CASE 4

1
CASE 4

• 25yr/F
• Vomiting and headache - 3 months
• CT Scan Cystic lesion in the posterior
• cranial fossa
• 
  

2
(No Transcript)
3
(No Transcript)
4
(No Transcript)
5
(No Transcript)
6

• DIAGNOSIS

7

• CEREBELLAR
• HAEMANGIOBLASTOMA

8

• Vomiting and headache 3 months
• Amenorrhoea 3 months
• Vitals stable
• Pupils Bilaterally equal and reactive
• Fundus Bilateral Papilloedema
• No distal neurologic deficit

9

• CT Scan
• Cystic lesion with intensely
• enhancing mural nodule in the right
• cerebellum
• Edema of the surrounding white
• matter
• ? Haemangioblastoma of the
• right cerebellum with mild
• proximal hydrocephalus

10

• Sub-occipital Craniotomy and excision of
• Haemangioblastoma was done

11
Cyst Fluid

• 5 ml of turbid pale yellow (Xanthochromic) fluid
  was drained.
• Microscopy revealed occasional mononuclear cells

12
Histopathology

• Vascular channels lined by endothelial cells
• Stromal cells surrounding the vascular channels
  are round to polygonal with hyperchromatic
  nucleus and abundant vacuolated cytoplasm
• Foci of atypical cells
• Areas of haemorrhage

13
DIAGNOSIS

• CEREBELLAR
• HAEMANGIOBLASTOMA

14

• DISCUSSION

15
Posterior Cranial fossa tumours

• Children
• Pilocytic Astrocytomas
• Medulloblastoma/PNET
• Atypical teratoid/rhabdoid tumour
• Ependymoma
• Astrocytoma/glioblastoma
• Miscellaneous

16
Posterior Cranial fossa tumours

• Adults
• Hemangioblastoma
• Metastatic carcinoma
• Pilocytic astrocytoma
• Medulloblastoma
• Ependymoma
• Choroid plexus papilloma
• Miscellaneous

17
Cystic Tumours

• Haemangioblastoma
• Metastatic Carcinoma
• Pilocytic Astrocytoma-Low grade
• Cystic Craniopharyngioma
• Ganglioglioma
• Germ cell neoplasm (Teratoma)

18
Vascular Tumours

• Angiomatous Meningioma
• Haemangiopericytoma
• Haemangioblastoma
• Vascular Malformations

19
Haemangioblastoma

• 1-2 of all intracranial tumours
• Most frequently cerebellar lesions
• Late adulthood
• 25 with Von Hippel Lindau Syndrome
• Difficult to smear
• Cyst fluid-Xanthochromic
• Capillaries and stromal cells
• Stromal cells Large oval to polygonal,hyper
  chromatic oval nucleilipid rich foamy cytoplasm

20
Metastases

• The most common neoplasm in CNS
• Occur in15-40 of systemic malignancies
• Cerebral hemispheres,cerebellum and meninges
• Primaries lung,breast,skin(melanoma), kidney and
  GIT
• Spherical, contrast enhancing, necrotic centres
• Highly cellular with glandular or squamous
• differentiation
• Absence of fibrillary background

21
(No Transcript)
22
Pilocytic Astrocytoma

• Well circumscribed may be cystic
• Cyst fluid is clear to slightly yellow and
  translucent . GFAP positive
• Children and young adults
• Cerebellum,optic nerve,hypothalamus and third
  ventricle
• Firm consistency resists spreading
• Biphasic Cellular and loose textured(cystic)
• Cells with bipolar long processes

23
(No Transcript)
24
(No Transcript)
25
Craniopharyngioma

• 3 of intracranial tumours
• 2nd-3rd decade of life
• Sellar region ectopic sites optic nerves,
  pineal region,sphenoid bone, pharynx,
  cerebellopontine angle,paranasal sinus
• Solid and cystic with calcification
• Machine-oil like cyst fluid
• Sheets of squamoid cellskeratinous debris
• Surrounding gliotic tissue

26
(No Transcript)
27
Ganglioglioma

• Desmoplastic infantile astrocytoma
• lt24 months of age rarely in other age groups
• Supratentorial
• Hypodense cystic massenhancing peripheral solid
  component
• No gross haemorrhage or necrosis in cysts
• Spindled astrocytes with fibroblasts,collagen and
  reticulin fibres

28
Germ cell tumours (Teratoma)

• Affect the pineal and sellar regions
• 90 cases in lt20 yrs age
• MF 21

29
(No Transcript)
30
Angiomatous Meningioma

• Large or small vascular channels
• Vessels may have thick hyalinized walls
• Intervening nests of meningothelial cells may be
  inconspicuous
• Attached to the dura

31
Haemangiopericytoma

• Dura based 2-5 of meningeal lesions
• Young to middle aged adults
• Male predominance any site
• Irregular margins nonhomogenous enhancement
  absence of calcification
• Highly cellularirregular cells with ill-defined
• cytoplasmic margin
• Staghorn vascular patternS-100 negative

32
(No Transcript)
33
Cerebellar Haemangioblastoma

• Benign neoplasms representing 1-2 of all
  primary central tumours
• 25 associated with Von Hippel Lindau(VHL)
  complex the rest sporadic
• Highly vascular tumours 2 principal components-
  capillaries and stromal cells
• Origin of stromal cells not well defined
• VEGF polycythemia

34

• No capsule . No mitotic changes
• Wall of the cyst neural glial cells
• Cyst fluid Xanthochromic
• Progesterone receptors
• Abuts piamater- vascular supply
• Mural noduleHypervascular, small sized

35

• Macroscopically 4 types
• simple cystic(6)clear fluid,smooth walls
• macrocystic (65) cyst, mural nodule
• Solid(25) maked vascularization
• Microcystic(4) solid, small cysts

36
(No Transcript)
37
(No Transcript)
38
(No Transcript)
39
(No Transcript)
40
(No Transcript)
41

• THANK YOU

42
(No Transcript)
43
(No Transcript)
44
(No Transcript)
45
Diag of VHL

• Positive family history single cerebellar
  haemangioblastoma
• No family history at least 2 cerebellar
  haemangioblastomas
• OR
• 1 haemangioblastoma 1 visceral tumour