Glioma pathophysiology: Difference between revisions

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__NOTOC__
{{Glioma}}  
{{Glioma}}  
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}


==Pathology==
==Pathophysiology==
High-grade gliomas are highly-[[vascular]] tumors and have a tendency to infiltrate.  They have extensive areas of [[necrosis]] and [[hypoxia (medical)|hypoxia]].  Often tumor growth causes a breakdown of the [[blood-brain barrier]] in the vicinity of the tumor.  As a rule, high-grade gliomas almost always grow back even after complete surgical excision.
High-grade gliomas are highly-[[vascular]] tumors and have a tendency to infiltrate.  They have extensive areas of [[necrosis]] and [[hypoxia (medical)|hypoxia]].  Often tumor growth causes a breakdown of the [[blood-brain barrier]] in the vicinity of the tumor.  As a rule, high-grade gliomas almost always grow back even after complete surgical excision.


On the other hand, low-grade gliomas grow slowly, often over many years, and can be followed without treatment unless they grow and cause symptoms.
On the other hand, low-grade gliomas grow slowly, often over many years, and can be followed without treatment unless they grow and cause symptoms.


===Microscopic Images===
===Gross Pathology===
[http://www.peir.net Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
[http://www.peir.net Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
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Image:Pilocytic astrocytoma 1.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. As illustrated, many lesions are composed largely of spongy tissue rich in microcysts. Characteristic of [[pilocytic astrocytoma]]s in general, the lesion is largely a solid mass of neoplastic cells without an obvious background of infiltrated brain.
Image:Glioma Gross 1.jpg|Brain: Pontine Glioma: Gross; fixed tissue, anterior view of [[brain stem]] and [[cerebellum]] with bosselated tumor adjacent to [[basilar artery]]
Image:Pilocytic astrocytoma 2.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. The perivascular radiating processes in some lesions can create a likeness to an [[ependymoma]]. Note the spongy background unusual for [[ependymoma]]s.
Image:Glioma Gross 2.jpg|Brain: Pontine Glioma: Gross; fixed tissue, sagittal section [[brain stem]] and [[cerebellum]]
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Image:Pilocytic astrocytoma 3.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. Other [[pilocytic astrocytoma]]s are solid, rather than microcystic, and may be lobular.
Image:Glioma Gross 3.jpg|Brain: Glioma: Gross; fixed tissue, horizontal section [[brain stem]] and [[cerebellum]] with obvious gelatinous appearing neoplasm a pontine glioma
Image:Pilocytic astrocytoma 4.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. Rosenthal fibers, usually confined to the solid rather than spongy regions are found in many pilocytic [[astrocytoma]]s, but are not requisite for the diagnosis.
Image:Glioma Gross 4.jpg|Brain: Oligodendroglioma: Gross; natural color, large, well circumscribed lesion in left [[frontal lobe]]
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Image:Pilocytic astrocytoma 15.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. Rosenthal fibers are extremely abundant in some lesions. Particularly in the [[cerebellum]], it can be difficult to distinguish such solid, paucicellular, highly fibrillar [[pilocytic astrocytoma]]s from reactive gliosis with abundant Rosenthal fiber formation.
Image:Glioma Gross 5.jpg|Brain: Glioma: Gross; fixed tissue, horizontal sections [[brain stem]] and [[cerebellum]] showing large pontine glioma
Image:Pilocytic astrocytoma 16.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. A loose array of polar cells creates an additional variant of pilocytic [[astrocytoma]].
Image:Glioma Gross 6.jpg|Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis: Gross; fixed tissue, view of cerebral hemispheres from inferior with [[brain stem]] and [[cerebellum]] removed. Pontine asymmetry is easily seen due to low grade [[astrocytoma]] and meningeal gliomatosis is easily seen over [[frontal lobe]]s
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Image:Pilocytic astrocytoma 7.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. Some pilocytic [[astrocytoma]]s are traversed by prominent collagenous septa.
Image:Glioma Gross 7.jpg|Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis in 7 yo boy: Gross; fixed tissue, view of cerebral hemispheres from vertex meningeal gliomatosis.
Image:Pilocytic astrocytoma 8.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. Unusual pilocytic [[astrocytoma]]s have an extensive mucinous background without microcysts.
Image:Glioma Gross 8.jpg|Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis: Gross; in situ dural nodule
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Image:Comparison.jpg|CNS: Comparison of normal [[optic nerve]] and [[pilocytic astrocytoma]] of the [[optic nerve]]. These two figures compare, at the same magnification, the normal [[optic nerve]] (left) with one containing a [[pilocytic astrocytoma]] (right). The [[neoplasm]] enlarges the compartments of the [[nerve]] and extends in collar-like fashion into the [[subarachnoid]] space.
Image:Glioma Gross 9.jpg|Brain: Oligodendroglioma: Gross; fixed tissue, multiple coronal sections, cerebral hemispheres with large tumor and hemorrhage into tumor
Image:Pilocytic astrocytoma 9.jpg|CNS: [[Pilocytic astrocytoma]]; The "hair cells" for which this lesion is named are readily seen.
Image:Glioma Gross 10.jpg|Brain: Oligodendroglioma: Gross; fixed tissue, coronal section, cerebral hemispheres, large hemorrhagic lesion in one hemisphere
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Image:Pilocytic astrocytoma 10.jpg|CNS: [[Pilocytic astrocytoma]]; Nuclear hyperchromasia and [[pleomorphism]] are common. Note the typical cellular elongation, and, at the center of the illustration, the [[eosinophil]]ic granular body that populates [[pilocytic astrocytoma]]s and certain other slowly growing gliomas.
Image:Glioma Gross 11.jpg|Brain: Oligodendroglioma: Gross; fixed tissue, ischemic tissue, anterior to tumor mass
Image:Pilocytic astrocytoma 11.jpg|CNS: [[Pilocytic astrocytoma]]; Intracytoplasmic Rosenthal fibers are prominent in some pilocytic [[neoplasm]]s.
Image:Glioma Gross 12.jpg|Brain: Oligodendroglioma: Gross; natural color, coronal section, cerebral hemispheres, large lesion, left parieto occipital white matter
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Image:Malignant ependymoma.jpg|Brain: [[Malignant]] [[ependymoma]]: Micro med mag H&E tumor cells.
Image:Glioma Gross 13.jpg|Brain: Gliomatosis Cerebri: Gross; fixed tissue, coronal sections, cerebral hemispheres, lesion is in temporal lobes and hypothalamus
Image:Oligodendroglioma 2.jpg|CNS: [[Oligodendroglioma]]; Occasional [[oligodendroglioma]]s contain cells with minute, refractile [[eosinophil]]ic bodies representing miniature Rosenthal fibers.
Image:Glioma Gross 14.jpg|Brain: Ventriculitis: Gross; fixed tissue, case of glioma with meningitis, a nice view of ventriculitis in one lateral ventricle
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Image:Oligodendroglioma 1.jpg|CNS: [[Oligodendroglioma]]; The cells of some [[oligodendroglioma]]s acquire sufficient [[cytoplasm]] and process formation to become decidedly astrocytic, but their nuclei retain the roundness, uniformity, and chromatin distribution typical of [[oligodendroglioma]].
Image:Glioma Gross 15.jpg|Brain: Glioma Thalamic Grade Ii-Iii: Gross; fixed tissue, four coronal sections, cerebral hemispheres, very large hemorrhagic lesion
Image:Anaplastic oligodendroglioma.jpg|[[Anaplastic]] [[oligodendroglioma]]: [[Anaplastic]] [[oligodendroglioma]]s are highly cellular and associated with vascular proliferation.
Image:Glioma Gross 16.jpg|Brain: Glioma Thalamic Grade Ii-Iii: Gross; fixed tissue, coronal section, cerebral hemispheres with large hemorrhagic lesion
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Image:Oligodendroglioma frozen.jpg|CNS: [[Oligodendroglioma]] (frozen section); [[Oligodendroglioma]]s in frozen sections lack the distinctive halos so often seen in permanent sections. Cellular monomorphism and infiltration of [[cerebral cortex]] with perineuronal satellitosis suggest the correct diagnosis.
Image:Glioma Gross 17.jpg|Brain: Glioma Thalamic Grade Ii-Iii: Gross fixed tissue coronal section cerebral hemispheres lesions appears to be in choroid plexus of lateral ventricle in this picture. There is blood in fourth ventricle
Image:Clear cell ependymoma.jpg|CNS: Clear cell [[ependymoma]]; Perinuclear clearing similar to that seen in [[oligodendroglioma]]s is a prominent feature of the clear cell variant. Note the vague perivascular pseudorosettes. The lesion was a discrete occipital intraventricular mass.
Image:Glioma Gross 18.jpg|Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres (58 yo man)
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Image:Glioblastoma multiforme 1.jpg|CNS: [[Glioblastoma multiforme]]; Brain: [[Glioblastoma multiforme]]. Grade I-Ii: Micro med mag with H&E, [[tumor]] well shown
Image:Glioma Gross 19.jpg|Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres
Image:Glioblastoma multiforme 2.jpg|CNS: [[Glioblastoma multiforme]] arising in an [[astrocytoma]]. At higher magnification, gemistocytic [[astrocytoma]] with microcystic change is apparent at the bottom of the illustration and cellular nodules of [[glioblastoma multiforme]] are seen at the top. The 6-year history of symptoms attested to the initially low-grade nature of this astrocytic tumor.
Image:Glioma Gross 20.jpg|Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres
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Image:Glioblastoma multiforme 103.jpg|CNS: [[Glioblastoma multiforme]]; Characteristic of most [[glioblastoma]]s are small cells with elongated nuclei and bipolar processes. As here, the [[chromatin]] is generally not markedly dense nor are nucleoli usually prominent.
Image:Glioma Gross 21.jpg|Brain: Infarct Subcortical: Gross; fixed tissue, close-up view of old small subcortical infarct, a case of microglioma
Image:Glioblastoma multiforme 104.jpg|CNS: [[Glioblastoma multiforme]]; Vascular proliferation, a common feature of glioblastoma, produces tufts which often grow directionally. Here, as is often the case, they are oriented toward a focus of necrosis (top right).
Image:Glioma Gross 22.jpg|Brain: Microglioma: Gross; fixed tissue; [[cerebellum]] and fourth ventricle with periventricular tumor invasion
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Image:Glioblastoma multiforme 105.jpg|CNS: [[Glioblastoma multiforme]]; At high magnification, the neovascular tuft is a mass which, as can be confirmed by immunohistochemistry, is formed of both endothelial cells and smooth muscle cells (pericytes).
Image:Glioma Gross 23.jpg|Brain: Microglioma: Gross fixed tissue horizontal sections cerebellum and brain stem with periventricular neoplastic infiltrate
Image:Glioblastoma multiforme 106.jpg|CNS: [[Glioblastoma multiforme]]; In many instances, [[necrosis]] is surrounded by a distinctive collar of cells, which are often smaller than those in surrounding neoplastic tissue. The phenomenon is referred to as pseudopalisading.
Image:Glioma Gross 24.jpg|Brain: Microglioma: Gross fixed tissue horizontal section midbrain and cerebellum at mid pons level periventricular tumor infiltration
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Image:Cerebrospinal dissemination of glioblastoma multiforme 1.jpg|CNS: Cerebrospinal dissemination of glioblastoma multiforme; As seen at low (left) and high (right) magnification, the small undifferentiated-appearing cells of this glioblastoma are drop metastases colonizing the nerve roots of the cauda equina.
Image:Glioma Gross 25.jpg|Brain: Microglioma: Gross fixed tissue horizontal section rostral pons and cerebellum
Image:Cerebrospinal dissemination of glioblastoma multiforme 2.jpg|CNS: Cerebrospinal dissemination of glioblastoma multiforme; As seen at low (left) and high (right) magnification, the small undifferentiated-appearing cells of this glioblastoma are drop metastases colonizing the nerve roots of the cauda equina.
Image:Glioma Gross 26.jpg|Brain: Microglioma: Gross fixed tissue horizontal section rostral pons and cerebellum periventricular tumor invasion
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Image:Glioblastoma multiforme 116.jpg|CNS: [[Glioblastoma multiforme]]; Higher magnification reveals the small cell nature of such tumors.
Image:Glioma Gross 27.jpg|Brain: Microglioma: Gross fixed tissue coronal section cerebral hemispheres with mild ventricular dilation
Image:Glioblastoma multiforme 117.jpg|CNS: [[Glioblastoma multiforme]]; Some glioblastomas are especially infiltrative of the cerebral cortex where subpial, perivascular, and perineuronal accumulations are prominent.
Image:Glioma Gross 28.jpg|Glioma: Optic Nerve
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Image:Glioblastoma multiforme 126.jpg|CNS: [[Glioblastoma multiforme]]; Although this densely cellular and largely undifferentiated lesion technically merits a diagnosis of [[anaplastic]] [[astrocytoma]], it is, for practical purposes, a glioblastoma.
Image:Glioma Gross 29.jpg|Brain: Oligodendroglioma, Frontal Lobe
Image:Glioblastoma multiforme malignant astrocytoma 1.jpg|Brain: [[Glioblastoma multiforme]] [[malignant]] [[astrocytoma]]
Image:Glioma Gross 30.jpg|Brain: Oligodendroglioma, Mixed Astrocytoma & Oligodendroglioma
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Image:Glioblastoma multiforme pallisading.jpg|Brain: [[Glioblastoma multiforme]]; pallisading
Image:Glioma Gross 31.jpg|Brain: Oligodendroglioma
Image:Glioblastoma multiforme vascular proliferation.jpg|Brain: [[Glioblastoma multiforme]]; vascular proliferation
Image:Glioma Gross 32.jpg|Brain: Oligodendroglioma
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Image:Glioblastoma multiforme extravasated blood.jpg|Brain: [[Glioblastoma multiforme]]; Plump and juicy [[endothelial cell]]s, extravasated blood
Image:Glioma Gross 33.jpg|Brain: Oligodendroglioma; Ventricular Cobblestone Effect
Image:Glioblastoma multiforme perivascular lymphocytes.jpg|Brain: [[Glioblastoma multiforme]]; perivascular [[lymphocyte]]s
Image:Glioma Gross 34.jpg|Eye: Neurofibromatosis; Glaucoma; Glioma
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Image:Glioblastoma multiforme thrombosed vessel.jpg|Brain: [[Glioblastoma multiforme]]; thrombosed vessel
Image:Glioma Gross 36.jpg|Brain: Glioma, Grade II Anaplastic
Image:Hemosiderin in glioblastoma.jpg|Brain: [[Glioblastoma multiforme]]; [[Hemosiderin]] in glioblastoma
Image:Glioma Gross 37.jpg|Brain: Glioma, [[Brain stem]], Low Grade
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===Gross Images===
[http://www.peir.net Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
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Image:Glioma Gross 1.jpg|Brain: Pontine Glioma: Gross; fixed tissue, anterior view of [[brain stem]] and [[cerebellum]] with bosselated tumor adjacent to [[basilar artery]]
Image:Glioma Gross 38.jpg|Fundoscopy: Eye; Optic Nerve Glioma, Optic Nerve
Image:Glioma Gross 2.jpg|Brain: Pontine Glioma: Gross; fixed tissue, sagittal section [[brain stem]] and [[cerebellum]]
Image:Glioma Gross 41.jpg|Brain: Glioma, Hypothalamic, Circle Around Region of Tumor
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Image:Glioma Gross 3.jpg|Brain: Glioma: Gross; fixed tissue, horizontal section [[brain stem]] and [[cerebellum]] with obvious gelatinous appearing neoplasm a pontine glioma
Image:Glioma Gross 39.jpg|CNS: Pilocytic Astrocytoma of the Spinal Cord. The fusiform expansion of the spinal cord produced by this pilocytic astrocytoma is not, on external examination alone, distinguishable from that produced by a nonresectable diffuse glioma.
Image:Glioma Gross 4.jpg|Brain: Oligodendroglioma: Gross; natural color, large, well circumscribed lesion in left [[frontal lobe]]
Image:Glioma Gross 42.jpg|Brain: Glioma, Pontine
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Image:Glioma Gross 5.jpg|Brain: Glioma: Gross; fixed tissue, horizontal sections [[brain stem]] and [[cerebellum]] showing large pontine glioma
Image:Glioma Gross 43.jpg|Brain: [[Glioblastoma Multiforme]]: Gross fixed tissue close-up large necrotic tumor mass in septum pellucidum
Image:Glioma Gross 6.jpg|Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis: Gross; fixed tissue, view of cerebral hemispheres from inferior with [[brain stem]] and [[cerebellum]] removed. Pontine asymmetry is easily seen due to low grade [[astrocytoma]] and meningeal gliomatosis is easily seen over [[frontal lobe]]s
Image:Glioma Gross 44.jpg|Brain: [[Glioblastoma Multiforme]]: Gross fixed tissue coronal section of the brain with a large necrotic tumor mass in septum pellucidum diagnosed as astrocytoma grade III
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Image:Glioma Gross 7.jpg|Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis in 7 yo boy: Gross; fixed tissue, view of cerebral hemispheres from vertex meningeal gliomatosis.
Image:Glioma Gross 45.jpg|Brain: [[Glioblastoma Multiforme]]: Gross natural color large hemorrhagic lesion in right centrum semiovale
Image:Glioma Gross 8.jpg|Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis: Gross; in situ dural nodule
Image:Pilocytic astrocytoma gross.jpg|CNS: Malignant pilocytic astrocytoma: A 29-year-old woman died 2 years after a diagnosis of "atypical pilocytic astrocytoma" of the pineal region. At autopsy, multiple tumor implants were present in the craniospinal subarachnoid spaces.
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===Microscopic Pathology===
[http://www.peir.net Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
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Image:Glioma Gross 9.jpg|Brain: Oligodendroglioma: Gross; fixed tissue, multiple coronal sections, cerebral hemispheres with large tumor and hemorrhage into tumor
Image:Pilocytic astrocytoma 1.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. As illustrated, many lesions are composed largely of spongy tissue rich in microcysts. Characteristic of [[pilocytic astrocytoma]]s in general, the lesion is largely a solid mass of neoplastic cells without an obvious background of infiltrated brain.
Image:Glioma Gross 10.jpg|Brain: Oligodendroglioma: Gross; fixed tissue, coronal section, cerebral hemispheres, large hemorrhagic lesion in one hemisphere
Image:Pilocytic astrocytoma 2.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. The perivascular radiating processes in some lesions can create a likeness to an [[ependymoma]]. Note the spongy background unusual for [[ependymoma]]s.
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Image:Glioma Gross 11.jpg|Brain: Oligodendroglioma: Gross; fixed tissue, ischemic tissue, anterior to tumor mass
Image:Pilocytic astrocytoma 3.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. Other [[pilocytic astrocytoma]]s are solid, rather than microcystic, and may be lobular.
Image:Glioma Gross 12.jpg|Brain: Oligodendroglioma: Gross; natural color, coronal section, cerebral hemispheres, large lesion, left parieto occipital white matter
Image:Pilocytic astrocytoma 4.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. Rosenthal fibers, usually confined to the solid rather than spongy regions are found in many pilocytic [[astrocytoma]]s, but are not requisite for the diagnosis.
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Image:Glioma Gross 13.jpg|Brain: Gliomatosis Cerebri: Gross; fixed tissue, coronal sections, cerebral hemispheres, lesion is in temporal lobes and hypothalamus
Image:Pilocytic astrocytoma 15.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. Rosenthal fibers are extremely abundant in some lesions. Particularly in the [[cerebellum]], it can be difficult to distinguish such solid, paucicellular, highly fibrillar [[pilocytic astrocytoma]]s from reactive gliosis with abundant Rosenthal fiber formation.
Image:Glioma Gross 14.jpg|Brain: Ventriculitis: Gross; fixed tissue, case of glioma with meningitis, a nice view of ventriculitis in one lateral ventricle
Image:Pilocytic astrocytoma 16.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. A loose array of polar cells creates an additional variant of pilocytic [[astrocytoma]].
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Image:Glioma Gross 15.jpg|Brain: Glioma Thalamic Grade Ii-Iii: Gross; fixed tissue, four coronal sections, cerebral hemispheres, very large hemorrhagic lesion
Image:Pilocytic astrocytoma 7.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. Some pilocytic [[astrocytoma]]s are traversed by prominent collagenous septa.
Image:Glioma Gross 16.jpg|Brain: Glioma Thalamic Grade Ii-Iii: Gross; fixed tissue, coronal section, cerebral hemispheres with large hemorrhagic lesion
Image:Pilocytic astrocytoma 8.jpg|CNS: [[Pilocytic astrocytoma]]: variations in histologic appearance. Unusual pilocytic [[astrocytoma]]s have an extensive mucinous background without microcysts.
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Image:Glioma Gross 17.jpg|Brain: Glioma Thalamic Grade Ii-Iii: Gross fixed tissue coronal section cerebral hemispheres lesions appears to be in choroid plexus of lateral ventricle in this picture. There is blood in fourth ventricle
Image:Comparison.jpg|CNS: Comparison of normal [[optic nerve]] and [[pilocytic astrocytoma]] of the [[optic nerve]]. These two figures compare, at the same magnification, the normal [[optic nerve]] (left) with one containing a [[pilocytic astrocytoma]] (right). The [[neoplasm]] enlarges the compartments of the [[nerve]] and extends in collar-like fashion into the [[subarachnoid]] space.
Image:Glioma Gross 18.jpg|Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres (58 yo man)
Image:Pilocytic astrocytoma 9.jpg|CNS: [[Pilocytic astrocytoma]]; The "hair cells" for which this lesion is named are readily seen.
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Image:Glioma Gross 19.jpg|Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres
Image:Pilocytic astrocytoma 10.jpg|CNS: [[Pilocytic astrocytoma]]; Nuclear hyperchromasia and [[pleomorphism]] are common. Note the typical cellular elongation, and, at the center of the illustration, the [[eosinophil]]ic granular body that populates [[pilocytic astrocytoma]]s and certain other slowly growing gliomas.
Image:Glioma Gross 20.jpg|Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres
Image:Pilocytic astrocytoma 11.jpg|CNS: [[Pilocytic astrocytoma]]; Intracytoplasmic Rosenthal fibers are prominent in some pilocytic [[neoplasm]]s.
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Image:Glioma Gross 21.jpg|Brain: Infarct Subcortical: Gross; fixed tissue, close-up view of old small subcortical infarct, a case of microglioma
Image:Malignant ependymoma.jpg|Brain: [[Malignant]] [[ependymoma]]: Micro med mag H&E tumor cells.
Image:Glioma Gross 22.jpg|Brain: Microglioma: Gross; fixed tissue; [[cerebellum]] and fourth ventricle with periventricular tumor invasion
Image:Oligodendroglioma 2.jpg|CNS: [[Oligodendroglioma]]; Occasional [[oligodendroglioma]]s contain cells with minute, refractile [[eosinophil]]ic bodies representing miniature Rosenthal fibers.
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Image:Glioma Gross 23.jpg|Brain: Microglioma: Gross fixed tissue horizontal sections cerebellum and brain stem with periventricular neoplastic infiltrate
Image:Oligodendroglioma 1.jpg|CNS: [[Oligodendroglioma]]; The cells of some [[oligodendroglioma]]s acquire sufficient [[cytoplasm]] and process formation to become decidedly astrocytic, but their nuclei retain the roundness, uniformity, and chromatin distribution typical of [[oligodendroglioma]].
Image:Glioma Gross 24.jpg|Brain: Microglioma: Gross fixed tissue horizontal section midbrain and cerebellum at mid pons level periventricular tumor infiltration
Image:Anaplastic oligodendroglioma.jpg|[[Anaplastic]] [[oligodendroglioma]]: [[Anaplastic]] [[oligodendroglioma]]s are highly cellular and associated with vascular proliferation.
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Image:Glioma Gross 25.jpg|Brain: Microglioma: Gross fixed tissue horizontal section rostral pons and cerebellum
Image:Oligodendroglioma frozen.jpg|CNS: [[Oligodendroglioma]] (frozen section); [[Oligodendroglioma]]s in frozen sections lack the distinctive halos so often seen in permanent sections. Cellular monomorphism and infiltration of [[cerebral cortex]] with perineuronal satellitosis suggest the correct diagnosis.
Image:Glioma Gross 26.jpg|Brain: Microglioma: Gross fixed tissue horizontal section rostral pons and cerebellum periventricular tumor invasion
Image:Clear cell ependymoma.jpg|CNS: Clear cell [[ependymoma]]; Perinuclear clearing similar to that seen in [[oligodendroglioma]]s is a prominent feature of the clear cell variant. Note the vague perivascular pseudorosettes. The lesion was a discrete occipital intraventricular mass.
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Image:Glioma Gross 27.jpg|Brain: Microglioma: Gross fixed tissue coronal section cerebral hemispheres with mild ventricular dilation
Image:Glioblastoma multiforme 1.jpg|CNS: [[Glioblastoma multiforme]]; Brain: [[Glioblastoma multiforme]]. Grade I-Ii: Micro med mag with H&E, [[tumor]] well shown
Image:Glioma Gross 28.jpg|Glioma: Optic Nerve
Image:Glioblastoma multiforme 2.jpg|CNS: [[Glioblastoma multiforme]] arising in an [[astrocytoma]]. At higher magnification, gemistocytic [[astrocytoma]] with microcystic change is apparent at the bottom of the illustration and cellular nodules of [[glioblastoma multiforme]] are seen at the top. The 6-year history of symptoms attested to the initially low-grade nature of this astrocytic tumor.
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Image:Glioma Gross 29.jpg|Brain: Oligodendroglioma, Frontal Lobe
Image:Glioblastoma multiforme 103.jpg|CNS: [[Glioblastoma multiforme]]; Characteristic of most [[glioblastoma]]s are small cells with elongated nuclei and bipolar processes. As here, the [[chromatin]] is generally not markedly dense nor are nucleoli usually prominent.
Image:Glioma Gross 30.jpg|Brain: Oligodendroglioma, Mixed Astrocytoma & Oligodendroglioma
Image:Glioblastoma multiforme 104.jpg|CNS: [[Glioblastoma multiforme]]; Vascular proliferation, a common feature of glioblastoma, produces tufts which often grow directionally. Here, as is often the case, they are oriented toward a focus of necrosis (top right).
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Image:Glioma Gross 31.jpg|Brain: Oligodendroglioma
Image:Glioblastoma multiforme 105.jpg|CNS: [[Glioblastoma multiforme]]; At high magnification, the neovascular tuft is a mass which, as can be confirmed by immunohistochemistry, is formed of both endothelial cells and smooth muscle cells (pericytes).
Image:Glioma Gross 32.jpg|Brain: Oligodendroglioma
Image:Glioblastoma multiforme 106.jpg|CNS: [[Glioblastoma multiforme]]; In many instances, [[necrosis]] is surrounded by a distinctive collar of cells, which are often smaller than those in surrounding neoplastic tissue. The phenomenon is referred to as pseudopalisading.
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Image:Glioma Gross 33.jpg|Brain: Oligodendroglioma; Ventricular Cobblestone Effect
Image:Cerebrospinal dissemination of glioblastoma multiforme 1.jpg|CNS: Cerebrospinal dissemination of glioblastoma multiforme; As seen at low (left) and high (right) magnification, the small undifferentiated-appearing cells of this glioblastoma are drop metastases colonizing the nerve roots of the cauda equina.
Image:Glioma Gross 34.jpg|Eye: Neurofibromatosis; Glaucoma; Glioma
Image:Cerebrospinal dissemination of glioblastoma multiforme 2.jpg|CNS: Cerebrospinal dissemination of glioblastoma multiforme; As seen at low (left) and high (right) magnification, the small undifferentiated-appearing cells of this glioblastoma are drop metastases colonizing the nerve roots of the cauda equina.
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Image:Glioma Gross 36.jpg|Brain: Glioma, Grade II Anaplastic
Image:Glioblastoma multiforme 116.jpg|CNS: [[Glioblastoma multiforme]]; Higher magnification reveals the small cell nature of such tumors.
Image:Glioma Gross 37.jpg|Brain: Glioma, [[Brain stem]], Low Grade
Image:Glioblastoma multiforme 117.jpg|CNS: [[Glioblastoma multiforme]]; Some glioblastomas are especially infiltrative of the cerebral cortex where subpial, perivascular, and perineuronal accumulations are prominent.
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Image:Glioma Gross 38.jpg|Fundoscopy: Eye; Optic Nerve Glioma, Optic Nerve
Image:Glioblastoma multiforme 126.jpg|CNS: [[Glioblastoma multiforme]]; Although this densely cellular and largely undifferentiated lesion technically merits a diagnosis of [[anaplastic]] [[astrocytoma]], it is, for practical purposes, a glioblastoma.
Image:Glioma Gross 41.jpg|Brain: Glioma, Hypothalamic, Circle Around Region of Tumor
Image:Glioblastoma multiforme malignant astrocytoma 1.jpg|Brain: [[Glioblastoma multiforme]] [[malignant]] [[astrocytoma]]
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Image:Glioma Gross 39.jpg|CNS: Pilocytic Astrocytoma of the Spinal Cord. The fusiform expansion of the spinal cord produced by this pilocytic astrocytoma is not, on external examination alone, distinguishable from that produced by a nonresectable diffuse glioma.
Image:Glioblastoma multiforme pallisading.jpg|Brain: [[Glioblastoma multiforme]]; pallisading
Image:Glioma Gross 42.jpg|Brain: Glioma, Pontine
Image:Glioblastoma multiforme vascular proliferation.jpg|Brain: [[Glioblastoma multiforme]]; vascular proliferation
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Image:Glioma Gross 43.jpg|Brain: [[Glioblastoma Multiforme]]: Gross fixed tissue close-up large necrotic tumor mass in septum pellucidum
Image:Glioblastoma multiforme extravasated blood.jpg|Brain: [[Glioblastoma multiforme]]; Plump and juicy [[endothelial cell]]s, extravasated blood
Image:Glioma Gross 44.jpg|Brain: [[Glioblastoma Multiforme]]: Gross fixed tissue coronal section of the brain with a large necrotic tumor mass in septum pellucidum diagnosed as astrocytoma grade III
Image:Glioblastoma multiforme perivascular lymphocytes.jpg|Brain: [[Glioblastoma multiforme]]; perivascular [[lymphocyte]]s
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Image:Glioma Gross 45.jpg|Brain: [[Glioblastoma Multiforme]]: Gross natural color large hemorrhagic lesion in right centrum semiovale
Image:Glioblastoma multiforme thrombosed vessel.jpg|Brain: [[Glioblastoma multiforme]]; thrombosed vessel
Image:Pilocytic astrocytoma gross.jpg|CNS: Malignant pilocytic astrocytoma: A 29-year-old woman died 2 years after a diagnosis of "atypical pilocytic astrocytoma" of the pineal region. At autopsy, multiple tumor implants were present in the craniospinal subarachnoid spaces.
Image:Hemosiderin in glioblastoma.jpg|Brain: [[Glioblastoma multiforme]]; [[Hemosiderin]] in glioblastoma
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Revision as of 14:47, 14 September 2012

Glioma Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Pathophysiology

High-grade gliomas are highly-vascular tumors and have a tendency to infiltrate. They have extensive areas of necrosis and hypoxia. Often tumor growth causes a breakdown of the blood-brain barrier in the vicinity of the tumor. As a rule, high-grade gliomas almost always grow back even after complete surgical excision.

On the other hand, low-grade gliomas grow slowly, often over many years, and can be followed without treatment unless they grow and cause symptoms.

Gross Pathology

Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology


  • Brain: Glioma: Gross; fixed tissue, horizontal section brain stem and cerebellum with obvious gelatinous appearing neoplasm a pontine glioma
    Brain: Glioma: Gross; fixed tissue, horizontal section brain stem and cerebellum with obvious gelatinous appearing neoplasm a pontine glioma
  • Brain: Oligodendroglioma: Gross; natural color, large, well circumscribed lesion in left frontal lobe
    Brain: Oligodendroglioma: Gross; natural color, large, well circumscribed lesion in left frontal lobe


  • Brain: Glioma: Gross; fixed tissue, horizontal sections brain stem and cerebellum showing large pontine glioma
    Brain: Glioma: Gross; fixed tissue, horizontal sections brain stem and cerebellum showing large pontine glioma
  • Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis: Gross; fixed tissue, view of cerebral hemispheres from inferior with brain stem and cerebellum removed. Pontine asymmetry is easily seen due to low grade astrocytoma and meningeal gliomatosis is easily seen over frontal lobes
    Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis: Gross; fixed tissue, view of cerebral hemispheres from inferior with brain stem and cerebellum removed. Pontine asymmetry is easily seen due to low grade astrocytoma and meningeal gliomatosis is easily seen over frontal lobes


  • Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis in 7 yo boy: Gross; fixed tissue, view of cerebral hemispheres from vertex meningeal gliomatosis.
    Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis in 7 yo boy: Gross; fixed tissue, view of cerebral hemispheres from vertex meningeal gliomatosis.
  • Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis: Gross; in situ dural nodule
    Brain: Pontine Glioma and Diffuse Meningeal Gliomatosis: Gross; in situ dural nodule


  • Brain: Oligodendroglioma: Gross; fixed tissue, multiple coronal sections, cerebral hemispheres with large tumor and hemorrhage into tumor
    Brain: Oligodendroglioma: Gross; fixed tissue, multiple coronal sections, cerebral hemispheres with large tumor and hemorrhage into tumor
  • Brain: Oligodendroglioma: Gross; fixed tissue, coronal section, cerebral hemispheres, large hemorrhagic lesion in one hemisphere
    Brain: Oligodendroglioma: Gross; fixed tissue, coronal section, cerebral hemispheres, large hemorrhagic lesion in one hemisphere


  • Brain: Oligodendroglioma: Gross; fixed tissue, ischemic tissue, anterior to tumor mass
    Brain: Oligodendroglioma: Gross; fixed tissue, ischemic tissue, anterior to tumor mass
  • Brain: Oligodendroglioma: Gross; natural color, coronal section, cerebral hemispheres, large lesion, left parieto occipital white matter
    Brain: Oligodendroglioma: Gross; natural color, coronal section, cerebral hemispheres, large lesion, left parieto occipital white matter


  • Brain: Gliomatosis Cerebri: Gross; fixed tissue, coronal sections, cerebral hemispheres, lesion is in temporal lobes and hypothalamus
    Brain: Gliomatosis Cerebri: Gross; fixed tissue, coronal sections, cerebral hemispheres, lesion is in temporal lobes and hypothalamus
  • Brain: Ventriculitis: Gross; fixed tissue, case of glioma with meningitis, a nice view of ventriculitis in one lateral ventricle
    Brain: Ventriculitis: Gross; fixed tissue, case of glioma with meningitis, a nice view of ventriculitis in one lateral ventricle


  • Brain: Glioma Thalamic Grade Ii-Iii: Gross; fixed tissue, four coronal sections, cerebral hemispheres, very large hemorrhagic lesion
    Brain: Glioma Thalamic Grade Ii-Iii: Gross; fixed tissue, four coronal sections, cerebral hemispheres, very large hemorrhagic lesion
  • Brain: Glioma Thalamic Grade Ii-Iii: Gross; fixed tissue, coronal section, cerebral hemispheres with large hemorrhagic lesion
    Brain: Glioma Thalamic Grade Ii-Iii: Gross; fixed tissue, coronal section, cerebral hemispheres with large hemorrhagic lesion


  • Brain: Glioma Thalamic Grade Ii-Iii: Gross fixed tissue coronal section cerebral hemispheres lesions appears to be in choroid plexus of lateral ventricle in this picture. There is blood in fourth ventricle
    Brain: Glioma Thalamic Grade Ii-Iii: Gross fixed tissue coronal section cerebral hemispheres lesions appears to be in choroid plexus of lateral ventricle in this picture. There is blood in fourth ventricle
  • Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres (58 yo man)
    Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres (58 yo man)


  • Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres
    Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres
  • Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres
    Brain: Cerebral Sarcoma or Microglioma: Gross; fixed tissue, coronal section, cerebral hemispheres


  • Brain: Infarct Subcortical: Gross; fixed tissue, close-up view of old small subcortical infarct, a case of microglioma
    Brain: Infarct Subcortical: Gross; fixed tissue, close-up view of old small subcortical infarct, a case of microglioma
  • Brain: Microglioma: Gross; fixed tissue; cerebellum and fourth ventricle with periventricular tumor invasion
    Brain: Microglioma: Gross; fixed tissue; cerebellum and fourth ventricle with periventricular tumor invasion


  • Brain: Microglioma: Gross fixed tissue horizontal sections cerebellum and brain stem with periventricular neoplastic infiltrate
    Brain: Microglioma: Gross fixed tissue horizontal sections cerebellum and brain stem with periventricular neoplastic infiltrate
  • Brain: Microglioma: Gross fixed tissue horizontal section midbrain and cerebellum at mid pons level periventricular tumor infiltration
    Brain: Microglioma: Gross fixed tissue horizontal section midbrain and cerebellum at mid pons level periventricular tumor infiltration


  • Brain: Microglioma: Gross fixed tissue horizontal section rostral pons and cerebellum
    Brain: Microglioma: Gross fixed tissue horizontal section rostral pons and cerebellum
  • Brain: Microglioma: Gross fixed tissue horizontal section rostral pons and cerebellum periventricular tumor invasion
    Brain: Microglioma: Gross fixed tissue horizontal section rostral pons and cerebellum periventricular tumor invasion


  • Brain: Microglioma: Gross fixed tissue coronal section cerebral hemispheres with mild ventricular dilation
    Brain: Microglioma: Gross fixed tissue coronal section cerebral hemispheres with mild ventricular dilation
  • Glioma: Optic Nerve
    Glioma: Optic Nerve


  • Brain: Oligodendroglioma, Frontal Lobe
    Brain: Oligodendroglioma, Frontal Lobe
  • Brain: Oligodendroglioma, Mixed Astrocytoma & Oligodendroglioma
    Brain: Oligodendroglioma, Mixed Astrocytoma & Oligodendroglioma


  • Brain: Oligodendroglioma
    Brain: Oligodendroglioma
  • Brain: Oligodendroglioma
    Brain: Oligodendroglioma


  • Brain: Oligodendroglioma; Ventricular Cobblestone Effect
    Brain: Oligodendroglioma; Ventricular Cobblestone Effect
  • Eye: Neurofibromatosis; Glaucoma; Glioma
    Eye: Neurofibromatosis; Glaucoma; Glioma


  • Brain: Glioma, Grade II Anaplastic
    Brain: Glioma, Grade II Anaplastic
  • Brain: Glioma, Brain stem, Low Grade
    Brain: Glioma, Brain stem, Low Grade


  • Fundoscopy: Eye; Optic Nerve Glioma, Optic Nerve
    Fundoscopy: Eye; Optic Nerve Glioma, Optic Nerve
  • Brain: Glioma, Hypothalamic, Circle Around Region of Tumor
    Brain: Glioma, Hypothalamic, Circle Around Region of Tumor


  • CNS: Pilocytic Astrocytoma of the Spinal Cord. The fusiform expansion of the spinal cord produced by this pilocytic astrocytoma is not, on external examination alone, distinguishable from that produced by a nonresectable diffuse glioma.
    CNS: Pilocytic Astrocytoma of the Spinal Cord. The fusiform expansion of the spinal cord produced by this pilocytic astrocytoma is not, on external examination alone, distinguishable from that produced by a nonresectable diffuse glioma.
  • Brain: Glioma, Pontine
    Brain: Glioma, Pontine


  • Brain: Glioblastoma Multiforme: Gross fixed tissue close-up large necrotic tumor mass in septum pellucidum
    Brain: Glioblastoma Multiforme: Gross fixed tissue close-up large necrotic tumor mass in septum pellucidum
  • Brain: Glioblastoma Multiforme: Gross fixed tissue coronal section of the brain with a large necrotic tumor mass in septum pellucidum diagnosed as astrocytoma grade III
    Brain: Glioblastoma Multiforme: Gross fixed tissue coronal section of the brain with a large necrotic tumor mass in septum pellucidum diagnosed as astrocytoma grade III


  • Brain: Glioblastoma Multiforme: Gross natural color large hemorrhagic lesion in right centrum semiovale
    Brain: Glioblastoma Multiforme: Gross natural color large hemorrhagic lesion in right centrum semiovale
  • CNS: Malignant pilocytic astrocytoma: A 29-year-old woman died 2 years after a diagnosis of "atypical pilocytic astrocytoma" of the pineal region. At autopsy, multiple tumor implants were present in the craniospinal subarachnoid spaces.
    CNS: Malignant pilocytic astrocytoma: A 29-year-old woman died 2 years after a diagnosis of "atypical pilocytic astrocytoma" of the pineal region. At autopsy, multiple tumor implants were present in the craniospinal subarachnoid spaces.

Microscopic Pathology

Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

  • CNS: Pilocytic astrocytoma: variations in histologic appearance. As illustrated, many lesions are composed largely of spongy tissue rich in microcysts. Characteristic of pilocytic astrocytomas in general, the lesion is largely a solid mass of neoplastic cells without an obvious background of infiltrated brain.
    CNS: Pilocytic astrocytoma: variations in histologic appearance. As illustrated, many lesions are composed largely of spongy tissue rich in microcysts. Characteristic of pilocytic astrocytomas in general, the lesion is largely a solid mass of neoplastic cells without an obvious background of infiltrated brain.
  • CNS: Pilocytic astrocytoma: variations in histologic appearance. The perivascular radiating processes in some lesions can create a likeness to an ependymoma. Note the spongy background unusual for ependymomas.
    CNS: Pilocytic astrocytoma: variations in histologic appearance. The perivascular radiating processes in some lesions can create a likeness to an ependymoma. Note the spongy background unusual for ependymomas.



  • CNS: Pilocytic astrocytoma: variations in histologic appearance. Rosenthal fibers are extremely abundant in some lesions. Particularly in the cerebellum, it can be difficult to distinguish such solid, paucicellular, highly fibrillar pilocytic astrocytomas from reactive gliosis with abundant Rosenthal fiber formation.
    CNS: Pilocytic astrocytoma: variations in histologic appearance. Rosenthal fibers are extremely abundant in some lesions. Particularly in the cerebellum, it can be difficult to distinguish such solid, paucicellular, highly fibrillar pilocytic astrocytomas from reactive gliosis with abundant Rosenthal fiber formation.
  • CNS: Pilocytic astrocytoma: variations in histologic appearance. A loose array of polar cells creates an additional variant of pilocytic astrocytoma.
    CNS: Pilocytic astrocytoma: variations in histologic appearance. A loose array of polar cells creates an additional variant of pilocytic astrocytoma.







  • CNS: Oligodendroglioma (frozen section); Oligodendrogliomas in frozen sections lack the distinctive halos so often seen in permanent sections. Cellular monomorphism and infiltration of cerebral cortex with perineuronal satellitosis suggest the correct diagnosis.
    CNS: Oligodendroglioma (frozen section); Oligodendrogliomas in frozen sections lack the distinctive halos so often seen in permanent sections. Cellular monomorphism and infiltration of cerebral cortex with perineuronal satellitosis suggest the correct diagnosis.
  • CNS: Clear cell ependymoma; Perinuclear clearing similar to that seen in oligodendrogliomas is a prominent feature of the clear cell variant. Note the vague perivascular pseudorosettes. The lesion was a discrete occipital intraventricular mass.
    CNS: Clear cell ependymoma; Perinuclear clearing similar to that seen in oligodendrogliomas is a prominent feature of the clear cell variant. Note the vague perivascular pseudorosettes. The lesion was a discrete occipital intraventricular mass.



  • CNS: Glioblastoma multiforme; Characteristic of most glioblastomas are small cells with elongated nuclei and bipolar processes. As here, the chromatin is generally not markedly dense nor are nucleoli usually prominent.
    CNS: Glioblastoma multiforme; Characteristic of most glioblastomas are small cells with elongated nuclei and bipolar processes. As here, the chromatin is generally not markedly dense nor are nucleoli usually prominent.
  • CNS: Glioblastoma multiforme; Vascular proliferation, a common feature of glioblastoma, produces tufts which often grow directionally. Here, as is often the case, they are oriented toward a focus of necrosis (top right).
    CNS: Glioblastoma multiforme; Vascular proliferation, a common feature of glioblastoma, produces tufts which often grow directionally. Here, as is often the case, they are oriented toward a focus of necrosis (top right).


  • CNS: Glioblastoma multiforme; At high magnification, the neovascular tuft is a mass which, as can be confirmed by immunohistochemistry, is formed of both endothelial cells and smooth muscle cells (pericytes).
    CNS: Glioblastoma multiforme; At high magnification, the neovascular tuft is a mass which, as can be confirmed by immunohistochemistry, is formed of both endothelial cells and smooth muscle cells (pericytes).
  • CNS: Glioblastoma multiforme; In many instances, necrosis is surrounded by a distinctive collar of cells, which are often smaller than those in surrounding neoplastic tissue. The phenomenon is referred to as pseudopalisading.
    CNS: Glioblastoma multiforme; In many instances, necrosis is surrounded by a distinctive collar of cells, which are often smaller than those in surrounding neoplastic tissue. The phenomenon is referred to as pseudopalisading.


  • CNS: Cerebrospinal dissemination of glioblastoma multiforme; As seen at low (left) and high (right) magnification, the small undifferentiated-appearing cells of this glioblastoma are drop metastases colonizing the nerve roots of the cauda equina.
    CNS: Cerebrospinal dissemination of glioblastoma multiforme; As seen at low (left) and high (right) magnification, the small undifferentiated-appearing cells of this glioblastoma are drop metastases colonizing the nerve roots of the cauda equina.
  • CNS: Cerebrospinal dissemination of glioblastoma multiforme; As seen at low (left) and high (right) magnification, the small undifferentiated-appearing cells of this glioblastoma are drop metastases colonizing the nerve roots of the cauda equina.
    CNS: Cerebrospinal dissemination of glioblastoma multiforme; As seen at low (left) and high (right) magnification, the small undifferentiated-appearing cells of this glioblastoma are drop metastases colonizing the nerve roots of the cauda equina.


  • CNS: Glioblastoma multiforme; Higher magnification reveals the small cell nature of such tumors.
    CNS: Glioblastoma multiforme; Higher magnification reveals the small cell nature of such tumors.
  • CNS: Glioblastoma multiforme; Some glioblastomas are especially infiltrative of the cerebral cortex where subpial, perivascular, and perineuronal accumulations are prominent.
    CNS: Glioblastoma multiforme; Some glioblastomas are especially infiltrative of the cerebral cortex where subpial, perivascular, and perineuronal accumulations are prominent.





References


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