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Lesions arising in the pineal gland present a particular challenge in the context of intraoperative consultation. The organ is difficult to access, and so biopsies are often small in size. Lesions arising in this area are not frequent, and therefore, the experience level of most pathologists is relatively lacking. Table 10.1 summarizes the differential diagnosis of the most commonly encountered lesions...
Table 8.1 lists the most common tumors arising in the cerebellar region and Table 8.2 lists lesions most commonly arising in the cerebellopontine angle region. A useful way of thinking about cerebellar lesions is with reference to the age of the patient.
Even before one begins to process the tissue, there is some history provided with the specimen. History is important in the evaluation of the biopsy in that it allows the pathologist to commence formulating a differential diagnosis. Critical pieces of history include the age of the patient, location of the lesion, imaging findings, some sense of the clinical course, and prior history. There are a...
The majority of neuropathology lesions submitted for frozen section end up representing tumors. We often approach these cases somewhat biased in thinking that we are likely to be dealing with a neoplasm. Consequently, we may be caught off guard by a nonneoplastic process. Additionally, our experience with nonneoplastic lesions in the central nervous system is generally not as extensive as with tumors.
Of primary dural-based tumors of the central nervous system, meningiomas are clearly the most commonly encountered and are the primary focus of this chapter. The differential diagnosis of dural-based neoplasms is listed in Table 6.1. Meningiomas arise anywhere in the central nervous system where meningothelial cells can be found, most commonly proximal to the dura. Occasionally, meningiomas arise...
The most common primary tumor of the central nervous system is astrocytoma, and in particular glioblastoma. The focus of this chapter is to discuss tumors that are most likely to arise in the cerebral hemispheres (in addition to metastatic neoplasms which were addressed in Chap. 4) (Table 5.1). Most of these tumors represent fibrillary or diffuse astrocytomas. These lesions can arise at any age; most...
There are a whole host of lesions that may involve the spinal cord and be the target of a biopsy. These lesions are summarized in Table 11.1 according to their location within the spinal cord parenchyma itself (intramedullary), between the spinal cord and dura (intradural, extramedullary), and arising outside the dura (extradural). Most of these lesions have been addressed elsewhere in this book in...
Intraoperative pathologic consultation is an important part of many neurosurgery procedures in which tissue is being obtained for purposes of rendering a diagnosis. The primary goal of the brain biopsy procedure is to ensure that the tissue sampled is adequate to make an accurate final diagnosis. To this end, communication between the neurosurgeon and the pathologist is important. By way of illustration,...
Table 7.1 summarizes the differential diagnosis of the most commonly encountered intraventricular lesions. The most frequently seen entities in this general grouping include ependymomas, choroid plexus tumors, and central neurocytomas.
After one has reasonably ruled out the possibility of a nonneoplastic diagnosis (see Chap. 3), one is left with considering a diagnosis of tumor. The first question one needs to ask along these lines is whether or not the neoplasm could represent a metastasis. Metastatic neoplasms are the most commonly encountered tumors in the central nervous system. Because the appearance of these lesions often...
The Frozen Section Library series provides concise, user-friendly, site specific handbooks that are well illustrated and highlight the pitfalls, artifacts and differential diagnosis issues that arise in the hurried frozen section scenario. Frozen Section Library: Central Nervous System is a convenient, user friendly handbook to assist in the evaluation of central nervous system related frozen sections...
Ganglioglioma and dysembryoplastic neuroepithelial tumor are both low-grade glioneuronal neoplasms that most commonly occur in association with chronic epilepsy. Rare cases of tumors with composite features of ganglioglioma and dysembryoplastic neuroepithelial tumor have been reported. We retrospectively reviewed the clinicopathologic features of 8 composite tumors (7 were female; median age, 20 years)...
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