Brainstem gliomas

Last updated on Wednesday, September 10 2008 by jdmiles

Related images:

Brainstem Glioma in Spinal Cord Transverse
Transverse section showing Brainstem Glioma in Spinal Cord. In this image, it is hard to find any non-tumor (perhaps just adjacent to ventral fissure). Also, the subarachnoid space is packed with tumor.

Leptomeningeal gliomatosis in a patient with brainstem glioma, gross photograph of cauda equina
The leptomeninges are thickened by tumor, obscuring the nerve roots of the cauda equina.

Brainstem Glioma, transverse section
Brainstem Gliomas generally referred to diffuse fibrillary astrocytomas centered within the pons. These most often demonstrate anaplastic features, at least focally. In this case, we see hemorrhage and necrosis typical of glioblastoma multiforme.

Brainstem Glioma, ventral surface of brain, close-up.
The presence of expanding mass lesion involving the pons is best appreciated by noting the relationship between the pontine parenchyma and a basilar artery, as the former seems to almost envelop the latter.

Brainstem Glioma Ventral 2
Brainstem Glioma Ventral 2

IIIrd ventricular glioma, H&E stain x100
The nebulous term brainstem glioma should be restricted to infiltrating glioma centered within the pontine portion of the brainstem. This patient demonstrated an exophytic piloid glioma extending into the third ventricle. Although difficult to resect, these...

IIIrd ventricular glioma, H&E stain x200
At this magnification, the piloid morphology of the astrocytic tumor cells can be appreciated,as can the tendency of the tumor cells to form perivascular rosettes. Although a definite diagnosis could not be ascertained due to the minute size of the endoscopic...

IIIrd ventricular glioma x400
At this magnification, the piloid morphology of the astrocytic tumor cells can be appreciated.

Infiltrating Glioma, Thalmus, neurofilament immunohistochemical staining x 200
Neurofilament immunostaining may be quite useful in demonstrating the infiltrative nature of an astrocytic tumor. Here, we see thalamic neurons and axons intimately admixed with numerous poorly differentiated tumor cells.

Inflitrating Glioma, Thalamus H&E stain x200
For reasons that are not immediately apparent, astrocytomas originating in the pons and thalamus tend to be infiltrative fibrillary astrocytomas while those originating within the midbrain and medulla are often circumscribed and occasionally exophytic.

"Tectal Glioma", H&E stain x 200
Tectal Glioma should not be confused with brainstem glioma, which is why neither term should be used in pathological diagnosis. As with other astrocytic tumors involving the midbrain, these tend to be piloid in morphology, circumscribed, and relatively slow-growing.

Tectal Glioma, Transverse section through midbrain
Despite its circumscribed nature and slow growth pattern, proximity of these astrocytomas to the cerebral aqueduct leads to noncommunicating hydrocephalus with accompanying signs of increased intracranial pressure.

Thalamic Glioma, Sagittal section of autopsy brain
As with pontine (brain stem) gliomas, astrocytic tumor centered within the thalamus tend to be high grade infiltrating astrocytic tumors. In this case, gross features of necrosis and hemorrhage typical of glioblastoma multiforme can be appreciated.