INTRODUCTION TO INTRAOPERATIVE BRAIN SMEARS

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INTRODUCTION TO INTRA-OPERATIVE BRAIN SMEARS

• DR GERHARD D VAN DER LINDE

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INTRODUCTION

• Alternative/adjunct approach to frozen section
  for rapid intra-operative diagnosis in
  neuropathology
• Simple but accurate
• No freezing artifact
• Cytology capture fine cellular detail that frozen
  sections often obscure
• Sensitivity 92
• Specificity very high
• Familiarity with clinical history

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TECHNIQUE

• Select area of interest
• Dissect 1mm cube and place on end of slide
• Press second slide perpendicular to first
• Optimal pressure and smear
• Fix in 95 ethyl alcohol immediately
• Usual HE staining method

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NORMAL APPEARANCE

• Neuropil background supports neurons and
  neuroglia
• Neuron
• Astrocyte
• Oligodendrocyte
• Ependyma
• Choroid plexus

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EPENDYMA AND CHOROID PLEXUS
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NEURONS,ASTROCYTES,OLIGODENDROCYTES
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DIFFUSE/FIBRILLARY ASTROCYTIC TUMORS

• 80 of adult primary brain tumors
• Cerebral hemispheres,cerebellum,brain stem,spinal
  cord
• Late middle age
• Grading (Daumas-Duport)
• nuclear atypia
• Mitosis
• Endothelial cell proliferation
• necrosis

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CONTINUE

• A gt AA gt GBM
• Infiltrative growth pattern
• Grade 2 nuclear atypia in fibrillary background
• Grade 3 nuclear atypia and mitotic activity
• Grade 4 nuclear atypia, mitosis, endothelial
  proliferation and/or necrosis

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ASTROCYTOMA GR 2
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ASTROCYTOMA GR 2
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LOW GRADE ASTROCYTOMA
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GBM
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GBM
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OLIGODENDROGLIOMA

• 5-15 of adult brain tumors
• Cerebral hemispheres (white matter)
• Present in middle life (50 years)
• Infiltrative growth pattern
• No consensus regarding grading
• Small cells, uniform round nuclei, many
  calcifications and branching capillaries

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OLIGODENDROGLIOMA
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OLIGODENDROGLIOMA
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EPENDYMOMA

• Childhood tumor (10-15 y)
• Pushing growth pattern
• No consensus regarding grading
• Peri-ventricular and lumbo-sacral growth pattern
  
• Uniform appearance of cells
• True and pseudo-rosettes
• Myxopapillary ependymoma-arranged around
  myxohyaline material

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EPENDYMOMA
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EPENDYMOMA
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MYXOPAPILLARY EPENDYMOMA
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CHOROID PLEXUS PAPILLOMA

• First decade of life
• Presents with hydrocephalus
• Within lateral ventricles (most commonly)
• Papillary neoplasm with fibrovascular cores lined
  by cuboidal epithelium

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CHOROID PLEXUS PAPILLOMA
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PNET

• Infants and children
• Topography defines terminology
• Cerebellum-medulloblastoma
• Cerebrum-pnet
• Eye-retinoblastoma
• Pluripotential primitive small round blue cell
  tumors
• Cellular uniform small discohesive cells, high
  NC, angular nuclei, inconspicuous cytoplasm,
  high mitotic index, necrosis, hyperchromasia,
  rosettes

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MEDULLOBLASTOMA
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MEDULLOBLASTOMA
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MENINGIOMA

• Predominantly in adults
• Arise from meningothelial cells of arachnoid
• External surfaces of brain and inside ventricles
• Syncytial clusters, whorls, sheets, eosinophilic
  cytoplasm, indistinct cell borders
• Cytoplasmic intranuclear inclusions
• Psammoma bodies

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MENINGIOMA
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MENINGIOMA
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PRIMARY BRAIN LYMPHOMA

• 2 of extra-nodal lymphomas
• 1 of intra-cranial tumors
• Immunosuppressed patients (AIDS)
• Multiple tumor masses within brain parenchyma
• Most common intermediate to high grade B cell
  lymphomas

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PBL
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METASTATIC CNS TUMORS

• Most commonly from lung, breast, skin (malignant
  melanoma), kidney, GIT and choriocarcinoma

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METASTASIS