Introduction to the histology and pathology of the nervous system. Brief overview of most common brain cancers and histological changes of neurons and glial cells
2. Nervous System Overview
• Derives from the ectoderm
• Neural tube and Neural crest
• Consists of two main structural divisions:
• Central nervous system
• Brain
• Spinal cord
• Peripheral nervous system
• Neurons
• Ganglia
• Consists of two main functional divisions:
• Somatic
• Sensory (afferent)
• Motor (efferent)
• Autonomic
• Parasympathetic
• Symptathetic
Image obtained from: https://s-media-cache-ak0.pinimg.com/originals/e0/4f/cd/e04fcd5f8dc1a0a4bbed2bf0bb371253.jpg
3. Neuron Classification
Processes
• 1. Multipolar
• 2. Bipolar
• 3. Pseudounipolar
Processes
• 1. Multipolar
• 2. Bipolar
• 3. Pseudounipolar
Axonal length
• Pyramidal cells:
• 1. Golgi I
• Motor cortex
• Extremely long
can be more
than a meter
• 2. Golgi II cells
• Interneurons
• Very short
axons
Axonal length
• Pyramidal cells:
• 1. Golgi I
• Motor cortex
• Extremely long
can be more
than a meter
• 2. Golgi II cells
• Interneurons
• Very short
axons
Function
• 1. Motor
• 2. Sensory
• 3. Interneurons
Function
• 1. Motor
• 2. Sensory
• 3. Interneurons
NeurotransmitterNeurotransmitter
4. Neurotransmitters
• NTs will have either a positive or negative effect on the post-
synaptic neuron
• Act on ionotropic (ligand-gated) and metabotropic (GCPR)
receptors
• Excitatory synapses
• Releases excitatory NTs that cause depolarization in the post-
synaptic neuron
• usually due to transmitter-gated Na channels
• Ex: Acetylcholine, glutamate, serotonin
• Inhibitory synapses
• Releases inhibitory NTs that hyperpolarize the post-
synaptic neuron
• Usually due to transmitter-gated Cl channels
• Ex: GABA, Glycine
• Vesicle transport
• Anterograde
• Kinesin
• Retrograde
• Dynein
5. Neuron Processes
Bipolar neuron
•One axon and one dendrite
•Uncommon – usually involved in special senses such as
equilibrium, hearing, and vision
•Also found within the ganglia of the vestibulocochlear (VIII) nerve
Pseudounipolar/Unipolar neuron
•Technically two processes single process of the nerve divides
into two processes, giving the appearance of a unipolar neuron
•One branch extends to the periphery, and another to the CNS
•Found in: dorsal root ganglia
•Afferent
Multipolar neuron
•Have one axon and multiple dendrites
•Found in: multiple places
•anterior horn of the spinal cord
•Autonomic ganglia
•Interneurons
•Pyramidal cells and Purkinje cells
•Most abundant process Histology: A Text and Atlas. 7th ed
6. Neuron histologyNeuron histology
• Similarly to muscle tissue, nerve fascicles also have multiple layers. These layers will
contain the same prefixes endo-(”within”), peri- (“enclosing”/”surrounding”), and epi-
(“on top of”).
1. Epineurium
• The epineurium consists of dense connective tissue
1. Perineurium
• This layer is thin, flat, and immediately surrounds each fascicle. The perineurium is
important when it comes to distinguishing nervous tissue apart from muscle fibers, as this
layer, while thin, gives nerve bundles their boundaries
1. Endoneurium
• This layer consists of fine connective tissue
• Nuclei
• Schwann cells-– In the PNS, these crescent=shaped nuclei will be visible tangential to nerve
fibers.
• Fibroblasts – In the endoneurium, these small and dense nuclei will be present
• Endothelium– These usually run parallel to nerve fibers
9. SynapsesSynapses
1. Axosomatic
• Synapse is between an axon and a
cell body
1. Axodendritic
• Between axons and cell bodies
• Some have dendritic spines
projection of actin filaments
• Long term memory and/or learning
1. Axoaxonic
• Between axons and other axons
1. Axosomatic
• Synapse is between an axon and a
cell body
1. Axodendritic
• Between axons and cell bodies
• Some have dendritic spines
projection of actin filaments
• Long term memory and/or learning
1. Axoaxonic
• Between axons and other axons
10. Synapse ClassificationSynapse Classification
• Chemical Synapses
• Release of neurotransmitters from the
presynaptic neuron to the post synaptic
neuron
• Presynaptic
element/knob/component/bouton
• Synaptic vesicles attach to membrane
• Mediated by soluble NSF attachment receptors
(SNAREs)
• V-snare
• T-snare
• synaptotagmin 1 – replaces SNARE
(NSF/SNAP25)
• Active zones Rab-GTPase docking complexes
(see page 35), t-SNAREs, and synaptotagmin
binding proteins
• Synaptic cleft
• 20-30nm space
• Postsynaptic element/membrane
• Formed from a portion of the post-synaptic
membrane of the postsynaptic neuron
• Electrical synapses
• Not common in vertebrates
• Mainly just seen in cardiac and smooth
msucle
11. Nissl Substance
Rough ER in a
neuronal cell
body
Photo curtesy of Michigan State University College of Medicine
12. Unique features of nervous tissue
• Nervous tissue consists of two main cell types:
• Neurons
• Glia
• The CNS and PNS have different glia, which function as supporting cells
to neurons
• CNS glia
1. Oligodendrocytes
2. Ependymal cells
3. Astrocytes
4. Microglia
• PNS glia
1. Schwann cells
13. Astrocytes
There are no regions of the CNS
that are devoid of astrocytes
• Astrocytes in the white matter are referred to
as fibrous, and astrocytes in grey matter are
referred to as protoplasmic
• Gold staining (shown in the picture) is a
marker for astrocytes.
• These star-shaped cells are the largest and
most abundant of all glial cells in the CNS
• These cells vital for brain functioning are also
highly involved in CNS pathologies
• They are involved in metabolic functioning
such as NT recycling, act as an extracellular K
buffer, and are also involved in
repair/scarring
• Their foot processes make up the blood brain
barrier.Photo curtesy of Michigan State University College of Medicine
14. Astrocyte function
• There are two main types of
astrocytes:
1. Fibrous
• Found in white matter
• Foot processes contact Node of Ranvier
• Processes thinner
1. Protoplasmic
• Found in gray matter
• Less GFAP
• Highly branched
• Bergmann Glia
• Develop from radial glia after the
granular layer is developed
• Complex and contact Purkinje cells in
the cerebellum
• “specialized astrocytes” that migrate to
the cerebellum
• Astrocytes are extremely unique in that
they have the ability to also
communicate via neurotransmitters
Fibrous Astrocytes
Protoplasmic Astrocytes
Histology: a Text and Atlas. 7 editionFuller GN, Burger PC in Central Nervous System in Sternberg SS, ed Histology for Pathologists. Philadelphia: Lippincott-Raven, 1997
15. Astrocyte
function
Astrocytes are heavily involved in
metabolic functioning of the CNS and
are also involved in many CNS
pathologies.
Pathological changes in astrocytes
includes hypotrophy (in the case of
chronic depression) and hypertrophy
(in the case of trauma).
Sofroniew & Vinters, 2010
16. Glial fibrillary acidic protein
(GFAP) – Marker for
astrocytes
• GFAP- an intermediate filament found
in glial cells of the CNS
• Provides structure to astrocytes as well
as mechanical support
• Important for the establishment of the
blood brain barrier
• Often used clinically as a marker for
astrocytic brain tumors
• While it is often used as a marker for
brain tumors, astrocytes will still stain
for this. Just in a smaller amount. In a
non pathological brain sample, it
should stain positive for GFAP and
negative for Vimentin
Anon (2017) “Dictionary - Expression: Gfap - The Human Protein Atlas,.
17. MicrogliaMicroglia
Derive from the neural crest
monocytes
Appearance: Shape of rod/cigar
Glial nodules
Vimentin class of intermediate
filaments
•Microglia are an important part of
immunity as well as a major part of
inflammation in the CNS.
18. GangliaGanglia
• Ganglia are nerve cell body bundles located outside of the CNS
• They will have nerve fibers leading to them and from them
• Ganglia consist of:
1. Sensory ganglia
2. Autonomic ganglia
1. Sympathetic ganglia
• Located in sympathetic chain
• Some are also located on the aorta (anterior surface)
• Send longer processes to viscera
1. Parasympathetic ganglia
• Located near target organs
1. Enteric ganglia
• Located in submucosal and mesenteric plexus
• Receive both parasympathetic (presynaptic) and enteric stimulation
• Ganglia are nerve cell body bundles located outside of the CNS
• They will have nerve fibers leading to them and from them
• Ganglia consist of:
1. Sensory ganglia
2. Autonomic ganglia
1. Sympathetic ganglia
• Located in sympathetic chain
• Some are also located on the aorta (anterior surface)
• Send longer processes to viscera
1. Parasympathetic ganglia
• Located near target organs
1. Enteric ganglia
• Located in submucosal and mesenteric plexus
• Receive both parasympathetic (presynaptic) and enteric stimulation
19. Peripheral GangliaPeripheral Ganglia
• Contains pseudounipolar neurons
• Gives “bullseye” appearance
• Can also often see lipofuscin
• Contain cell bodies of sensory
neurons NOT synaptic stations
1. Dorsal root ganglia – spinal nerves
• Posterior region of the spinal cord
1. Sensory ganglia – cranial nerves
• Picture shows Gasserian ganglion
fifth cranial nerve (trigeminal)
• Nerve impulse travels through the
ganglion and reaches a synapse on V in
the brain stem
• Conducts sensory nerve impulses
• Contains pseudounipolar neurons
• Gives “bullseye” appearance
• Can also often see lipofuscin
• Contain cell bodies of sensory
neurons NOT synaptic stations
1. Dorsal root ganglia – spinal nerves
• Posterior region of the spinal cord
1. Sensory ganglia – cranial nerves
• Picture shows Gasserian ganglion
fifth cranial nerve (trigeminal)
• Nerve impulse travels through the
ganglion and reaches a synapse on V in
the brain stem
• Conducts sensory nerve impulses
Trigeminal (sensory) ganglion
Dorsal root ganglion
22. Sympathetic gangliaSympathetic ganglia
• Mesenteric plexus is in between
two layers of smooth muscle
• Sympathetic trunk/paravertebral
ganglia
• E.g superior cervical
• Prevertebral ganglia next to
abdominal aorta
• Celiac
• Superior mesenteric
• Inferior mesenteric
• Aorticorenal
• Mesenteric plexus is in between
two layers of smooth muscle
• Sympathetic trunk/paravertebral
ganglia
• E.g superior cervical
• Prevertebral ganglia next to
abdominal aorta
• Celiac
• Superior mesenteric
• Inferior mesenteric
• Aorticorenal
Mesenteric Plexus
Tuolodine BluePhoto curtesy of Michigan State University College of Medicine
23. Dorsal root vs Autonomic ganglia
• Pseudounipolar
• Larger than
autonomic ganglia
• “smooth” and oval
• Has more satellite
cells due to greater
surface volume
• Multipolar
• Surrounded by
satellite cells
• More angular than
DRG
• Parasympathetic are
located near the
organs
• Have lipofuscin
Both are located in the peripheral nervous system (so both have
Schwann cells), and both consist of large neuronal cell bodies
surrounded by nerve fibers.
25. Photo curtesy of Michigan State University College of Medicine
Ventral root of
the Spinal Cord
26. Motor (anterior) vs
sensory (dorsal) horn
Motor (anterior) vs
sensory (dorsal) horn
• The neurons of the dorsal horn
are much smaller compared to
the anterior horn
• the dorsal horn has less of a
metabolic demand to other
regions of the CNS; functions as
an interneuron
• The ventral horn projects onto
muscles may have to project a
very long distance
• The neurons of the dorsal horn
are much smaller compared to
the anterior horn
• the dorsal horn has less of a
metabolic demand to other
regions of the CNS; functions as
an interneuron
• The ventral horn projects onto
muscles may have to project a
very long distance
27. Histology of the Brain
Categorized histologically into four different regions:
1. Cerebral cortex
2. Cerebellum
3. Hippocampus
4. Lateral Ventricle wall
28. Cerebral Cortex Histology
• Layer I – Molecular layer
• Few neurons/glia
• Layer II – Outer granular layer
• Small pyramidal neurons
• Stellate neurons
• Layer III – Outer pyramidal layer
• Moderate-sized Pyramidal
• Layer IV – Inner granular layer
• Dense stellate neurons
• Layer V – Inner pyramidal layer
• Also called ganglionic layer
• Large pyramidal neurons
• Layer VI – Multiform cell layer
• Mixture of small pyramidal and stellate
29. Cerebral cortex
Connectome
Red at the deepest corical layer shows
pyramidal cells intertwined with
stellate – the stellate are inhibitory
Cell bodies of pyramidal cells seen in
layer 5
31. Cerebral cortex
layers
Cerebral cortex
layers
Notice the difference in size between
the pyramidal cells of layer III and
layer V (luxol blue stains).
Layer V in the motor cortex are able to
send projections as far as the spinal
cord
layer III
Layer V
33. Hippocampus Histology
• Hippocampal and dentate gyrus are both
divided into 3 layers instead of 6 like the
cerebral cortex.
1. Polymorphic layer
• Both: nerve fibers and mall interneuron cell
bodies
1. Middle layer
• Dentate gyrus granular cells: cell bodies of
dentate gyrus neurons
• Hippocampal pyramidal layer-: pyramidal cell
bodies of hippocampus
1. Molecular layer
• Dentate gyrus: the dendrites of the middle
pyramidal layer
• Hippocampus: dendrites of pyramidal cells
• The dentate gyrus of the hippocampus is one
of the few areas of the brain that can
regenerate new neurons
• Involved in memory
• Express nestin (intermediate filament)
Photo curtesy of Michigan State University College of MedicineLuxol Blue
37. Staining- Silver Stain
Cajal/Golgi
Cajal/ Golgi Stain – University of Oklahoma College of Medicine
Silver stain that is used to
visualize nervous tissue under
light microscopy.
Silver stain that is used to
visualize nervous tissue under
light microscopy.
38. Luxol Blue
•Stains myelin and myelinated axons in
brain/spinal cord blue; Stains phospholipids
•H&E
•Standard staining method in histology, but
difficult to differentiate between axons and
dendrites in nervous tissue
•Nissl will be basophilic and cytoplasm
eosinophilic; astrocytes extremely hard to
see- nuclei appear clear
•Better for pathology – astrocytes
eosinophilic in damaged tissue (fibrous
components)
Neuro Staining- Common
Nissl Stain
•Classic Stain
•Nissl bodies are stained purple
•Good for measuring neuron density
Picture curtesy of Duke University Picture curtesy of Duke University
Photo credit: Neurodigitch
39. Neuro Staining- Pathological
PAS
•Stains: glucides, glycogen,
mucus, fungus, phospholipids,
glycolipids
•Detects: Metabolic
abnormalities
Congo red
•Stains/detects: Amyloid
plaques and amyloid
angiopathy
Fat Staining – Sudan III, Oil
Red O, Sudan Black B
•Glycerides, fatty acids,
glyco/phospholipids
•Glycerides stain red and
others blue with SBB
•Frozen sections used instead of
paraffin-embedded
•Detects abnormal deposits –
may also detect lipid
phagocytes
Bielschowsky
•Modified silver stain
•Neurofibrils black
•cytoplasm, nuclei, and blood vessels
light brown
•RBCs dark brown
•Neuropil tannish yellow
•In neurology, it’s used for locating
neurofibrillary tangles and plaques
Photo credits: NewcomerSupply Photo credit: Neuropathology Database Photo credit: Neuropathology DatabasePhoto credit: Neuropathology Database
40. Neuropathology – Specific
PTAH
•NOTE: normally used for muscle tissue
•Myelin stains a bluish-purple, nuclei/Nissl stain
basophili, cytoplasm stains pinkish brown, collagen
stains reddish orange
•Pathology: Used to view reactive astrocytosis
Masson's Trichrome
•Stains bone, nuclei, and collagen blue
•Usually used for muscle pathologies, but also
stains brain/spinal cord parenchymal tissue
(pinkish red)
•Pathology: shows fibrosis
Toluidine blue
•Stains: acid
mucopolysaccharides stains
red
•Also used with cresyl violet
and heavy metal impregnation
•Detects: Metachromatic
leukodystrophy
Picture curtesy of Duke UniversityPicture curtesy of Duke University Photo credit: Arai, Nobutaka, MD, DMS
41. Vimentin
•Stains: mesenchymal tissue
•Detects: meningiomas
Tau (AT)
•Stains: microtubule-associated
protein tau
•Color: dark brown
•Detects: Tauopathies
α-Synuclein
•Stains: synaptic-associated protein α
synuclein
•Color: dark brown
•Detects: α-synucleinopathies
Aβ- amyloid
•Stains: Aβ peptide (comes from
amyloid precursor protein)
•Color: dark brown
•Detects: Alzheimer's
Immunohistochemical staining
Picture credit: PathologyOutlines Picture credit: FrontalCortex Picture credit: Carl HobbsPhoto credit: alzforum
42. Good vs bad staining/preservation of the
CNS
• Bad preservation shrunken cells that look apoptotic (surrounded by an
empty space)
• This is due to poor fixation
• Good preservation large pale-staining nucleus, visible Nissl substance,
large cell body
44. Inclusion BodiesInclusion Bodies
• Lipofuscin
• Age-related
• gold
• Neuromelanin
• Non-pathological melanocytes derive from the
neural crest
• Actually pathological when it’s NOT there –
neurodegenerative diseases
• Missing in the substantia nigra and locus cereleus
in Parkinson’s
• Lewy bodies
• Eosinophilic – seen in Parkinson’s disease
• Lipofuscin
• Age-related
• gold
• Neuromelanin
• Non-pathological melanocytes derive from the
neural crest
• Actually pathological when it’s NOT there –
neurodegenerative diseases
• Missing in the substantia nigra and locus cereleus
in Parkinson’s
• Lewy bodies
• Eosinophilic – seen in Parkinson’s disease
45. Neuronal response to injuryNeuronal response to injury
Different in CNS and PNS!
•Axons in the PNS usually rapidly
regenerate, and usually axons in
the CNS never regenerate
Involves two main processes:
1.Axonal degeneration
2.Neuronal regeneration
• Myelin tends to inhibit neuronal
regeneration
• Schwann cells
inhibit/downregulate proteins
that are specific for myelin and
upregulate glial growth factors
(GGFs)
46. Neuronal Response to InjuryNeuronal Response to Injury
• Both CNS and PNS will induce axonal
degeneration and (attempt) neuronal
regeneration
CNS: the extent of oligodendrocyte damage is
dependent on whether or not they’re still
receiving signals from the axon. If they
detach, the cell will undergo apoptosis
• Regeneration is greatly affected by the
reduced ability of macrophages to cross the
blood-brain barrier, apoptosis, and the
formation of a scar by astrocytes
PNS: The extent of damage is dependent on the
migration and proliferation of macrophages
• Schwann cell degeneration and Blood-nerve
barrier is disrupted on the entire length of the
axon
• Both CNS and PNS will induce axonal
degeneration and (attempt) neuronal
regeneration
CNS: the extent of oligodendrocyte damage is
dependent on whether or not they’re still
receiving signals from the axon. If they
detach, the cell will undergo apoptosis
• Regeneration is greatly affected by the
reduced ability of macrophages to cross the
blood-brain barrier, apoptosis, and the
formation of a scar by astrocytes
PNS: The extent of damage is dependent on the
migration and proliferation of macrophages
• Schwann cell degeneration and Blood-nerve
barrier is disrupted on the entire length of the
axon
47. Neuronal response to injury in
PNS
Neuronal response to injury in
PNS
• Traumatic degeneration
degeneration at the site of the axon
• Usually only a couple internodal
segments
• If it extends further or more
proximally, it usually results in
apoptosis
• Regeneration (traumatic)
• Schwann cells will arrange
themselves in endoneurial tubes
Removal of debris from axons and
myelin inside of the tubes tubes
collapse proliferating Schwann
cells form bands of Bungner
bands guide the growth of new
axons growth cone if the cone
sprouts associate with a band, it
regenerates between the layers of
the Schwann cell external lamina
bands guide neurites to rebuild the
axon proximally to distally axon
regrowth stops Schwann
differentiation
• Anterograde (Wallerian)
degeneration distal to injury
site
• 8-24 hours after axon damage
• Axon swells disintegration
axonal cytoskeleton breakdown
disassembly of the cytoskeleton
(granular disintegration) axon
fragmentation f phagocytosis of
myelin debris by Schwann cells and
(later) macrophages
• Secretion of GGFs Schwann cell
division Arrangement of
Schwann cells on external laminae
48. Neuronal response to injuryNeuronal response to injury
• Acute damage
• Oxygen/Glucose depletion need
continuous supply for high
metabolic demand
• Action potentials – maintain
membrane gradients
• Cytoplasmic dendritic
arborization
• May be as long as a meter
• Trauma
• Chronic damage
• Slower
• Aberrant protein aggregates
• maintaining cellular integrity is
extremely important – protein turnover
highly regulated
• Not doing so leads to misfolding and
subsequent proteinopathies
Reactive gliosis (astrocytes)
•Injury astrocyte activation
hypertrophy (increase in cytoplasmic
processes) densely packed processes
over time with GFAP intermediate
filaments permanent scar (plaque)
Soma and Axon changes
•Changes in the cell body are proportional to
the amount of axoplasm destroyed
•Axonal injury retrograde signaling
c-jun (TF) upregulation cell body
swells nucleus moves to the periphery
•Chromatolysis: Nissl bodies disappear
from the center of the neuron and move
to the periphery 1-2 days later (peak ~ 2
weeks)
50. Neuronal
Pathology
Acute injury Red Neurons
Not one change, but a spectrum
Due to hypoxia or ischemia
Earliest marker of cell death
12-24 hours after injury
Irreversible
Histology:
1.Somite shrinkage
2.Pyknosis of nucleus
3.Nucleolus disappears
4.Loss of Nissl substance
5.Cytoplasm stains eosinophilic
Introduction to neuropathology UCSF
51. Ependymal cell
pathology
Ependymal granulation
oScarring
oSeen often in hydrocephalus
oNonspecific
Subendymal glyosis
Little clinical significance
Seen in tuberous sclerosis – Shaslan’s gliosis
Intranuclear virus inclusion
CMV
Inclusion bodies
Buried ependyma
Usually fond in cerebral parenchyma
•
UCSF School of Medicine
52. • Outcome is dependent on
severity – can observe via
GFAP
• Outcome is dependent on
severity – can observe via
GFAP
Astrocyte PathologyAstrocyte Pathology
Sofroniew & Vinters, 2010
53. Astrocyte Pathology
Astrocytes seen at the edge of a malignant
brain tumor
Hypertrophic astrocytes in progressive
multifocal Leukoencephalopathy
(PML)
NOTE: Astrocytes will often have aberrant
morphology according to particular pathology
54. Severe Astrogliosis
•Scarring after tissue repair
•Seen in: degenerative disease
•Appearance: Scar will fit in with surrounding tissue called isomorphic gliosis
•If it’s sudden, the directions will be random anisomorphic gliosis
Alzheimer-type 1 and type 2 glia
•NOTE: Not due to Alzheimer’s.
•Appearance: Large nuclei with visible nuclear membrane and nucleoli
•Type 2 glia (naked glia)- show little cytoplasm
•Seen in: Wilson’s disease/hepatic encephalopathy
Intranuclear viral inclusion
•Inclusion bodies seen in viral infections
•Stain: H&E – inclusion bodies are eosinophilic
•Can also observe with immunostaining (antibodies)
•Seen in: CMV
Astrocyte Pathology
55. Astrocytosis
•Proliferation of astrocytes
•Usually due to tissue damage
Gemistocytic (“plump”) astrocyte
•Appearance: swollen cytoplasm with increased intermediate filaments
•Seen in: areas of tissue damage
•Acute change reactive
•Stain(s): H&E (eosinophilic) shows short, thick processes; GFAP
•Swollen nuclei
•Seen in: Creutzfeldt-Jakob disease and progressive multifocal leukoencephalopathy
Necrobiosis
•Death of astrocytes
•Seen in: Acute/cytotoxic edema
Eosinophilic inclusion
• Pink-staining (eosinophilic) cytoplasmic inclusions
• Seen in: Polymicrogyria and Aicardi syndrome
• Have also been found in some healthy individuals
Pathologycenter.jp
56. Corpora amylacea (Polyclucosan body)
•Masses of hyaline that are located within glia and their processes
•Two main types:
•Intraneuritic: Not disease-specific
•Present before pyramidal loss in hippocampal sclerosis
•Amyloid bodies
•Accumulates in the processes
•Staining: H&E – stains dark eosinophilic; PAS staining – positive (red)
Rosenthal fibers
•Appearance: Corkscrew-shaped
•Stain(s): H&E–eosinophilic in processes; PTAH stains astrocytic fiber bundles blue
•Seen in: gliosis and pilocytic astrocytomas
•Clinically significant for Alexander’s disease
•Appear in end-feet extend throughout the brain, vessels, and pia mater
Glial bundles
•Stain: GFAP
•Formed in the ventral spinal nerve root
•Sometimes dorsal root
•Seen in: Werdnig-Hoffmann disease clinically significant
57. Astrocytes expressing phosphorylated tau
Bergmann’s gliosis
•Proliferation of Bergmann glia
•Appearance: Small cell body with large nuclei
Appear in a row in the cerebellar cortex with loss of Purkinje cells
• Seen in: Hypoxia/Ischemia; peritumoral compression
Thorn-shaped astrocytes
•Appearance: aggregations of tau proteins
o Appear short and thick
• Seen in: tauopathies- not specific
Tuft-shaped astrocytes
•Appearance: aggregation of phosphorylated tau in the processes
o Located close to the cell body
•Seen in: PSP confirms diagnosis
o Can be aging-related (ARTAG) or pathology- related
• Appearance: Morphology can vary according to stains used
o BG stain or anti-tau antibodies
o Morphologies: thorn-shaped, tuft-shaped, plaques
Hard to see with H&E or Bodian silver staining
• Seen in: Progressive supranuclear palsy (PSP), Corticobasal degeneration (CBD)
Neurology.org
58. Astrocytic plaques
• Aggregates of phosphorylated tau
• Distal portions of processes
• Appear patchy/wreath-like
• Seen in: CBD confirms diagnosis
Foamy spheroid bodies
• NOTE: May be mistaken for axonal swelling
• The bodies are surrounded by bundles of intermediate filament
• Punctuate adhesions between them
• Indistinct border
• Doesn’t stain well with H&E
• Some have some eosinophilic granular structrures
• Commonly found in substantia nigra zona reticularis
Grotesque cells (Bizarre glial cells)
• Seen in: dysplastic disorders
• Found in lesion sites – focal cortical dysplasia, tuberous scerosis
• Appearance: similar to gemistocytic astrocytes in H&E
• Eosinophilic cell bodies
• Stain with anti-GFAP and anti-vimentin Ig
Harvard School of
Medicine
59. Oligodendrocyte Pathology
Acute Swelling
•Seen more in oligodendroglia than astrocytes
•Usually seen in the case of edema
Perineuronal satellitosis
•Usually in cerebral grey matter
Mucoid degeneration
•Polysaccharide accumulation from degeneration
•Seen in oligodendrogliomas
Intranuclear viral inclusion
•extraneural viral inclusions
•JC virus
•progressive multifocal leukoencephalopathy
•Measles virus
•subacute sclerosing panencephalitis
60. CGIs
•argyrophilic inclusions in cytoplasm
•ubiquitin and α-synuclein
•Seen in multiple system atrophy
•Look like tadpoles
•olivopontocerebellar atrophy, striatonigral degeneration, or
Shy–Drager syndrome
CGIs
•argyrophilic inclusions in cytoplasm
•ubiquitin and α-synuclein
•Seen in multiple system atrophy
•Look like tadpoles
•olivopontocerebellar atrophy, striatonigral degeneration, or
Shy–Drager syndrome
Abnormal tau proteins
•neurodegnerative diseases
•Observed with GB/immunostaining
Abnormal tau proteins
•neurodegnerative diseases
•Observed with GB/immunostaining
Glial coiled bodies
•PSP and CBD, Alzheimer’s disease
•GB-stained coiled bodies
•Not specifically in tauopathies
Glial coiled bodies
•PSP and CBD, Alzheimer’s disease
•GB-stained coiled bodies
•Not specifically in tauopathies
Agyrophilic threads
•PSP and CBD
•Found in processes, not cytoplasm
Agyrophilic threads
•PSP and CBD
•Found in processes, not cytoplasm
Oligodendrocyte PathologyOligodendrocyte Pathology
CHAO, L. et al Recurrence and histological evolution of dysembryoplastic neuroepithelial tumor: A case report and review of the literature.
62. Glioma vs. normal histology
Glioma Normal
Dictionary – Normal Cerebral Bortex- The Human Protein Atlas 2017Cancer Dictionary- Glioma- The Human Protein Atlas 2017
63. Medulloblastoma Oligodendroglioma Astrocytoma Meningioma Ependymoma
Most common
Location
Neuroaxis- fourth
ventricle; ; can send
“drop metastases;” to
spinal cord
Frontal lobe
Adults- Frontal lobe
Children- Posterior
Fossa/cerebellum
Parasagittal; olfactory
groove and lesser
wing of the
sphenoid
Adults- cauda equina
Children- 4th
ventricle
Cell type-
derives from
Small cell tumor-
primitive
neuroectoderm
Oligodendrocytes Astrocytes Arachnoid cap cells Ependymal cells
Prognosis
Variable; responds to
radiation
Highly malignant-
seeding (drop
metastasis)
Relatively good-
5 year survival ~80%
Slow growing
Variable- benign or
malignant (g.
multiforme)
Relatively good- not
invasive; benign
Poor prognosis;
technically benign
Frequency
20% of primary
pediatric intracranial
tumors
5% of gliomas
70% of gliomas; Most
common tumor
Most common benign
tumor- 15%
5% of gliomas
Other
more frequent in
children; Homer-
Wright rosettes, small
blue cells
Frequently calcifies
Homer-Wright
rosettes
(neuroblastoma)
Associated with NF2;
concentric whorls
and calcified
psammoma bodies
Characteristic
perivascular rosettes;
Rod-shaped
blepharoplasts (basal
ciliary bodies) found
near nucleus
64. Astrocytomas
• Defined based on morphological features
1. Cellularity
2. nuclear atypia
3. mitotic rate
4. endothelial
5. Proliferation
6. Necrosis
• Graded based off of WHO classification system
1. pilocytic astrocytoma (Grade I)
2. astrocytoma (Grade II)
• Diffuse
1. anaplastic astrocytoma (Grade III)
• Diffuse
1. glioblastoma (Grade IV)
• Diffuse
Suck et al. 2015Webpathology.com
65. Astrocytomas – Classification ContinuedAstrocytomas – Classification Continued
Two main types based off of
histology:
1.WHO grades II, III, IV – Poor prognosis
• Low-grade astrocytoma
o Grade II
o 10-15%
• Anaplastic astrocytoma
o Grade III
o 25%
• Glioblastoma
o Grade IV
o 50-60%
• Giant cell glioblastoma – rare
o Grade IV
• Gliosarcoma – rare
o Grade IV
2. Localized WHO grades I and II
– Better prognosis
• Pilocytic astrocytoma – most common
o Grade I
• Pilomyxoid astrocytoma
o Grade II
• Subependymal giant cell astrocytoma
o Grade I
• Pleomorphic xanthoastrocytoma
o Grade II
NOTE: there are no Grade I infiltrating
astrocytomas
66. Infiltrating AstrocytomasInfiltrating Astrocytomas
• ~80% of brain tumors in adults
• Usually between 30 and 60 years of age
• Symptoms
• Seizures
• Headaches
• Focal neurologic deficits
• Usually found in the cerebral cortex
Three types of infiltrative astrocytomas
depending on WHO classification:
1. Diffuse (grade II)
2. Anaplastic (grade III)
3. Glioglastoma (grade IV)
Pathologystudent.com
67. Brainstem glioma- usually
means pilocytic astrocytoma
• Still a grade I and relatively
benign, but can lead to more
severe symptoms and/or death
based off of location
• This often involves cranial nerve
palsies
• May be a cause of “locked-in”
syndrome
• Symptoms usually related to
pressure- headache, loss of
balance, nausea/vomiting, AMS
The Armed Forces Institute of Pathology
Johns Hopkins Pathology
68. Glioblastoma multiforme
(high grade astrocytoma)
• 55% of primary brain tumors
Prognosis: Poor – 1 year median survival
• Malignant and rapid
Histology:
• Unique features: pseudopalisades,
perivascular pseudorosettes (Homer-
Wright)
• Tumor cells have an eosinophilic
cytoplasm
• Contain glial fibrillary acidic protein
(GFAP)
• Intermediate filament
Most common region(s): frontal lobe,
temporal lobes, basal nuclei
File: Glioblastoma- MR sagittal with contrast.jpg- Wikimedia Commons
69. Glioblastoma multiforme
• Four molecular subtypes:
1. Classic
2. Proneural
3. Neural
4. Mesenchymal
“Butterfly glioma” can pass the corpus
callosum
Appears similar to anaplastic
astrocytoma, except necrosis and
proliferation of endothelial cells is also
observed.
Gross samples will show varying
consistency, some firm and some
soft/yellow (necrosis); some show
hemorrhage as well
Robbins & Cotran Pathologic Basis of Disease, 9e
71. Angiogenic
patterns
• Neuroglioblastoma multiforme
A. Normal vasculature (cerebral cortex)
B. Sprouting angiogenesis at the tumor
sight
C. Angiogenesis increases; sprouting
pattern with increased vessel density
D. Proliferation of endothelial cells – looks
like a “garland”
E. Tufts of capillary along with
proliferation of both endothelium and
pericytes; look like a glomerulus
F. Tumor is invasive; signs of
perivascular cuffing
Stiver S. Frontiers in Bioscience: A Virtual Library of Medicine, 2004
72. MeningiomaMeningioma
• Usually affects adults
• Common in individuals with NF2
• Derives from precursor cells to
the meninges
• Usually a good prognosis unless
the meningioma develops in a
critical area (e.g. grows in the
posterior fossa towards the
medulla)
• Usually well-defined and
rounded. Can extend into bone
and press on brain, but usually
operable
Pathologyoutlines.com
73. MeningiomasMeningiomas
Usually a good prognosis (WHO I/IV) and
rarely reoccur
•Many different histological patters (do not
imply prognosis):
1. Psammomatous
2. Syncytial
3. Fibroblastic
4. Transitional
5. Secretory
6. Microcytic
Atypical meningiomas More aggressive
and more likely to reoccur; higher rate of
mitosis
Anaplastic/malignant meningioma Very
aggressive and has similar appearance to a
sarcoma- bad prognosis
Usually a good prognosis (WHO I/IV) and
rarely reoccur
•Many different histological patters (do not
imply prognosis):
1. Psammomatous
2. Syncytial
3. Fibroblastic
4. Transitional
5. Secretory
6. Microcytic
Atypical meningiomas More aggressive
and more likely to reoccur; higher rate of
mitosis
Anaplastic/malignant meningioma Very
aggressive and has similar appearance to a
sarcoma- bad prognosis
Robbins & Cotran Pathologic Basis of Disease, 9e
75. Oligodendroglioma – Macroscopic
• Grayish pink masses
• Can distinguish from astrocytomas
sometimes macroscopically, as
oligodendrogliomas are more
circumscribed
• May show:
• Mucoid change
• Cystic degeneration
• Hemorrhage
• Calcification
Robbins & Cotran Pathologic Basis of Disease, 9e
79. Four main types of
rosettes
1. Homer-Wright
1. Technically a pseudorosette
2. Seen in neuroglioblastoma,
medulloblastoma, and
primitive neuroectodermal
tumors
3. halo of tumor cells surrounding
a central region containing
neuropil
2. Flexner-Wintersteiner
1. Retinoblastoma
2. Look similar to primitive
retinal cells
3. central lumen containing
cytoplasmic extensions from
the tumor cells
Kristine Krafts, MD Pathology Student
80. 3. True Ependymal Rosette
• Ependymomas
• Tumor cells surrounding an
empty lumen
• Trying to create small ventricles
• Not seen in every ependymoma
3. Perivascular Pseudorosette
• Ependymomas (most commmon),
medullablastoma, PNET, central
neurocytoma, glioblastomas
• Central structure isn’t part of the
tumor
Kristine Krafts, MD Pathology Student
82. Acoustic neuroma/ SchwannomaAcoustic neuroma/ Schwannoma
• Cranial nerves (aside from the
optic nerves, which are
technically just an extension of
the procencephalon) are part of
the PNS
• This means cancer of peripheral
nerves will involve Schwann cells
instead of oligodendrocytes
• Rare (8%) and benign
• It affects women more than men
• Usually it is asymptomatic until
it grows big enough to affect
hearing
Photo credit: library.med.utah.edu
83. Pituitary adenoma
IMPORTANT:
Technically
NOT a brain
tumor!
– it’s located
in the brain,
but isn’t a
tumor
involving
neurons or
glia. It
involves
endocrine
cells. Duke Pathology- Nervous System Part 2
85. Pediatric CNS tumors
• Accounts for ~20% of all childhood cancer
• Most occur (~70%) below the tentorium cerebelli in the posterior fossa (compared to adults
who are most likely to get it above the tentorium cerebelli)
• Most common CNS tumors in children (in decreasing order of prevalence)
1. Cystic cerebellar astrocytoma
• Most common overall
1. Medulloblastoma
• Most common malignant
1. brainstem glioma
• Risk Factors
1. Turcot Syndrome
2. NF1
3. Cigarettes
These CNS tumors can affect adults
as well, but they are more common
in pediatric patients
88. Retinoblastoma – Macroscopic
White mass, elevated, surface
vessels
Same patient – shows
“glow” in eye
Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 9462Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 9461
89. Treatment/Prognosis of RetinoblastomaTreatment/Prognosis of Retinoblastoma
• Cure rate has risen as high as 90% if discovered early
• Surgical treatments involve enucleation and en bloc resection
• Other less invasive treatments involve cryotherapy, chemothreapy,
laser photocoagulation, thermochemotherapy, and external-beam
radiation therapy
• Cure rate has risen as high as 90% if discovered early
• Surgical treatments involve enucleation and en bloc resection
• Other less invasive treatments involve cryotherapy, chemothreapy,
laser photocoagulation, thermochemotherapy, and external-beam
radiation therapy
Source: radiopaedia.org
90. Medulloblastoma
• Four genetically- defined groups:
1. WNT activated
2. SHH activated (TP53 mutated or TP53 wild type)
3. Medulloblastoma group 3
4. Medulloblastoma group 4
• Four Histologically-defined groups:
1. Classic
• More common in childhood
1. Desmoplastic/nodular
• More common in infants/adults
1. Medulloblastoma with extensive nodularity
• More common in infants
1. Large cell/anaplastic
Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 7912
91. MedulloblastomaMedulloblastoma
• Drop metastasis is a common
finding in group 3/4 (shown in
picture)
• Prognosis strongly influenced by:
o surgical resection
o presence of metastases
o In approximately 40% at time of
diagnosis
o expression of HER2/Neu
• Symptoms typically present
associated with raised intracranial
pressure due to hydrocephalus
• Most arise from the cerebellum-
more specifically from the vermis
• Posterior vermis syndrome
Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 5316
92. Medulloblastoma differential diagnosisMedulloblastoma differential diagnosis
Children
• Ependymoma
• It usually arises from the floor of the
4th
ventricle same general location
• Also found in the foramen of
Luschka
• Choroid plexus papilloma (CPP)
• Pilocytic astrocytoma
• Atypical teratoid/rhabdoid
tumor
• Brainstem glioma (exophytic)
Adults
• Cerebellar metastasis
• Hemangioblastoma
• Choroid plexus papilloma (CPP)
• Ependymoma
Robbins & Cotran Pathologic Basis of Disease, 9e
94. Diffuse Brainstem Gliomas
• Locations:
• Mesencephalon
• Pons
• Pontine gliomas (DIPG) are the most
common location (~70% of cases)
• Medulla
• Medullary gliomas are the least
common location
• DIPG
• Most common mutation is in
the H3F3A gene
• “flat floor of the fourth
ventricle” sign – the fourth
ventricle appears flattened,
which may also result in
hydrocephaly
• Prognosis
• Poor – 2 year survival rate is
only 20%
Case courtesy of Dr Vinay Shah,
Radiopaedia.org, rID: 20163
Case courtesy of A.Prof Frank Gaillard,
Radiopaedia.org, rID: 5683
“flat floor” sign
emerges as anterior rootlets from the anterior lateral sulcus and conveys motor output from visceral and somatic motor neurons.
● joins the posterior roots distal to the spinal ganglion and within the intervertebral foramen to form the spinal nerve.
How does the hippocampus receive input?
Information from the thalamus, amygdala, and claustrum is passed through the entorhinal cortex (medial temporal lobe) which projects information to the hippocampus through either the alvear CA1 or the perforant pathway subiculum
Most information that is transmitted via the perforant pathway is projected to the granular cells of the dentate gyrus
Granular “mossy cells” (which are excitatory/abundant in zinc) CA4/CA3 of dentate hilus polymorphic layer Ammon’s horn of CA1 sibiculum fimbria/fornix mammillary body/anterior thalamic nucleus/cingulate gyrus
Bielschowsky - This is a gorgeous stain that is used almost exclusively to outline tangles and plaques (which stain black against a gold background). This silver stain colors axis cylinders and neurofibrils black, cytoplasm and nuclei tan to light brown, blood vessels yellow, tan, or brown, and RBCs tan to dark brown. The background or neuropil is a pale tan to yellow (or gold). Glial fibers are usually not stained
The morphologic features consist of shrinkage of the cell body, pyknosis of the nucleus, disappearance of the nucleolus, and loss of Nissl substance, with intense eosinophilia of the cytoplasm.
http://missinglink.ucsf.edu/lm/introductionneuropathology/response%20_to_injury/Injury_Images/acute%20ischemia1wc.jpg
Morphological classification varies from histological classification which differs from WHO classification (though WHO tries to bring these two concepts together)