Past Year Question 2009

A.      Give short account:

a.       Meningioma has the gross appearance of being irregular, bosselated mass that usually single but occasionally might be multiple. Cut section shows whorl, solid appearance. Hyperostosis of the underlying bone might be seen.

b.      Astrocytoma is divided based on their different histologic features and its occurrence into:

a.       GI : Pilocyticastrocytomas:

Well circumscribed cystic spaces with mural solid nodule on the cystic wall. It is the most common in children (Pediatrician tumor) seen infratentorially (cerebellum affection).

b.      GII: Diffuse astrocytoma:

Infiltrative mass of gray white in colour.

c.       GIII: Anaplastic astrocytoma:

Similar gross appearance as GII with abundance mitotic figure but there is no vascular proliferation neither necrosis.

d.      GIV: Glioblastomamultiforme:

Variegated appearance (pleomorphic) with areas of necrotic foci, cysts and hemorrhage.

c.       Mycosis fungoides is a type of NHL that arises from the skin (cutaneous T-cell lymphoma). It has negative response to dermatologic treatment (it is not an infection)

d.      Acute lymphadenitis is divided into:

a.       Localized:

As it drains a focus of infection eg in tonsillitis lead cervical LN enlargement.

b.      Generalized:

Associated with systemic vireamia or bacteremia eg infectious mononucleosis, measles.

Both conditions clinically diagnosed as enlarged tender palpable LN with red overlying skin. Grossly seen as swollen, gray-red engorged LN (cardinal signs?). Microscopically, there is sign of inflammation (cells?, vessels?) and sometimes suppuration may follows leading to abscess. Fate?

B.      Tabulate difference between:

a.       The CSF changes in meningitis are:

	PYOGENIC	ASPETIC (VIRAL)	TUBERCOLOUS
PRESSURE	Raised	Raised	Raised
GROSS ASPECT	Turbid	Clear	Clear and may clot
CELL COUNT	Neutrophilia	Lymphocytosis	Leukocytosis (esp lymphocyte & PMNL)
BIOCHEMISTRY -          GLUCOSE -          PROTEIN -          CHLORIDE	Very low Increased Normal / Low	Normal Slight elevation Normal	Decreased Very high Very low

b.      Differences between HL & NHL are:

	HODGKIN LYMPHOMA	NON-HODGKIN LYMPHOMA
SITE	Localized to single group of axial LN	Multiple peripheral LN involvement
SPREADS	Contiguity	Not contiguous spread
LN involvement	Mesenteric and Waldeyer’s ring rarely involved	Common involvement of Mesenteric and Waldeyer’s ring
Extranodal presentation	Rare	Common
Systemic manifestation	Present	Not present
MICROSCOPIC APPEARANCE	RS cells against a non-neoplastic inflammatory cells	Absence of RS cell and inflammatory background

C.      Discuss :

A)     Hydrocephalus is the accumulation of excessive CSF within the ventricular system of the brain.

There are two types that occur :      


1)      Hydrocephalus with normal CSF pressure aka compensatory hydrocephalus.

↑Volume of CSF due to ↓ brain volume. It may be either

·         Localized in cases like infarcts.

·         Diffuse such as in Alzheimers’ disease where there is a general enlargement of the cerebral ventricles and widening of the cortical sulci.

2)     Hydrocephalus with raised CSF pressure

It occurs when there is obstruction to CSF flow, or ↑ formation, or ↓ absorption.

·         Non communicatinghydrocephalus :

(neoplasms and cysts obstructing the aqueduct and 3^rd ventricle, as well as gliosis and inflammation involving aqueduct)

·         Communicating hydrocephalus :

1)      Post meningitic fibrotic adhesion in subarachnoid space

2)      Arnold Chiari malformation

3)      Deficient absorption of CSF as in dural sinus thrombosis

4)      Choroid plexus papilloma (↑ secretion )

Effects :

Depends on age of patient and cause of hydrocephalus. If obstruction occurs after fusion of skull suture, it causes an ↑ in intracranial pressure. If occurs before fusion (in early life) , the head enlarges and the effects of progressively ↑ intracranial pressure are delayed. However, progressive atrophy of brain occurs.

B)   Classifications of Hodgkin’s lymphoma

1)      Rye classification into 4 subtypes

·         Lymphocyte predominance

·         Mixed cellularity

·         Lymphocyte depletion

·         Nodular sclerosis

2)      WHO classification into 5 subtypes

·         Nodular sclerosis

·         Mixed cellularity

·         Lymphocyte-rich

·         Lymphocyte depletion

·         Lymphocyte predominance.

3)      Ann Arbor classification into 4 stages

·         STAGE 1 : Involvement of single lymph node region or involvement of single extralymphatic organ or site

·         STAGE 2 : Involment of 2 or more lymph node regions on SAME SIDE of diaphragm or with involvement of limited continuousextralymphatic organ or tissue

·         STAGE 3 : Involvement of lymph node regions on BOTH SIDES of diaphragm, which may include the spleen and/or limited contiguous extralymphatic organ or site.

·         STAGE 4 : Multiple or wide spread involvement of bone or more extra lymphatic organs or tissues WITH OR WITHOUT lymphatic involment.

All stages are further subdivided on basis of absence (A) or presence (B) of systemic symptoms : fever, night sweat, and/or weight loss of greater than 10% of body weight.

D.      Problem solving:

                                                           i.       

1.       Pilocytic astrocytoma

2.       Most common Primary CNS tumors in adults and children are; Meningioma, Pilocytic astrocytoma, ependymoma, oligodendroglioma and medulloblastoma

Childhood cns tumor

1) pilocytic astrocytoma (benign)

2) ependymoma (not sure benign or malignant cuz in my note tulis malignant, adekwntulis benign)

3) medulloblastoma (malignant)

Middle age n old person

1) anaplastic astrocytoma

2) glioblastoma

                                                         ii.       

1.       Diffuse type of Non-hodgkin’s lymphoma? (page 206) xtaula,info die bgsikitsgt..

2.