Neuroscience

Edward R. Flotte, 2006

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NEUROPATHOLOGY

Stains:

· Neuron: body = Nissl,

· Processes = silver (Golgi, Bodian, Bielschowski),

· Myelin = Luxol-fast blue

· Muscle = Gomori trichrome

· India ink, mucicarmine = cryptococcus.

· Fat = Sudan, oil-red-O

· Congo Red = b amyloid

· PAS = glycogen, carbohydrate (fungi, parasites also)

· Gomori methamine (GMS) = fungi

· AFB = mycobacteria

Hamartoma: disorganized cells in right location. Choristoma: Normal cells in wrong location

Markers:

· AFP = endodermal sinus;

· chromogranin = pituitary adenoma, paraganglioma;

· cytokeratin = craniopharyngioma, chordoma, choroid plexus;

· desmin = teratoma;

· EMA, vimentin = meningioma;

· BHCG = choriocarcinoma;

· S100 = schwannoma, glioma, pnet, etc;

· PTAH = ependymoma.

· CD20, (CD45, CD3) = lymphoma (B-cells).

· CD1a = Langerhans cells.

· Melanoma: cytokeratin, HMB45, S100, (AE1/3-)

Rosenthal fibers: pilocytic, alexanders (large brain, cause unknown, sporadic)

Babes nodule: glial nodules, form in viral encephalitis

Schiller-Duval bodies: seen in endodernal sinus tumors

Alzheimer type II cells:

· Hyperplasic protoplasmic astrocytes with large irregular clear nuclei, prominent nucleolus, paired nuclei, no cytoplasm.

· Seen in hepatic encephalopathy and Wilsons disease (alzheimer type I more common – also has Opalski cells)

Perivascular lymphocyte cuffing: gangliogliomas, herpes encephalitis, AIDS

Basal ganglia calcification: Fahr disease (familial), hypo & hyperparathyroidism, anoxic, MELAS, Cockayne, NF, TS, Downs, carbon monoxide, lead

Basal ganglia necrosis: hypoxic, Toxic: methanol (putamen), carbon monoxide (GPm), cyanide, manganese. Leighs (¯ T1), Wilson, Alexanders, Canavans, MLD, Hallervorden-Spatz, metachromatic leukodystrophy, toxo, crypto, HUS, hepatic encephalopathy (T1), TPN ( T1)

Cerebellar atrophy: EtOH, chronic Dilantin, Friedrichs

Kernicterus: unconjugated bilirubin, GP, hiipocampus, STN

· Seen in Rh incompatibility (hydrops fetalis), heridatary sperocytosis, hemolysis, Crigler-Najjar (glucuronyl transferase def.), Dubin-Johnson

· Conjugated bilirubin doesn’t cross BBB

Inclusions:

Cowdry type A: intranuclear, halo, large. HSV, CMV measles.

Cowdry B: small, no halo. polio

Ground glass: intranuclear. JC (PML)

Intracytoplasmic: rabies (Negri), Picks, Lewy (parkinsons), Lafora, Hirano (Alzheimers), Bunina (ALS), Marinesco (aging)

Astrocytes: corpora amylacea (normal aging, polyglucosan, often subpial, stain w/ fungal stains); Rosethal fibers

Microglia: elongated nuclei, scant cytoplasm.

Pituitary:

· Anterior = nests of epithelioid cells separated by fibrovascular septae.

· Posterior = loose spindle cells, has pituicytes (astrocytes).

Pencil bundles of Wilson: myelinated fibers in the caudate.

Fibrinoid necrosis: (of vessels) in post-XRT, PAN, temporal arteritis.

Calcospherites: prolactinoma, oligo, ganglioglioma, adult pilocytics

Segmental demyelination: PNS: diptheria, MLD, Charcot-Marie-Tooth

Rosettes:

Pseudorosettes: around blood vessel, ependymoma

True Rosettes: around fibrillary material, ependymoma

Homer-Wright: fibrillary material, medullos, neuroblastoma, pineocytoma, PNETs

Flexner-Wintersteiner: resembles cone photoreceptors, central lumen; pinealblastoma, Retinoblastoma

Eosinophilic Granular Bodies: intracytoplasmic. Seen in pilocytics, PXA, ganglioglioma

Immunohistochemistry:

Neurons: synaptophysin (axons & periphery of cell body), NSE (not neuron specific), NeuN (nucleus). EM: dense core granules.

Astrocytes: GFAP, S100 (nonspecific glial)

Oligodendroglia: NONE. (Myelin Basic Protein experimentally)

Ependyma: S100. (GFAP- except tanycytes - GFAP+). PTAH is a stain, not IHC marker.

Choroid plexus: Transthyretin, S100.

Microglia: HAM56, KP1

Leptomeninges: EMA

Melanocytes: HMB45, S100

Revised 11/12/06

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