By Jeffrey T. Joseph MD PhD
This textbook presents sensible info on tips on how to practice and interpret smears and use smears for diagnostic intraoperative neuropathology. The ebook covers so much facets of mind biopsies that require intraoperative or ''frozen section'' analysis, together with tumors, non-neoplastic lesions, infectious illnesses, and metastases to the mind. the writer additionally discusses extra common features of smears, together with their education and common interpretation.
Emphasis is at the structural information regarding mind lesions provided by means of the means of smears, in addition to the styles of smears produced via varied tumors. greater than two hundred full-color illustrations supplement the text.
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Additional resources for Diagnostic neuropathology smears
However, in this context and with features elsewhere, these cells most likely represent reactive T-cells. qxd 05/10/2006 2:27 PM Page 31 Chapter 4: Reactive Lesions 31 FIGURE 4-11. Perivascular lymphocytes in a smear of demyelination. A. A fluffy, gliotic background typical of a biopsy adjacent to an actively demyelinating lesion. At the bottom of the tissue is a small, very blue vessel (arrow). B. At high power, many small round blue cells surround the vessel (arrows). Flattened endothelial cells (arrowheads) sheathe the vessel.
Low-grade oligodendrogliomas, which share similar signal characteristics with PML, usually have some local mass effect. Within white matter, the viral colonies grow centrifugally to form plaques of demyelination (Figure 5-14). In the center of the plaques, most infected oligodendrocytes have died, leaving behind a few reactive yet infected astrocytes. The absence of myelin leaves grossly darkened splotches. qxd 05/12/2006 1:34 PM Page 47 FIGURE 5-13. MRI scans of PML. The lesion (arrow) is hyperintense in T2-weighted imaging (A), yet fails to enhance after contrast administration (B).
Some give a meningitis picture, with superficial enhancement. Look at the available tissue. Does it stink? Think anaerobic bacteria. Is it pus? Think abscess. Is it a nice smooth lump of tissue with a cystlike structure? In the right setting, the gross diagnosis becomes cysticercosis. Finally, examine the smear. Is the tissue normal brain or does it only contain reactive gliosis? It may be near the lesion. If the sample is densely cellular, what constitutes the cellularity? Atypical glia might suggest a glioma but progressive multifocal leukoencephalopathy (PML) should be in the differential.
Diagnostic neuropathology smears by Jeffrey T. Joseph MD PhD