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MRI suprasellar mass
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Autopsy image
Contributed by Nelli S. Lakis M.D., M.Sc.
Xanthogranulomatous reaction
3 components
Tumor tongues
Nuclear palisading
Wet keratin
Cystic degeneration
Fibrosis
Inflammatory infiltrate
Adamantinomatous
epithelium
Stellate reticulum
Beta catenin
Contributed by Valeria Barresi, M.D, Ph.D.
Extra-axial, dural mass
Images hosted on other servers:
MRI
Contributed by Valeria Barresi, M.D, Ph.D.
Mitoses
Malignant morphology
Whorls
Necrosis
EMA
CK AE1 / AE3
H3K27me3
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Location in brain
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Local anatomy (horse)
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Axial MR images
Axial T1 and T2 weighted MR images
Hyperintense cortically based mass
Contributed by Saman Seyed Ahmadian, M.D.
T2 FLAIR MRI
T2 MRI
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T2 MRI
Contributed by Saman Seyed Ahmadian, M.D.
Cyst lining
Meningothelial hyperplasia
Calcification
No apparent meningothelial cells
EMA
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Huge well demarcated mass in frontal lobe
Case #312
EMA
GFAP
Trichrome
Contributed by John DeWitt, M.D., Ph.D. and Meaghan Morris, M.D., Ph.D.
MRI axial T1 FLAIR
MRI axial T1 precontrast
MRI axial T1 postcontrast
MRI axial T1 FLAIR
MRI axial T1 postcontrast
MRI coronal T1 precontrast
MRI coronal T1 postcontrast
Bright on FLAIR
Contrast enhancing
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Glioma with cystic spaces in the cerebral hemisphere
Contributed by Eman Abdelzaher, M.D., Ph.D., John DeWitt, M.D., Ph.D. and Meaghan Morris, M.D., Ph.D.
CNS WHO grade 2 astrocytoma, NOS
Subpial accumulation
CNS WHO grade 2 astrocytoma, NOS
Perineuronal satellitosis
Perivascular accumulation
Mitotically active
Pleomorphic hypercellular astrocytic appearance
Gemistocytic histology
Variable morphology and necrosis
Microvascular proliferation
Entrapped neurons
R132H IDH1
ATRX
p53
Ki67
Olig2
IDH
ATRX
p53
Ki67
Contributed by Chunyu "Hunter" Cai, M.D., Ph.D.
Small cell change - meningothelial
Small cell change - transitional
Spontaneous necrosis
Macronuclei
Sheeting
Brain invasion - nest
Brain invasion - protrusions
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Features of AT / RT subtypes
Contributed by Chunyu Cai, M.D., Ph.D. (Case #502)
MRI T1 postsagittal
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AT / RT in a 9 month old
Axial CT head, unenhanced
MRI brain, unenhanced and enhanced
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Posterior fossa, cerebellum and brain stem tumors
Contributed by Nirupama Singh, M.D., Ph.D., Chunyu Cai, M.D., Ph.D. (Case #502) and Geling Li, M.D., Ph.D.
Vesicular chromatin and prominent nucleoli
Eosinophilic globs
Mitotic figures
Myxoid area
Chondroid
Geographic necrosis
Gland
Large pale cell
Rhabdoid cell
Small blue cell
Densely packed immature cells
INI1
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Rhabdoid cell
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Methylation array analysis
Cluster analysis
Contributed by Borislav Alexiev, M.D.
PET / CT
Contributed by Borislav Alexiev, M.D.
Soft tissue mass
Contributed by Borislav Alexiev, M.D.
Chest wall mass
Small round cell morphology
Solid growth pattern
Spindle cell morphology
Mitoses
Myxoid stroma
CD99 expression
WT1 expression
MYC expression
Contributed by Lawrence J. Jennings, M.D., Ph.D.
Real time RT-PCR
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T2 weighted and postcontrast T1 weighted axial
Contributed by Nirupama Singh, M.D., Ph.D., Carmen Perrino, M.D. and P.J. Cimino, M.D., Ph.D.
Neuroblasts with no cytoplasm
Homer Wright rosettes
Small tumor cells
Pseudorosettes
Embryonal cells
Neurocytic cells
Focal ganglion cells
Necrosis
MVP
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Recurrent molecular alterations
Case presentation of CNS NB FOXR2
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MRI
Intradural enhancing lesion
Spinal angiography
Scalloping of lumbar vertebrae
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Intraoperative
Lesion after durotomy
Hypervascular well marginated mass
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Lesion after en block removal
Hemorrhagic cystic change
Contributed by Eman Abdelzaher, M.D., Ph.D.
Encapsulated lesion
Zellballen architecture
Zellballen architecture
Salt and pepper chromatin
Focal sclerosis
Reticulin
Synaptophysin
S100 positive sustentacular cells
S100 positive chief and sustentacular cells
GFAP negative
GFAP positive sustentacular cells
EMA
Low Ki67
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Numerous perinuclear dense core granules
Prominent rough endoplasmic reticulum and Golgi apparatus
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DNA methylation cluster analysis of CEPs and other tumors
Chromosomal copy number analysis
Case 8: paraganglioma of the filum terminale
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Coronal section diagram
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Intraventricular mass on MRI
Calcifications on CT
T1+C MRI
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Endoscopic view of intraventricular tumor
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Intraventricular mass
Contributed by Rebecca Yoda, M.D.
Circumscribed border
Fibrillary matrix
Perinuclear clearing
Perivascular pseudorosette
Neurocytic rosettes
Linear arrangement
Calcifications
Branching capillaries
Hyalinized vessels
Lipomatous change
Necrosis
Mitotic activity
Synaptophysin IHC
NeuN IHC
GFAP IHC
Contributed by Nazar M. T. Jawhar, M.D. (Case #119)
Circumscribed border
Perivascular pseudorosettes
Perinuclear clearing
Rosettes and perivascular pseudorosettes
Calcification
Linear cellular arrangement
Uniform, round cells
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TEM showing neuronal features
Ultrastructure recapitulating neuropil and synapses
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DNA methylation based classification
Contributed by Valeria Barresi, M.D., Ph.D.
T1 weighted MRI
T2 weighted MRI
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Right cerebellopontine angle mass
Contributed by Valeria Barresi, M.D., Ph.D.
Lipidized cells
Perivascular matrix
Synaptophysin immunostaining
NeuN immunostaining
GFAP immunostaining
Olig2 immunostaining
EMA immunostaining
Ki67 immunostaining
Contributed by Valeria Barresi, M.D., Ph.D.
Sheets of uniform neurocytic cells
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Axial CT scan reveals hyperdense mass
Various images
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Optic chiasm enlargement
Contributed by Valeria Barresi, M.D., Ph.D.
T1 weighted sagittal MRI
T1 sagittal contrast enhancement
T2 weighted axial MRI
FLAIR axial MRI
Contributed by Valeria Barresi, M.D., Ph.D.
Epithelioid cells
Spindle cells
Intermingled typical meningioma
Mitoses
Alcian blue
Podoplanin immunostaining
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FISH 18p, 22q, 14q, 1p
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MR shows small cyst
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Cyst at foramen of Monro
Contributed by Kshitij Mankad, M.D.
MRI coronal
MRI sagittal
MRI transverse
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Fourth ventricle tumor
Contributed by Ashirwad Merve, M.B.B.S., Ph.D.
Choroid plexus papilloma
Ki67 in choroid plexus papilloma
Atypical choroid plexus papilloma
Ki67 in atypical choroid plexus papilloma
Choroid plexus carcinoma
Ki67 in choroid plexus carcinoma
Transthyretin
Cytokeratin
SMARCB1 (INI1)
Contributed by Ashirwad Merve, M.B.B.S., Ph.D.
Intraoperative smear
Contributed by Ashirwad Merve, M.B.B.S., Ph.D.
Methylation array copy number variation plot
Contributed by Chunyu Cai, M.D., Ph.D. (Case #514)
MRI
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Various images
Contributed by Chunyu Cai, M.D., Ph.D. (Case #514)
H&E clear cell
H&E blocky collagen
IHC SMARCE1
IHC CAIX
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Mechanisms of sudden death due to colloid cyst
Typical location of colloid cyst
Contributed by Mohamed Kayed, M.D., Ph.D.
Small colloid cyst, T1 sagittal MRI
Small colloid cyst, T2 sagittal MRI
Large colloid cyst, MRI
Large colloid cyst, CT
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Extensive chronic hydrocephalus
Large colloid cyst
T1 hyperintense colloid cyst
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Intraoperative view of a colloid cyst
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2 cm colloid cyst
Endoscopically excised colloid cyst
Contributed by Eman Abdelzaher, M.D., Ph.D.
Fibrous wall and proteinaceous contents
Attached choroid plexus
Pseudostratified ciliated cells
Goblet cells
Cuboidal lining
Xanthogranulomatous reaction
EMA
S100
CD68
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Thick proteinaceous material
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Ciliary pattern of colloid cyst
Colloid cyst
Contributed by P.J. Cimino, M.D., Ph.D. and Chris Dampier, M.D.
Methylation copy number plot
Dimensionality reduction of medulloblastoma
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Methylation based CNS tumor clustering
Impact of tumor purity
Workflow in surgical neuropathology
Heterogeneity of histologic diagnoses
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Large right hemispheric mass
Contributed by Yue-E Wang, M.S., Ph.D., Jingjing Chen, Ph.D., Wei Wang, Ph.D., An-Li Zhang, M.D., Wenchao Zhou, Ph.D. and Hai-Bo Wu, M.D., Ph.D.
MRI - sagittal T1
MRI - sagittal T2
Contributed by Mariana Voudouri, M.D. and George Zanazzi, M.D., Ph.D.
Epithelioid neoplasm with desmoplasia
Cellular atypia
Perivascular tumor cell accumulation
CD34
SMARCB1 / INI1
Contributed by Branavan Manoranjan, M.D., Ph.D., Abdelsimar T. Omar II, M.D., Hai-Bo Wu, M.D., Ph.D., Robert Nordal, M.D. and Yves Starreveld, M.D., Ph.D.
Microcysts and myxoid matrix
Trichrome
Contributed by Mariana Voudouri, M.D. and George Zanazzi, M.D., Ph.D.
MRI of posterior left frontal tumor
Sagittal T1
Axial T2 / FLAIR
Axial postcontrast
Contributed by Mariana Voudouri, M.D. and George Zanazzi, M.D., Ph.D.
Hypercellular with clustering
Area of necrosis
Marked pleomorphism
ATRX
GFAP
Synaptophysin
p53
- See Case reports
Contributed by Katherine Schwetye, M.D., Ph.D.
Oligodendroglial-like appearance
Tumor adjacent parenchyma
Bland cytomorphology and nuclear features
S100 positive
Ki67 low
These photographs were previously published in Human Pathology, Vol. 70, Schwetye KE et al., "Unusual high-grade features in
pediatric diffuse leptomeningeal glioneuronal tumor: comparison with a typical low-grade example", p.105-112 Copyright Elsevier (2017).
Contributed by Mariana Voudouri, M.D. and George Zanazzi, M.D., Ph.D.
MRI coronal T2 brainstem tumor
MRI axial T2 / FLAIR right cerebellar tumor
MRI axial T1 post contrast right cerebellar flocculus tumor
Contributed by Mariana Voudouri, M.D. and George Zanazzi, M.D., Ph.D.
Astrocytic morphology
Pleomorphism
Oligodendroglial morphology
GFAP
ATRX
Ki67
Contributed by Rawia Mubarak Mohamed, M.D. and Najla Saleh Ben Gashir, M.D. (Case #477)
Tumor in thalamic region
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CT - axial noncontrast: pontine tumor
MRI - axial T2: pontine tumor
MRI - sagittal T1: pontine tumor
MRI - sagittal T2: pontine tumor
MRI - axial T2: pontine tumor
Contributed by John DeWitt, M.D., Ph.D.
Diffusely infiltrating astrocytic tumor cells
Necrosis
H3 K27M
R132H-IDH1
ATRX
p53
Contributed by Chunyu Cai, M.D., Ph.D.
Clusters of tumor cell seeding
H3 K27M
H3K27Me3
Contributed by Rawia Mubarak Mohamed, M.D. and Najla Saleh Ben Gashir, M.D. (Case #477)
High grade infiltrating glial cells
Olig2
H3 K27M
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Relative distribution of LEATs
Proposed modification of LEAT classification
Nodular appearing neoplasm
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Representative imaging features in adolescent
Typical imaging features
10 year old girl with seizure
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Surgical resection of epileptogenic tumor
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Frontobasal surgical specimen
Contributed by P.J. Cimino, M.D., Ph.D. and Chris Dampier, M.D.
Nodular growth pattern
Specific glioneuronal (pathognomonic) component
Floating neuron
Cystic component
GFAP
IDH1 p.R132H
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Smear preparations
Partially arranged as columnar structures
Fine neuritic processes
Contributed by P.J. Cimino, M.D., Ph.D. and Chris Dampier, M.D.
SCNA plot
Dysembryoplastic neuroepithelial tumor (DNET)
Contributed by Chunyu Cai, M.D., Ph.D.
MRI cervical spine ependymoma
MRI posterior fossa ependymoma
MRI supratentorial ependymoma
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MRI: ependymoma of fourth ventricle
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Arising from floor of fourth ventricle
Contributed by Chunyu Cai, M.D., Ph.D., Maria Martinez-Lage, M.D. and Eman Abdelzaher, M.D., Ph.D.
Perivascular pseudorosettes
Ependymal rosettes
True ependymal rosettes
Ependymoma canal
Tanycytic ependymoma
EMA showing dot-like and ring-like positivity
GFAP
EMA
MAP2
H3K27me IHC PFB
Ependymal tumors by Dr. Rodriguez
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Cerebellopontine angle
Contributed by Jared T. Ahrendsen, M.D., Ph.D.
Temporal lobe mass
Contributed by Jared T. Ahrendsen, M.D., Ph.D.
Well circumscribed brain lesion
Mixed glioneuronal tumor
Ganglioglioma with binucleate neurons
Well demarcated mass
Dysplastic ganglion-like cells in gangliocytoma
Olig2 IHC
CD34 IHC
Synaptophysin IHC
Neuronal and glioneuronal tumors
by Dr. Fausto Rodriguez (PathCast)
Contributed by Bharat Ramlal, M.D.
T2 FLAIR MRI
T1 postcontrast MRI
Contributed by Bharat Ramlal, M.D. and Meaghan Morris, M.D., Ph.D.
Hypercellular neoplasm
Nuclear atypia and brisk mitotic activity
Atypical astrocytic tumor cells
Glomeruloid microvascular proliferation
Pseudopalisading necrosis
Marked nuclear pleomorphism
Primitive neuronal component
Adenoid morphology
Epithelioid glioblastoma
Granular cell morphology
Small cell glioblastoma
IDH1 R132H
GFAP
Olig2
Ki67
Synaptophysin
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MR: cystic lesion of right frontal lobe
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Ependymal cyst
Contributed by Jared T. Ahrendsen, M.D., Ph.D.
Glioblastoma MRI
Glioma MRI
Optic pathway glioma MRI
Spinal ependymoma MRI
Contributed by Jared T. Ahrendsen, M.D., Ph.D.
Circumscribed glioma
Pilocytic astrocytoma
Pleomorphic xanthoastrocytoma (PXA)
Glioma with infiltrating edge
Diffuse glioma entrapped neurons
High grade infiltrating glioma
Perivascular pseudorosettes
GFAP positive glioma
Contributed by Nicolas Kostelecky, M.D.
Sagittal T1 postcontrast
Coronal T1 postcontrast
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Spectrum of
radiologic
phenotypes
(n = 4)
Heterogeneous, solid / cystic, with rim enhancement
Solid / cystic with leptomeningeal involvement
Cystic / solid; temporoparietal region
Before surgery
Contributed by Irfan Yasin, M.B.B.S., Katherine Schwetye, M.D., Ph.D. and Miguel Guzman, M.D.
Glial and sarcomatous component
Sarcomatous component
Herringbone architecture
Severe atypia
GFAP
Reticulin
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VHL regulation of the HIF pathway
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T1+C MRI posterior fossa
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Cystic mass in medulla
Multiple spinal masses
Contributed by Rebecca Yoda, M.D.
Hemangioblastoma cut surfaces
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Variegated red-yellow tumor
Hemangioblastoma in situ
Contributed by P.J. Cimino, M.D., Ph.D.
Circumscribed border
Vascular and stromal cells
Foamy cytoplasm
Large branching vessels
Hyalinized stroma
Extensive hemorrhage
Nuclear atypia
Inhibin
CAIX
CD31
PAX8
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EM lipid droplets
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VHL next generation sequencing
Recurrent loss of chromosome 3
DNA methylation based classification
Idiogram of VHL mutation
Hemangioblastoma MRI
Hemangioblastoma histopathology
Case #488
Rosai-Dorfman disease of CNS
Contributed by Kathryn Gibbons, M.D.
ILBCL involving skin and subcutaneous tissue
Large lymphoma cells in small vessels
ILBCL involving the brain parenchyma
Vessel with involvement by ILBCL
Large lymphoma cells in the vessels
CD20
BCL6
MUM1
Contributed by Nicholas Joseph Dcunha, M.B.B.S., M.D. and Elanthenral Sigamani, M.B.B.S., M.D.
Mass in lung (CT scan)
Contributed by Nicholas Joseph Dcunha, M.B.B.S., M.D. and Elanthenral Sigamani, M.B.B.S., M.D.
Lymphocytic vasculitis with angioinvasion (lung)
CD20 in tumor cells and CD3
CD30 and EBV LMP1 IHC
Lymphocytic vasculitis with angioinvasion (skin)
CD20 and CD30 in tumor cells; CD3 and CD4 in reactive T cells
Lymphocytic vasculitis with angioinvasion (CNS)
CD20 and EBV LMP1 in tumor cells; CD3 in reactive T cells
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Cerebellar tumor extending into fourth ventricle
Contributed by Arnault Tauziede-Espariat, M.D., John DeWitt, M.D., Ph.D., Meaghan Morris, M.D., Ph.D.,
Nirupama Singh, M.D., Ph.D. and Eman Abdelzaher, M.D., Ph.D.
Genetically defined
WNT (for wingless integration site) activated
YAP1 immunoreactivity
Beta catenin immunoreactivity
SHH (sonic hedgehog) activated (either TP53 mutant or TP53 wild type)
Sheets of undifferentiated cells
Vague nodular formation
Vague nodular formation with reticulin
Neuron specific enolase (NSE)
Ki67
Synaptophysin
Beta catenin
INI1
YAP1 immunoreactivity
GAB1 immunoreactivity
OTX2 immunoreactivity
Histologically defined
Classic
Homer Wright rosettes
Desmoplastic / nodular medulloblastoma
Desmoplastic medulloblastoma
Pale nodular islands
Pale islands formed of uniform cells
Tumor in the subarachnoid space
Desmoplastic / nodular medulloblastoma
Reticulin fiber network
Medulloblastoma with extensive nodularity
Extensive nodularity
Large cell / anaplastic medulloblastoma
Apoptotic bodies, prominent nucleoli
Cell wrapping
Anaplasia in medulloblastoma
Special morphology
Melanocytic differentiation
Myogenic differentiation
Contributed by Arnault Tauziede-Espariat, M.D.
MGG staining
Contributed by Arnault Tauziede-Espariat, M.D.
MYCN amplification
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Diffuse melanocytosis
MRI of thoracic area
Abnormal signal in the left temporal lobe
Contributed by Rana Al-Zaidi, M.B.B.S.
55 year old man with nausea, vomiting and sudden loss of consciousness and 4 cm temporal lesion - primary CNS melanoma
Contributed by Jesse Kresak, M.D.
Melanocytoma
Melanocytoma: S100
Melanocytoma: MelanA
Melanocytoma: HMB45
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Melanoma cells in CSF
Images hosted on other servers:
Various images (figures 1A - 4C)
Contributed by Chunyu Cai, M.D., Ph.D.
MRI benign meningioma
MRI atypical meningioma
MRI en plaque meningioma
MRI secretory meningioma
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Tumor displaces brain without invading
Compression of underlying cortex
Resected tumor
Adherent to falx cerebri
Contributed by Chunyu Cai, M.D., Ph.D.
Meningothelial meningioma:
Meningothelial meningioma
Meningothelial meningioma syncycial
Meningothelial meningioma SSTR2
Fibrous meningioma:
Fibrous meningioma
Fibrous meningioma SSTR2a
Transitional meningioma:
Transitional meningioma
Angiomatous meningioma:
Angiomatous meningioma macrovascular
Angiomatous meningioma microvascular
Microcystic meningioma:
Microcystic meningioma vacuolated cytoplasm
Microcystic meningioma nuclear pleomorphism
Clear cell meningioma:
Clear cell meningioma
Clear cell meningioma SMARCE1
Lymphoplasmacyte rich meningioma:
Lymphoplasmacyte
rich meningioma
Lymphoplasmacyte
rich meningioma
CD3
Lymphoplasmacyte
rich meningioma
SSTR2
Secretory meningioma:
Secretory meningioma
Secretory meningioma pCEA
Secretory meningioma EMA
Other meningioma:
Metaplastic meningioma
Chordoid meningioma
Psammomatous meningioma
Contributed by Chunyu Cai, M.D., Ph.D.
Streaked cytoplasm
Psammoma body
Cellular whorls
Images hosted on other servers:
Meningothelial tumor
Molecular classification of meningioma
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Lung metastasis
Case #222
Alveolar soft part sarcoma (H&E)
MyoD1
PASD
TFE3
Vimentin
Contributed by Ankur Sangoi, M.D. (Case #425)
Metastatic lung adenocarcinoma, ALK rearranged
Metastatic lung adenocarcinoma, ALK rearranged
Napsin A
TTF1
ALK break-apart FISH images (ALK gene in RED)
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Metastatic GI carcinoma (signet ring cells)
Contributed by Ahmed Ijaz Gilani, M.B.B.S., M.D., Ph.D.
MRI T1 with contrast
MRI T2
Contributed by Ahmed Ijaz Gilani, M.B.B.S., M.D., Ph.D. and Aisha Hassan Memon, M.B.B.S.
Radial arrangement
Epithelioid tumor cells
Papillary structures
Microcystic pattern
Hyalinized fibrovascular core with myxoid matrix
Alcian blue
GFAP
Olig2
EMA
Ki67
Contributed by Ahmed Ijaz Gilani, M.B.B.S., M.D., Ph.D. and Brittany Pakalniskis, M.D. (Case #399)
Stromal globules
Papillary structures and rosettes
Stromal globules (Diff-Quik stain)
Stromal globules (Pap stain)
Contributed by Jared T. Ahrendsen, M.D., Ph.D. and John DeWitt, M.D., Ph.D.
MRI, brain: T1 post
MRI, brain: T2
MRI: frontal lobe tumor with cystic change
Images hosted on other servers:
Axial flair frontal lobe tumor
Axial flair large temporal lobe tumor
Contributed by Jared T. Ahrendsen, M.D., Ph.D. and John DeWitt, M.D., Ph.D.
Diffusely infiltrating glial neoplasm
Microcalcifications
Perinuclear halos
Chicken wire vasculature
Secondary structures of Scherer
Cellularity and vascular proliferation
Focal necrosis
Brisk mitotic activity
Mixed astrocytic histology
IDH1 R132H
p53
ATRX
Contributed by Chunyu "Hunter" Cai, M.D., Ph.D.
T1 precontrast sagittal
T1 precontrast coronal
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Suprasellar mass
Solid suprasellar mass with small cystic component
Preoperative MRI
Contributed by Nelli S. Lakis, M.D., M.Sc. and Chunyu "Hunter" Cai, M.D., Ph.D.
Papillary architecture
Fibrovascular cores
Stroma
Lymphocytic inflammation
BRAF V600E immunostain
Images hosted on other servers:
Heterogeneously enhancing mass in pineal gland
Images hosted on other servers:
Right frontal papillary meningioma
Large, lobulated, irregular mass
Mass with a broad base
Postoperative shows severe leptomeningeal seeding
Avidly enhancing meningioma
Preoperative sagittal and axial adolinium enhanced MR images
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Meningioma smear
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Bundles of intermediate filaments
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MAPK pathway mutations
Contributed by P.J. Cimino, M.D., Ph.D.
T1 postcontrast MRI
Images hosted on other servers:
Intraoperative surgical image
Exophthalmos - optic nerve glioma
Orbital pilocytic astrocytoma
Images hosted on other servers:
Intraocular pilocytic astrocytoma
Cerebellar tumor
Contributed by P.J. Cimino, M.D., Ph.D.
Biphasic appearance
Compact fibrillary area
Cystic area
Rosenthal fibers
Eosinophilic granular bodies
Microvascular proliferation
Multinucleated cells
Hyalinized vessels
Extensive regressive features
Oligodendroglial-like
cytomorphology
Mitosis
GFAP piloid processes
Rosenthal fiber - GFAP
ATRX retained nuclear immunoreactivity
Increased Ki67 with anaplasia
Masson trichrome - EGBs
Images hosted on other servers:
Eosinophilic granular bodies
Images hosted on other servers:
KIAA1549-BRAF fusion by FISH
Copy number variation plot
NTRK2 fusion by next generation sequencing
NF1 biallelic inactivation
Pilocytic astrocytoma methylation classifier
Pilocytic astrocytoma
Rosenthal fibers in pilocytic astrocytoma
Images hosted on other servers:
Chiasmatic / hypothalamic pilomyxoid astrocytoma in a 3 month old infant:
DWI: no sign of restricted diffusion
T2w: homogeneous hyperintense signal
T1w: hypointense signal
T1w+ contrast: solid mass with marked enhancement
Contributed by Eman Abdelzaher, M.D., Ph.D.
Angiocentric pattern
Monomorphous cells in a myxoid background
Images hosted on other servers:
Bipolar, thin processes
extending to basal
lamina of vessels;
dense core granules
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Pineal cyst
Images hosted on other servers:
Small blue cell neuroepithelial malignant tumor
Images hosted on other servers:
Presence of abundant filopodia and rare intercellular junctions but no definitive synapses
Contributed by Jared T. Ahrendsen, M.D., Ph.D.
Axial MRI T1 postcontrast
Axial MRI T2
Contributed by Jared T. Ahrendsen, M.D., Ph.D.
With necrosis
Histology
Homer-Wright pseudorosettes
Mitotic activity
Synaptophysin positive
Variably chromogranin positive
High Ki67
Images hosted on other servers:
Overview of pineoblastoma subtypes
Contributed by Federico Roncaroli, M.D.
Sagittal postcontrast MRI
Contributed by Federico Roncaroli, M.D. and Sylvia L. Asa, M.D., Ph.D.
Fascicles of spindle cells
Ill defined whorls
Schwannoma-like features
Mild nuclear atypia
Oncocytic pituicytoma
Oncocytic pituicytoma
Granular cell pituicytoma
GFAP expression
TTF1 nuclear expression
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Sagittal and coronal MRI
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Pituitary hyperplasia microscopic
| Tumor type | Transcription factor(s) | Hormone(s) | Other biomarkers | Clinical features |
| Tpit family | ||||
| Densely granulated corticotroph tumor | Tpit | ACTH | PAS; intense keratins | Florid Cushing disease or silent |
| Sparsely granulated corticotroph tumor | Tpit | ACTH (weak) | PAS (weak); strong keratins | Cushing disease or silent |
| Crooke cell tumor | Tpit | ACTH | PAS; ring-like keratins | Cushing disease or silent |
| Pit1 family | ||||
| Densely granulated somatotroph tumor | Pit1 | GH | Perinuclear keratins | Acromegaly |
| Sparsely granulated somatotroph tumor | Pit1 | GH (weak) | Keratin fibrous bodies (> 70%) | Acromegaly or silent |
| Mammosomatotroph tumor | Pit1, ER | GH, PRL | Perinuclear keratins | Acromegaly and hyperprolactinemia |
| Sparsely granulated lactotroph tumor | Pit1, ER | PRL (juxtanuclear) | Variable keratins | Hyperprolactinemia (tumor size correlates with PRL level) |
| Densely granulated lactotroph tumor | Pit1, ER | PRL | Variable keratins | Hyperprolactinemia |
| Acidophil stem cell tumor | Pit1, ER | PRL with or without GH (weak, focal) | Variable keratins with or without fibrous bodies | Hyperprolactinemia |
| Thyrotroph tumor | Pit1, GATA3 | TSH | Variable keratins | Elevated TSH with or without hyperthyroidism |
| Mature plurihormonal Pit1 lineage tumor | Pit1, GATA3, ER | Variable, often multiple | Perinuclear keratins | Acromegaly, hyperprolactinemia and hyperthyroidism |
| Immature Pit1 lineage tumor | Pit1 with or without GATA3 with or without ER | Variable, often limited / focal | Variable keratins with or without fibrous bodies | Silent or acromegaly or hyperprolactinemia or hyperthyroidism |
| SF1 family | ||||
| Gonadotroph tumor | SF1, GATA3, ER | FSH, LH | Variable keratins, follicular cells | Silent with or without elevated gonadotropins |
| No lineage fidelity | ||||
| Null cell tumor | None | None | Variable | Silent |
| Unclassified plurihormonal tumor | Multiple combinations | Multiple combinations | Variable | Variable |
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Sellar and suprasellar masses
Contributed by Sylvia L. Asa, M.D., Ph.D.
Densely granulated corticotroph tumor
Sparsely granulated corticotroph tumor
p27 in silent corticotroph tumor
Crooke cell tumor
Densely granulated somatotroph tumor
Sparsely granulated somatotroph tumor
Sparsely granulated lactotroph tumor
Thyrotroph tumor
Gonadotroph tumor
Contributed by Michael Punsoni, M.D.
Touch prep showing a cellular population of discohesive small round blue cells
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Ultrastructural features of some rare pituitary adenomas
Contributed by Shayan Anwar, M.B.B.S.
Axial T2 weighted MRI
Coronal FLAIR MRI
Axial T1 weighted precontrast MRI
Axial T1 weighted postcontrast MRI
Axial apparent diffusion coefficient (ADC)
Contributed by Aisha Memon, M.B.B.S.
Pleomorphic spindle cells
Epithelioid tumor cells
Eosinophilic granular bodies
Rosenthal fibers
Xanthomatous cells
Multinucleated tumor cells
GFAP
CD34
S100
Neurofilament
Reticulin stain
Pleomorphic xanthoastrocytoma:
a brief review
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Prototypical PLNTY
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FLAIR, CT scan and T1 postcontrast
Radiological variability in CT and MRI
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Operative view
Contributed by Eman Abdelzaher, M.D., Ph.D. and Jared T. Ahrendsen, M.D., Ph.D.
Diffuse growth pattern
Diffuse growth pattern of oligodendroglioma-like cells
Oligodendroglioma-like cells with mild nuclear pleomorphism
Calcification
Oligo-like features
Dystrophic calcifications
Polymorphic tumor cells
Olig2 diffusely positive
Strong, diffuse CD34 expression
CD34
CD34 in tumor cells and ramified neural cells
GFAP
Ki67
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Vague perivascular pseudorosetting
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Molecular and clinical findings
FGFR fusions
Distinct methylation signature
Genome wide copy number changes
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Brain MRI with contrast enhancing lesion
Solid and enhancing nodules on MRI
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Cerebral lymphoma
spreading across
the corpus callosum
Contributed by Elizabeth Courville, M.D. and Lena Young, D.O.
Perivascular infiltrate of atypical lymphoid cells
Diffuse infiltrate
of intermediate
to large
mononuclear cells
Cytology of mononuclear cells
Perivascular cuffing by neoplastic lymphocytes
Infiltrate of neoplastic intermediate to large lymphocytes with background inflammation and necrosis
Pleomorphic lymphocytes infiltrating brain
Immunohisto-
chemistry for B and T cells
ISH shows lambda restriction
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Marked enhancing mass at left frontal lobe
Hyperostosis, bony erosion in right anterior clinoid process
Tumor in right infratemporal fossa
Lesion was isointense on T1 and T2 weighted images
Avidly enhancing, complex falcine meningioma
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Squash prep 40x
Contributed by Eman Abdelzaher, M.D., Ph.D.
CT without contrast
CT with contrast
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Cerebellar and fourth ventricular RGNT
MRI of cerebellar vermis RGNT
Third ventricle RGNT
MRI of aqueduct and thalamic RGNT
Postcontrast T1 weighted MRI
MRI of pineal region and third ventricle RGNT
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Right frontal exophytic lesion
Spinal RGNT, intraoperative picture
Contributed by Eman Abdelzaher, M.D., Ph.D.
Biphasic neurocytic and glial components
Biphasic neurocytic and pilocytic components
Neurocytic rosettes
Neurocytes with stippled chromatin
Neurocytic rosettes and pseudorosettes
Cribriform pattern
Microcystic pattern
Microcystic pattern
Pilocytic-like area
Piloid and oligodendroglia-like cells
Synaptophysin
Synaptophysin
Negative neurocytes by GFAP
Glial fibrillary acidic protein (GFAP)
Epithelial membrane antigen (EMA)
Ki67
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Neurocytic rosettes
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RGNT, DNA methylation profiling
RGNT, recurrent genetic alterations
WHO classification of CNS tumors: glioneuronal tumors
Contributed by John DeWitt, M.D., Ph.D.
CT scan with contrast
Coronal T1 postcontrast
Sagittal T1 postcontrast
Axial T1 postcontrast
Contributed by John DeWitt, M.D., Ph.D.
Sheets of undifferentiated cells
Vague nodular formation
Vague nodular formation with reticulin
Neuron specific enolase (NSE)
Ki67
Synaptophysin
Beta catenin
INI1
Contributed by Meaghan Morris, M.D., Ph.D.
Anaplasia in medulloblastoma
Contributed by Valeria Barresi, M.D., Ph.D.
T1 weighted MRI
FLAIR MRI
T2 weighted MRI
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Surgically resected schwannoma
Acoustic schwannoma
Fish flesh tan cut surface
Contributed by Valeria Barresi, M.D., Ph.D.
Compact and loose areas
Atypical nuclei
Lipid laden histiocytes
Verocay bodies
S100
SOX10
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Intracranial SFT vascular permeability
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MRI of spinal SFT
MRI of parieto-occipital SFT
MRI of expansive SFT
PET / CT after SFT resection
Vividly enhancing mass, various images
Extra-axial mass, various images
Tumor mass in the left cerebellum
Resection cavity with residual tumor tissue
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Spinal SFT during resection
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SFT metastatic to liver
Contributed by Brenndan Crumley, M.D., M.P.H. and Katherine Schwetye, M.D., Ph.D.
Hypercellular neoplasm, patternless pattern
Neoplasm, haphazard spindle cells
Hypercellularity and staghorn vessels
CD34 positivity can be focal
STAT6 nuclear positivity
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NAB2::STAT6 mutation analysis results
NAB2::STAT6 RT PCR and sequencing
General overview of solitary fibrous tumors (not specific to CNS tumors) by Dr. Jerad Gardner
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Enhancing mass in the third ventricle
Contributed by Eman Abdelzaher, M.D., Ph.D.
MRI, T2
MRI, FLAIR
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Lateral ventricle
Spinal cord subependymoma, MRI
Intraparenchymal subependymoma, MRI
Fourth ventricle subependymoma
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Smooth contoured lobulated mass
Spinal cord
subependymoma
Intraparenchymal
subependymoma
Contributed by Eman Abdelzaher, M.D., Ph.D.
Circumscribed, lobulated mass
Contributed by Eman Abdelzaher, M.D., Ph.D., David Taylor, M.D. and Nazila Azordegan, M.D.
Nuclear clustering and microcystic change
Nuclear clustering
Nuclear clustering
Nuclear clustering
Microcystic change
Microcystic change and nuclear pleomorphism
Uniform nuclei
Uniform nuclei
Lobulated tumor
Clustered nuclei in fibrillary background
Dot-like perinuclear EMA
GFAP
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Cohesive tissue
clumps, elongated
cytoplasmic
processes
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Ultrastructural findings in subependymoma
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Key molecular and clinical characteristics
Methylation profiling
Copy number variations
Subependymoma
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Lumbar synovial cyst
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Cervical spine MRI
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Key diagnostic genes, molecules, pathways
CNS WHO grades of selected types
Newly recognized WHO 2021 tumor types
Contributed by P.J. Cimino, M.D., Ph.D.
Adult type IDH mutant gliomas
Adult type IDH wildtype gliomas
Contributed by P.J. Cimino, M.D., Ph.D.
Astrocytoma lacking mitoses
Increased mitotic activity
Pseudopalisading necrosis
Microvascular proliferation
Contributed by P.J. Cimino, M.D., Ph.D.
Glioblastoma EGFR amplification
Glioblastoma copy number plot
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Glioblastoma TERT promoter mutation
2021 WHO classification of CNS tumors: update I - gliomas
Contributed by Jared T. Ahrendsen, M.D., Ph.D.
Criteria for meningioma classification
Contributed by Jared T. Ahrendsen, M.D., Ph.D. and Chunyu Cai, M.D., Ph.D.
Brain invasion
Necrosis
Sheeting
Increased cellularity
Small cell transformation
Prominent nucleoli
Atypical meningioma
Anaplastic meningioma
Asa: 2020
Ellison: 2013
Gill: 2022
Gray: 2018
Gupta: 2016
Husain: 2021
IARC: 2022
Kleinschmidt-DeMasters: 2022
Love: 2015
Perry: 2017
Rodriguez: 2016
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