CENTRAL

NERVOUS
SYSTEM
 Normal Histology of the CNS
The parenchyma of the brain and spinal cord is composed of the
neurons and various classes of glia.
Neurons:
bodies and cytoplasmic processes of neuroepithelial cell types
Glial cells including (astrocytes, oligodendrocytes, ependymal cells
& microglia).
Gray matter is composed largely of neuronal cell bodies and their
processes. Other constituents of gray matter include glial cells of
astrocytic and oligodendroglial type and microglia.

White matter it is composed largely of axonal processes and their

accompanying myelin sheaths. Occasional neurons are encountered
in normal cerebral white matter. Oligodendrocytes are abundant in
white matter. Astrocytes in the white matter referred to as fibrillary
or fibrous astrocytes.
 Normal Histology of the CNS
The neurons are formed of a nerve
cell with its processes which are the
dendrites and the axon. The nerve
cell contains vesicular nucleus with
clear nucleolus, and also contains
''Nissl granules'' which are specific
basophilic bodies.
Astrocytes are the major supporting
cells in the brain, found in both gray
and white matter, and derive their
name from the star-shaped
appearance due to its multiple,
branching cytoplasmic processes.
Astrocytes have round to oval nuclei.
 Normal Histology of the CNS
Oligodendrocytes are a main cellular
constituent of the white matter, they are
also present along the myelinated fibers
within the gray matter.
Oligodendrocytes are small branched
cells with clear cytoplasm and round
small nucleus .
Ependyma line the ventricular system
and extend into the central canal of the
spinal cord. They form a single layer of
cuboidal to columnar cells (variably
ciliated) with vesiculated nuclei on the
basal surface.
 CNS Tumor Classification
The WHO classified the CNS tumors according to the tissue of origin in to:

[A] Tumors of neuroepithelial tissue.

[C] Tumors of the meninges.
[B] Tumors of cranial and spinal nerves.

[D] Lymphomas and hematopoietic neoplasms.

[E] Germ cell tumors.
[F] Tumors of the sellar region.
[G] Metastatic tumors.
 Neuroepithelial Tumors
The neuroepithelial tumors include:

Glial tumors most common type

of cns tumer (mcq)
Neuronal

Mixed Neuronal-Glial Tumors.

Embryonal Tumors.

Others.
 Gliomas
They are the commonest tumors of the CNS.
It constitutes about 60% of all intracranial tumors.
It includes:mcq except
 Astrocytoma .
 Oligodendroglioma.
 Ependymoma.
 Choroid Plexus Tumors
 Astrocytoma
20-30% of the cerebral gliomas.
In children: it is cystic(mcq),Pilocytic Astrocytoma (mcq)&
in cerebellum(mcq) .
In young adult: it involves spinal cord (cervical).
In old adult: it prefers cerebral hemisphere.
Grossly:
• Poorly defined, grayish white fleshy mass, infiltrates
brain tissue.
• It may be soft or firm according to its content of
neuroglial fibers.
• Mass ranges from few centimeters to gigantic size.
Microscopically:
• They are variably cellular.
• Have a matrix of glial cytoplasmic processes.
 Grading of Astrocytoma(mcq)
Tumor Grade Nomenclature Histological Features
Grade I(mcq) Pilocytic Astrocytoma Formed of well-differentiated
Common in children mature astrocytes. cerebellum

Moderate hypercellularity, mild

Grade II Diffuse Astrocytoma nuclear atypia, no or minimal
mitotic activity.

Increased cellularity and diffuse

Grade III Anaplastic Astrocytoma infiltration, increased nuclear
atypia, increased mitotic activity.

(mcq)
1-Vascular proliferation(mcq),
Grade IV(mcq) Glioblastoma Multiform 2-necrosis, crowded anaplastic
‫االسواء‬ cells, 3-multinucleated giant
cells, marked nuclear atypia,
marked mitotic activity. Tumor
may associated with
sarcomatous features
(Gliosarcoma).
A B C

A. ‫مهم‬Pilocytic Astrocytoma: shows biphasic pattern(mcq) consisting of compact areas of

elongated fibrillated cells alternating with microcystic areas of stellate astrocytes.
B. Diffuse Astrocytoma: Shows moderate hypercellularity of monotonous cells.
C. Anaplastic Astrocytoma: shows pleomorphic cells with nuclear hyperchromasia, mitoses.
A B

C D
GBM shows great histologic and cytologic variation with bizarre multinucleated
giant cells mixed with small dark anaplastic cells (A,B). GBM shows endothelial
proliferation (C) & pseudopalisading necrosis of neoplastic cells (D).
 Oligodendroglioma
 5% of all tumors….old age
 Discovered accidentally at P.M.
 They arise in the white matter, mainly in cerebrum.

Grossly:
 well defined grayish mass with cystic foci.
 Hemorrhage and calcification(mcq) are found.

Microscopiclly: mcq
 Sheets of uniform cells‫ا‬5‫عضه‬55‫د ب‬5555‫ ق‬with dense round
nuclei.
 Clear cytoplasm with perinuclear halo giving a
‘’Honey comb appearance’’ or ‘’Fried egg appearance’’
 (. chicken wire)
 Although the tumor is infiltrative, it grows slowly.
Oligodendroglioma Showing cells with small round uniform nuclei surrounded by
clear halos (Fried egg appearance of cells) with no anaplastic features, there is
delicate but rich vascular network (chicken wire).
 Ependymoma

 Ependymal cells lined the ventricular surface and

the central canal of the spinal cord.
 In children: mostly intraventricular.
 In adult: mostly in the spinal cord (Lumbo-sacral &
Caudal equina region).
A B

Horizontal section through mid pons shows a large grayish tumor )A(
.mass of ependymoma filling the fourth ventricle

(B) Ependymoma histologically shows a rosette pattern )mcq)or( pseudo)of the

 Medulloblastoma(embryo)
 Most common primitive neuroectodermal tumor
(PNET), which arise from remnants of neural tube.
 Usually in the cerebellum(mcq).(medullo &
polycystic homa el mostly fe el cerebellum)mcq

 Common in the children(mcq).

 Infiltrates aggressively & disseminates through
the spinal cord.

Microscopic:
Crowded neuroblasts cells with hyperchromatic
round to oval nuclei with scanty cytoplasm.
 A B

(A) Sagital section of cerebellum and brainstem shows solid mass of

medulloblastoma.
(B) MB in the midline of cerebellum, the tumor fills the fourth
ventricle (arrows).
A B
Classic medulloblastoma, composed of undifferentiated-looking cells with little
cytoplasm & hyperchromatic nuclei (A). Homer-Wright rosettes of
medulloblastoma consist of tumor cell nuclei disposed in circular fashion
around cytoplasmic processes (B,C).
 Neuroblastoma (emberyo)

 Highly malignant tumor.

 One of PNET.
 Typically found in the first decade of life.
 Usually arises deep within the cerebral
hemisphere.
 Meningioma
 not a glial tumer(mcq mohm)
 Represents 20% of primary intracranial tumors.
 Age: 40-50 years ,but may occur in young adults.
 It is a benign slowly growing tumor.
 Arises from meningothelial (arachnoidal) cells.
 Site: usually attached to dura, sagittal sinus,
posterior cranial fossa and over the spinal cord.
 Meningioma

Grossly:
 Well defined encapsulated round or oval mass,
firm, grayish white, with whorly appearance.
 It is adherent to the under surface of dura to drive
its blood supply.
 Secondary changes: bone, cartilage, calcification,
cysts & fat may be seen.
Gross pathology of Meningioma:
(A) Lateral view shows large extracerebral tumor strongly depressing
the prefrontal region.
(B) Another meningioma attached to dura.
 Meningioma
Microscopically:
 Whorled pattern(mcq) of meningothelial cells onion
skin(mcq), and psammoma bodies(mcq).

a) Meningothelial type: round or oval cells arranged in

whorls, separated by stroma.

b) Fibroblastic type: shows fibroblast proliferation.

c) Angioblastic type: shows network of capillaries.

d) Psammomatous type: central cells undergo hyalinization

and calcification.
A B

C D
Meningothelial Meningioma: Shows well defined cellular whorls with Psammoma
bodies (A,B).
Fibroblastic Meningioma: Shows spindled cells arranged in storiform pattern (C).
Psammomatous Meningioma: Shows abundant psammoma bodies (D).
 Schwanoma(peripheral nerves)
 It is benign , slowly growing nerve sheath tumor.
 Derived from schwan cells.
 Intracranial schwanoma of 8th cranial nerve called
‘’acoustic neuroma’’ involves cerebellopontine angle.
Gross: firm, round or fusiform, well encapsulated
mass, along one side of the nerves.
Microscopic: Two types of cells(biphasic
pattern(mcq) hya w el polycitic5‫ مهم‬5‫ مهم‬5‫مهم‬
Antoni type A(mcq): cells are long, spindle, having
elongated parallel nuclei (palisade manner).

Antoni type B(mcq): large rounded pale cells in a

Schwanoma grossly shows round well capsulated mass
attached to the nerve.
These are the classic microscopic appearances of a schwannoma. Note the more
cellular "Antoni A" pattern on the left with palisading nuclei (black arrow)
surrounding pink areas (Verocay bodies). On the right is the "Antoni B" pattern with
a looser stroma & fewer cells.