytoma.

C. Neuroblastoma.

D. Retinoblastoma metastases.

E. Ruptured AV malformation.

A. B. C. D. E.

0% 0% 0%0%0%

A 56 year old man develops 2 year history of increasing hand and forearm weakness and clumsiness. Later develops dysarthria and dysphagia. A year later he dies of pneumonia. Image shows two sections of spinal cord with arrows showing the pathology. What is the most likely diagnosis?

A. Parkinsonism.

B. Multiple Sclerosis.

C. Vitamin B12 deficiency (CDC)

D. Motor Neurone Disease (MND)

E. Amyotrophic Lateral Sclerosis (ALS)

A. Briefly describe pathological features seen in the image?

B. Explain the symptoms? What is the prognosis?

C. List one microscopic feature?

MND .. many subtypes:• Amyotrophic Lateral Sclerosis.• Progressive muscle atrophy (LMN) • Primary lateral sclerosis (UMN)• Progressive bulbar palsy

50y Female, Smoker, Headache, Diagnosis?

1 2 3 4 5

0% 0% 0%0%0%

A. Briefly describe pathological features seen in the images?

B. Explain the symptoms? What is the prognosis?

C. List two microscopic features?

1. Glioblastoma

2. Astrocytoma

3. Ependymoma

4. Medulloblastoma

5. Meningioma

• 40y fem, post therapy for Breast Ca – seizures, cognitive changes.38y Man with AIDS – Headache, arm weakness, gait disorder. Images Gross & MRI Diagnosis?

1 2 3 4 5

0% 0% 0%0%0%

A. Briefly describe pathological features seen in the images?

B. What is the Etiology? - JC virus

C. What is the pathogenesis? - Oligodendrocytes - demyelination

1. Glioblastoma

2. Astrocytoma

3. PML

4. Ependymoma

5. Medulloblastoma

“If we are not free, no one will respect us.”

- Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.