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There are many lesions that are associated with reactive new bone formation; this chapter predominantly covers those in which deposition of osteoid/bone matrix represents the primary pathological process. The key in recognizing these lesions is the identification of osteoid or woven bone (vs. lamellar bone) on the frozen section slide. Osteoid is the organic nonmineralized matrix of bone and, being...
Tumors that produce a chondroid matrix are traditionally grouped together regardless of their histogenesis. There are three types of cartilage: hyaline cartilage, fibrocartilage, and elastic cartilage. In the adult, hyaline cartilage is present in the joints; fibrocartilage is mostly found in the spine; and elastic cartilage is seen in the external ear, epiglottis, and a few other places. The vast...
Most tumors of fibrous and fibrohistiocytic origin generally produce collagen but do not form a mineralizing matrix, whereas high-grade tumors may have little to no matrix. Fibro-osseous lesions [fibrous dysplasia (FD) and osteofibrous dysplasia (OFD)] are composed of large volumes of fibrous connective tissue, principally collagens type I and III, as well as osseous areas. Fibrous and fibrohistiocytic...
Although almost all bone tumors contain giant cells, giant cell-rich lesions of bone encompass a number of entities in which the giant cells are an essential diagnostic component, chief among these are giant cell tumor (GCT) of bone, giant cell reparative granuloma (GCRG), and aneurysmal bone cyst (ABC). These lesions may have overlapping histomorphologic features, yet each possesses its own unique...
Lesions considered in this chapter include traditional “small blue round cell” neoplasms, specifically Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET) and lymphomas, solitary plasmacytoma/multiple myeloma, and other lesions that tend to be composed of a mixed population of rounded cells without epithelial differentiation or significant extracellular matrix deposition. These latter lesions...
Since aneurysmal bone cyst has already been covered with other giant cell-containing lesions, the other cystic lesions that will be discussed in this chapter have been limited to simple bone cyst and intraosseus ganglion. Given the rarity of true vascular lesions of the bone only hemangioma, hemangioendothelioma, and angiosarcoma are referenced.
Although metastatic carcinoma represents the commonest epithelial lesion that can arise in bone, there are at least two primary bone neoplasms, namely adamantinoma and chordoma, that one should always consider these before making a diagnosis of metastatic carcinoma.
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,...
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.
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 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...
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...
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.
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.
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...
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...
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