ASPEK DASAR KLINIKO-

NEUROPATOLOGI

FKIK UNIB 2021

Penyakit Bourneville = Tuberous sclerosis
Melanosis : Multipel organ
Inflamasi / Infeksi
Rabies (Mad dog) e.c. RNA virus
Rabies (Mad dog) e.c. RNA virus
 Neurosifilis
Stadium lanjut
(st.III) syfilis
Gangguan Vaskular
 Area target
intoksikasi CO
Fase akut
 Aneurisma
displasia lapis
muskular

Jenis :
Tunggal / Multipel

Kongenital
(genetik)

Didapat
(atherosklerosis,
mikotik)
Atherosklerosis
 Perdarahan
Intrasulcus /
Intraventrikel
• PERUBAHAN NEURONAL
Gangguan Metabolik
&
Defisiensi Vitamin
Alzheimer
Neoplasma
 Symptoms of Brain Tumor

TUMOR TYPE
Symptoms
Low grade Malignant Meningioma Primary CNS
glioma glioma lymphoma
Headache 40 % 50 % 36 % 35 %
Seizure 65-95 % 15-25 % 40 % 17 %
Hemiparesis 5-15 % 30-50 % 22 % 24 %
Mental status 10 % 40-60 % 21 % 61 %
abnormalities
 Gambaran Umum Tumor CNS
Tipe Usia Lokasi Gamb klinik Survival RT Kemoth

Astrositom Adult>child ST Lambat, berthn 5 th MS Yes At recur

Astro anapl Adult ST Tumbuh cepat 2.5 th MS Yes Yes

GBM adult, elder ST Cepat, >> ganas 1 th MS Yes At recur

Oligodendr Any ST, sering fron Kejang 5 th MS Yes Yes

BS glioma Child>adult BS tu pons Defisit n.cranial 1 th MS Yes Seldom

Piloctyc Ast Idem Cerebe,hipot Cure total reseksi 80% 10 th Yes Yes

Ependymo Child, adult Vent 4, cauda Idem, nyebar LCS 70% 5 th Yes Seldom

meduloBlas Child>adult Cerebelum Nyebar via LCS 55% 5 th Yes Yes

ST : supratentorial, BS : brainstem, RT : Radioterapi, MS : median surviv
Meningiom Adult Konvex, clival Cure total reseksi Long term Yes Rare
Gangguan Medulla Spinalis
NEURILEMMOMA /
SCHWANNOMA :
Degenerasi Sistem Saraf
Fisiologik : Degenerasi senilis, atrofi numerik neuron
 PRAKTIKUM
MODUL SARAF & JIWA
ASPEK NEUROPATOLOGI
MIKROSKOPIK
 TUMOR PRIMER SISTEM SARAF

SUSUNAN SARAF PUSAT SUSUNAN SARAF PERIFER

• HISTOLOGIK JINAK, • SEL SCHWAN

• KLINIK GANAS • JARAS SARAF/
• DAMPAK SSPst PLEKSUS
• UNSUR SARAF
PERIFER LAIN :
* medulla adrenal
* ganglion

36
Panels A and B show circumscribed
astrocytomas. Pilocytic astrocytomas
(Panel A) are typically indolent, have a
limited invasive capacity, and rarely
undergo anaplastic progression. These
tumors may have microvascular
hyperplasia and cellular pleomorphism
despite their designation as grade I tumors.
Pleomorphic xanthoastrocytomas (Panel B)
are also relatively circumscribed and,
despite their distinct, conspicuous cellular
pleomorphism, tend to be low-grade (grade
II) tumors with limited capacity for brain
invasion. Panels C through F show diffuse-
type astrocytomas, which have the
capacity for dispersion into the
surrounding brain and a high frequency of
anaplastic progression. A grade II
astrocytoma (Panel C) is well-
differentiated, with mild-to-moderate
nuclear pleomorphism. A grade III
astrocytoma (Panel D) has a high rate of
cell proliferation, as indicated by the
mitotic figures. These tumors commonly
have a moderate degree of cellular
pleomorphism and more heterogeneous
cellularity. Glioblastoma multiforme, grade
IV, is the most aggressive glial tumor and
has the distinctive features of palisading or
geographic necrosis (Panel E) and
conspicuous microvascular hyperplasia
(Panel F) in addition to marked cellular
pleomorphism. (Tissue samples, stained
with hematoxylin and eosin,
 1. Astrositoma, mikroskopik

Astrositoma Fibriler
(Jaras fibriler) Astrositoma Protoplasmik
(Kista mikrokistik)

38
 1. Astrositoma

Pleomorf, ada spider web, small gemistositik dan

Kista mikro = Astrositoma protoplasmik WHO gr.2

39
 2. Glioblastoma

Peningkatan Sellularitas

Astrositoma Glioblastoma
derajat rendah

40
A) gemistocytes (40x
objective), B) small cells
(40x), C) giant cells
(arrows, 40x), D) spindle
cells (between (arrows,
40x), E) oligodendroglial
component
(40x), F) small necroses
(*) and pseudopalisades
(10x)

Figure 1: Common cell

types and glioblastoma
characteristics
2. GLIOBLASTOMA

Gemistocyte cells
Dedifferentiated

42
2. Glioblastoma

Area nekrosis

43
Fibrillary perivascular pseudorosette is Ependymoma can have true Homer-
the hallmark of ependymoma. Wright rosettes.
 Thin, delicate, branching capillaries (chicken
wire vasculature) are a common feature in
oligodendroglioma. Note the round,
monotonous tumor cells with perinuclear halos.

Perinuclear halos (fried eggs) are a

common histologic feature in
oligodendroglioma.
 3. MENINGIOMA
Saat ini dikenal 15 varian
WHO : ada 3 gradasi, gr. 3 ganas

46
Meningothelial (syncytial) meningioma. Moderately large, oval nuclei are surrounded
by round or polygonal cytoplasm with poorly defined borders. The cells typically are
arranged in whorls. The center of some whorls display a psammona body. Fibrous
meningioma consists of fibrillated spindle cells arranged in interlacing bundles (HE)
3. Meningioma

48
Dept. Anatomical Pathology 49
SS4. Schwannoma

Antoni A

50
Biphasic: compact hypercellular Antoni A areas and myxoid hypocellular Antoni B areas (may
be absent in small tumors)
Cells are narrow, elongate, wavy with tapered ends interspersed with collagen fibers
Nuclear palisading around fibrillary process (Verocay bodies) are often seen in cellular areas
Tumor cells have ill defined cytoplasm, dense chromatin
4. Schwannoma

Palisading Area
Verrocay Body

Dept. Anatomical Pathology 52

5. Neurofibroma

53
Histology of the
neurofibroma with
mucinous
degeneration (H&E
staining). (A) The
spindle-shaped
tumor cells are in
fascicular pattern
(original
magnification
×100); (B)
microscopically the
subcutaneous mass
has clear boundary
(×100); (C,D)
mucinous
degenerative
change in loose
storiform (C:
original
magnification ×100,
D: original
magnification
×400).