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Brain Biopsy

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Brain Biopsy

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  1. Brain Biopsy Frozen Section/Touch Prep

  2. Brain Biopsy for Suspected Neoplasm • Is it Abnormal? • Is it Neoplastic? • What Type of Neoplasm is it? • What is the Neoplasm’s Grade?

  3. Brain Biopsy for Suspected Neoplasm • Is it Abnormal? Yes • Is it Neoplastic? Yes • What Type of Neoplasm is it? • What is the Neoplasm’s Grade?

  4. TOUCH PREP-GLIOBLASTOMA MULTIFORME

  5. TOUCH PREP-CNS LYMPHOMA

  6. TOUCH PREP-PRESENT CASE

  7. TOUCH PREP-PRESENT CASE

  8. H&E CD20 EBER Ki67

  9. Diagnosis: Malignant Lymphoma, High Grade, Diffuse Large B Cell Type, EBV positive

  10. CNS Lymphomas • Primary CNS Lymphoma • Immunosuppressed Patients • Immunocompetent Patients • Secondary CNS Lymphoma • 10% of systemic non-Hodgkin’s lymphomas involve CNS • Leptomeninges, epidural space are favored locations

  11. Primary CNS Lymphoma • Immunosuppressed Host • AIDS, s/p transplant, inherited immunodeficiency • 95% EBV positive • Median survival=1 year • Immunocompetent Host • Usually >60 years old • 10% EBV positive • Median survival=3 years

  12. Primary CNS Lymphoma • Epidemiology • Incidence increased 10X worldwide due to AIDS • Clinical • 10% of patients have a history of another cancer • Respond dramatically to corticosteroids • “ghost tumor”, “sentinel lesion” • Radiology • Often homogeneously enhancing, periventricular • Pathology • Most Diffuse Large B Cell Lymphoma • Hodgkins lymphoma=rare • Treatment • Gross total resection not indicated • Biopsy for diagnosis followed by chemotherapy

  13. Quandary • There are no B lymphocytes normally in the CNS • How do you get Primary B cell lymphomas in CNS?

  14. Primary CNS Lymphoma: Possible Etiologies • B cell transformed elsewhere in body that develops adhesion molecules specific for CNS endothelium • Systemic lymphoma that is eradicated by immune system but is protected in CNS • Clonal B cell neoplasm arising in polyclonal intracerebral inflammatory response

  15. Argani’s rule of tumor pathology Stuff happens