Brain Biopsy

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Brain Biopsy

• Frozen Section/Touch Prep

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Brain Biopsy for Suspected Neoplasm

• Is it Abnormal?
• Is it Neoplastic?
• What Type of Neoplasm is it?
• What is the Neoplasms Grade?

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Brain Biopsy for Suspected Neoplasm

• Is it Abnormal? Yes
• Is it Neoplastic? Yes
• What Type of Neoplasm is it?
• What is the Neoplasms Grade?

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TOUCH PREP-GLIOBLASTOMA MULTIFORME
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TOUCH PREP-CNS LYMPHOMA
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TOUCH PREP-PRESENT CASE
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TOUCH PREP-PRESENT CASE
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HE
CD20
EBER
Ki67
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Diagnosis

• Malignant Lymphoma, High Grade,
• Diffuse Large B Cell Type,
• EBV positive

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CNS Lymphomas

• Primary CNS Lymphoma
• Immunosuppressed Patients
• Immunocompetent Patients
• Secondary CNS Lymphoma
• 10 of systemic non-Hodgkins lymphomas involve
  CNS
• Leptomeninges, epidural space are favored
  locations

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Primary CNS Lymphoma

• Immunosuppressed Host
• AIDS, s/p transplant, inherited immunodeficiency
• 95 EBV positive
• Median survival1 year
• Immunocompetent Host
• Usually gt60 years old
• 10 EBV positive
• Median survival3 years

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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 lymphomarare
• Treatment
• Gross total resection not indicated
• Biopsy for diagnosis followed by chemotherapy

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Quandary

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

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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

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Arganis rule of tumor pathology

• Stuff happens

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