Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series, Expert Consult: Online and Print

654 Pages·2010·428.92 MB·English

by  Arie Perry MD

Practical Surgical
Neuropathology
Pattern Recognition Series
Series editors:
Kevin O. Leslie and Mark R. Wick
Practical Bone and Joint Pathology
Edited by Gene P. Siegal and Barry R. DeYoung
Practical Breast Pathology
Edited by Kristen Atkins and Christina Kong
Practical Cytopathology
Edited by Matthew Zarka and Barbara Centeno
Practical Dermatopathology
Written by James W. Patterson
Practical Gynecology
Edited by Joseph T. Rabban and Olga B. Ioffe
Practical Hepatic Pathology
Edited by Romil Saxena
Practical Lung Pathology, 2nd edition
Edited by Kevin O. Leslie and Mark R. Wick
Practical Lymph Node Pathology
Edited by Steven Kroft and Kaaren Reichard
Practical Renal Pathology
Edited by Donna Lager and Neil Abrahams
Practical Soft Tissue Pathology
Edited by Jason L. Hornick
Practical Surgical Neuropathology
Edited by Arie Perry and Daniel J. Brat
Practical Surgical
Neuropathology
A Diagnostic Approach
Arie Perry MD
Professor of Pathology and Neurological Surgery
Vice Chair, Department of Pathology
Director of Neuropathology Division and the Neuropathology
Fellowship Program
University of California at San Francisco (UCSF)
San Francisco, California
Daniel J. Brat MD, PhD
Professor and Vice Chair, Translational Programs
Director, Division of Neuropathology
Department of Pathology and Laboratory Medicine
Emory University School of Medicine
Atlanta, Georgia
1600 John F. Kennedy Blvd.
Ste. 1800
Philadelphia, PA 19103-2899
PRACTICAL SURGICAL NEUROPATHOLOGY: A DIAGNOSTIC APPROACH ISBN: 978-0-443-06982-6
© 2010 by Churchill Livingstone an affiliate of Elsevier Inc. All rights reserved.
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Notices
Knowledge and best practice in this field are constantly changing. As new research and e xperience broaden
our understanding, changes in research methods, professional practices, or medical t reatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information or
methods they should be mindful of their own safety and the safety of others, including parties for whom they
have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient,
and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or e ditors, assume any
liability for any injury and/or damage to persons or property as a matter of p roducts liability, negligence or
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material herein.
Library of Congress Cataloging-in-Publication Data
Practical surgical neuropathology : a diagnostic approach / [edited by] Arie Perry, Daniel J. Brat.
p. ; cm.
Includes index.
ISBN 978-0-443-06982-6
1. Brain–Tumors–Diagnosis. 2. Nervous system–Diseases–Diagnosis. 3. Pathology, Surgical. I. Perry,
Arie. II. Brat, Daniel J. III. Title.
[DNLM: 1. Nervous System Diseases–surgery. 2. Nervous System Diseases–pathology. 3. Pathology,
Surgical–methods. WL 368 P8947 2010]
RC280.B7P723 2010
616.99’481–dc22 2009053489
Acquisitions Editor: William Schmitt
Publishing Services Manager: Joan Sinclair
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Contributors
Daniel J. Brat, MD, PhD Eva Horvath, PhD
Professor and Vice Chair, Translational Programs Pathology Consultant
Director, Division of Neuropathology Endocrine Pathology Research
Department of Pathology and Laboratory Medicine St. Michael’s Hospital
Emory University School of Medicine Toronto, Ontario, Canada
Atlanta, Georgia
Anne Jouvet, MD, PhD
David A. Decker, MD Associate Professor of Pathology
Department of Neurology Centre de Pathologie et Neuropathologie EST
University of Florida College of Medicine Groupement Hospitalier EST
McKnight Brain Institute Hospices Civils de Lyon
Gainesville, Florida Lyon, France
Michelle Fèvre-Montange, PhD Scott E. Kilpatrick, MD
Université de Lyon Pathologists Diagnostic Services
Lyon, France Forsyth Medical Center
Winston-Salem, North Carolina
Christine E. Fuller, MD
Professor of Pathology B. K. Kleinschmidt-DeMasters, MD
Director of Neuropathology and Autopsy Pathology Professor and Head, Division of Neuropathology
Medical College of Virginia/Virginia Commonwealth University Department of Pathology
Richmond, Virginia University of Colorado Health Science Center
Denver, Colorado
Gregory N. Fuller, MD, PhD
Professor of Pathology (Neuropathology) Kalman Kovacs, MD, PhD
The University of Texas Graduate School of Biomedical Sciences Professor of Pathology
Professor and Chief Section of Neuropathology Department of Laboratory Medicine
The University of Texas M.D. Anderson Cancer Center St. Michael’s Hospital
Houston, Texas University of Toronto
Toronto, Ontario, Canada
Eyas M. Hattab, MD
Associate Professor M. Joe Ma, MD, PhD
Department of Pathology and Laboratory Medicine Assistant Professor of Pathology
Indiana University School of Medicine Department of Medical Education
Medical Director, Immunohistochemistry Laboratory University of Central Florida College of Medicine
Clarian Pathology Library Pathologist
Indianapolis, Indiana Department of Pathology
Florida Hospital—Orlando
Orlando, Florida
vv
Contributors
Ricardo V. Lloyd, MD Robert J. Spinner, MD
Professor of Pathology Professor
Department of Anatomic Pathology Neurologic Surgery, Orthopedics and Anatomy
Mayo College of Medicine Mayo Clinic
Rochester, Minnesota Rochester, Minnesota
Sonia Narendra, MD Tarik Tihan, MD, PhD
Pathology Resident Professor
SUNY Upstate Medical University Department of Pathology
Syracuse, New York University of California San Francisco
San Francisco, California
Werner Paulus, MD
Professor of Neuropathology Kenneth L. Tyler, MD
University of Muenster Reuler-Lewin Family Professor of Neurology and Professor of
Director Institute of Neuropathology Medicine and Microbiology
University Hospital Muenster Departments of Neurology, Medicine, Microbiology
Muenster, Germany University of Colorado Denver Health Sciences Center
Neurology Service, Denver VA Medical Center
Arie Perry, MD Denver, Colorado
Professor of Pathology and Neurological Surgery
Vice Chair, Department of Pathology Alexandre Vasiljevic, MD
Director of Neuropathology Division and the Neuropathology Centre de Pathologie et Neuropathologie EST
Fellowship Program Groupement Hospitalier EST
University of California at San Francisco (UCSF) Hospices Civils de Lyon
San Francisco, California Lyon, France
Richard A. Prayson, MD Franz J. Wippold, II, MD
Head, Section of Neuropathology Professor and Chief
Department of Anatomic Pathology Neuroradiology Section
Cleveland Clinic Foundation Mallinckrodt Institute of Radiology
Cleveland, Ohio Washington University School of Medicine
Attending Neuroradiologist
Bernd W. Scheithauer, MD Barnes-Jewish Hospital, Attending Neuroradiologist
Professor of Pathology St. Louis Children’s Hospital
Department of Anatomic Pathology St. Louis, Missouri
Mayo College of Medicine Adjunct Professor of Radiology/Radiological Sciences
Consultant F. Edward Hérbert School of Medicine
Mayo Clinic Uniformed Services University of the Health Sciences
Rochester, Minnesota Bethesda, Maryland
Robert E. Schmidt, MD, PhD James M. Woodruff, MD
Professor and Chief Emeritus Attending Physician
Division of Neuropathology Department of Pathology
Washington University School of Medicine Memorial Sloan-Kettering Cancer Center
St. Louis, Missouri New York, New York
Ana I. Silva, MD Anthony T. Yachnis, MD
Hospital Assistant Professor and Director of Anatomic Pathology
Department of Anatomic Pathology Department of Pathology, Immunology, and Laboratory Medicine
Hospital São Marcos University of Florida College of Medicine
Graga, Protugal Gainesville, Florida
vi
Series Preface
It is often stated that anatomic pathologists task. Because a panoply of patterns is difficult to
come in two forms: “Gestalt”-based individuals, approach mentally from a practical perspective,
who recognize visual scenes as a whole, match- we have asked our contributors to be complete
ing them unconsciously with memorialized and yet to discuss only principal interpretative
archives; and criterion-oriented people, who images. Our goal is eventually to provide a series
work through images systematically in segments, of monographs which, in combination with one
tabulating the results—internally, mentally, and another, will allow trainees and practitioners in
quickly—as they go along in examining a visual pathology to use salient morphological patterns
target. These approaches can be equally effective, to reach with confidence final diagnoses in all
and they are probably not as dissimilar as their organ systems.
descriptions would suggest. In reality, even “Gestaltists” subliminally As stated in the introduction to the PPPDA text, the evaluation of
examine details of an image, and, if asked specifically about particular dominant patterns is aided secondarily by the analysis of cellular com-
features of it, they are able to say whether one characteristic or another position and other distinctive findings. Therefore, within the context
is important diagnostically. of each pattern, editors have been asked to use such data to refer the
In accordance with these concepts, in 2004 we published a text- reader to appropriate specific chapters in their respective texts.
book entitled Practical Pulmonary Pathology: A Diagnostic Approach We have also stated previously that some overlap is expected
(PPPDA). That monograph was designed around a pattern-based between pathologic patterns in any given anatomic site; in addition,
method, wherein diseases of the lung were divided into six categories specific disease states may potentially manifest themselves with more
on the basis of their general image profiles. Using that technique, one than one pattern. At first, those facts may seem to militate against the
can successfully segregate pathologic conditions into diagnostically value of pattern-based interpretation. However, pragmatically, they do
and clinically useful groupings. not. One often can narrow diagnostic possibilities to a very few entities
The merits of such a procedure have been validated empirically by using the pattern method, and sometimes a single interpretation will be
the enthusiastic feedback we have received from users of our book. In obvious. Both of those outcomes are useful to clinical physicians caring
addition, following the old adage that “imitation is the sincerest form of for a given patient.
flattery,” since our book came out other publications and presentations It is hoped that the expertise of our authors and editors, together
have appeared in our specialty with the same approach. with the high quality of morphologic images they present in this
After publication of the PPPDA text, representatives at Elsevier, most Elsevier series, will be beneficial to our reader-colleagues.
notably William Schmitt, were enthusiastic about building a series of
texts around pattern-based diagnosis in pathology. To this end we have Kevin O. Leslie, MD
recruited a distinguished group of authors and editors to a ccomplish that Mark R. Wick, MD
vii

Preface
When Kevin Leslie and Mark Wick approached • Background data: The nervous system
us a few years ago to write a new neuropathol- is particularly challenging because of its
ogy textbook for a patterns-oriented organ- remarkable anatomic and cellular com-
based series, it was with some trepidation that plexity. For instance, the histology changes
we ultimately accepted. After all, there are completely from one area to another,
already some excellent texts available on this engendering diverse diagnostic differen-
topic, and we have both contributed chapters to tials depending on the site of involvement.
some of these in the past. However, the patterns Therefore, a review of basic neuroanatomy
approach used in the Leslie and Wick Practical and histopathology may help (Chapter 2). In
Pulmonary Pathology book is somewhat novel, addition, the use of ancillary techniques is
and we were not aware of others placing a major rapidly evolving, and therefore an overview
emphasis on this tactic toward neuropathology of immunohistochemistry, electron micros-
diagnosis. As our work progressed, we found copy, and molecular diagnostics is provided
additional ways of enhancing the reader’s experience and we are quite in Chapter 1.
excited about the final product! Our primary target audience is the • Intraoperative consultation and optimal processing: Nothing
general surgical pathologist and pathology trainees. However, while seems to provoke a panic attack more reliably than the “neuro
we focused most on common issues of surgical neuropathology, rarer frozen,” yet there is often little practical guidance available for
entities and clinicopathologic correlations are also well covered and this common setting. Furthermore, artifacts induced by frozen
illustrated. Therefore, we believe that this book will also be useful to sections and many other procedures implemented by either the
neuropathologists and clinical colleagues from related medical special- neurosurgeon or the pathologist can present serious pitfalls and
ties such as neurosurgery, neurology, neuroradiology, neuro-oncology, may preclude an accurate diagnosis. These important topics are
and pediatrics. In order to readdress the important question of why discussed in Chapter 3.
one should buy yet another neuropathology textbook, we provide the • Neuroradiology: As will be mentioned several times in this book,
following list of strengths. neuroradiology increasingly provides the most relevant gross
pathology for nervous system biopsy interpretation, particularly
• Patterns-based diagnostic approaches: In addition to offering the tra-
when the tissue sample is small. In this context the pathologist must
ditional disease-based approach to nervous system pathology (Chapters 5
become at least an amateur neuroradiologist so that important
through 25), this book provides instructive algorithms based on 8
radiologic-pathologic correlations are not missed. This critical topic
major (scanning magnification) patterns (immediately following the
is summarized and illustrated in Chapter 4.
introduction) and 20 minor (higher magnification) patterns (Chapter 1).
• The authors: In addition to being international authorities on
This material can be particularly helpful to less experienced morphol-
their topics, the authors were carefully selected for their clarity
ogists who may feel lost or overwhelmed by the myriad diagnostic pos-
and enthusiasm for teaching. They are highly sought conference
sibilities. After the reader obtains an appropriately focused differential,
speakers, writers, and recipients of teaching awards. One is
he or she can quickly turn to more detailed discussions of specific
also known for a somewhat unconventional but highly popular
entities in later chapters of the book. Alternatively, one can start with
teaching method. Dr. Perry’s innovative use of “neuropathol-
basic clinicoradiologic patterns combining patient age, location, and
ogy songs” to help medical students remember key features of
neuroimaging features to create a differential diagnosis (Table 1-1). In
neurological disorders has been the topic of several newspaper
fact, these two approaches are easily combined to further narrow the
and radio reports. By the time this book is published, a CD
differential. To further enhance this strategy, the key clinicopathologic
recording should be complete and readers interested in a fun
features for 21 common differentials and the immunoprofiles for 26
approach to musically reinforcing their knowledge base should
common tumors are summarized in Tables 1-3 and 1-4, respectively.
visit www. neuropathsongs.com.
Major neuroimaging patterns are listed in Box 4-1.
ix