Neuropathology — MCQs

Neuropathology US Medical PG Practice Questions and MCQs

Question 11: The following histological biopsy image shows presence of:

A. Pappenheimer bodies
B. Negri bodies
C. Henderson-Peterson bodies (Correct Answer)
D. Neurofibrillary tangles
E. Cowdry bodies

Explanation: ***Henderson-Peterson bodies*** - These are characteristic **large eosinophilic intracytoplasmic inclusions** found in the epidermal cells of patients with **Molluscum contagiosum**. - Histologically, these **molluscum bodies** progressively enlarge and displace the nucleus to the periphery of the cell, a hallmark of poxvirus cytopathic effect. - They are a classic histological finding for **Molluscum contagiosum**, a viral skin infection caused by a poxvirus. *Pappenheimer bodies* - These are **small, irregular basophilic granules** seen within red blood cells, representing **iron inclusions (siderotic granules)**. - They are associated with conditions like **sideroblastic anemia**, hemolytic anemia, or **post-splenectomy** states, and are not found in tissue biopsies. *Negri bodies* - These are **eosinophilic intracytoplasmic inclusions** found in the **hippocampal pyramidal cells** and **Purkinje cells of the cerebellum** in cases of **rabies** [1]. - They are specific to rabies infection and are distinct from the large molluscum bodies seen in Molluscum contagiosum [1]. *Neurofibrillary tangles* - These are **intracellular aggregates of hyperphosphorylated tau protein** found in the neurons of patients with **Alzheimer's disease** and other tauopathies [2]. - They are a hallmark of neurodegenerative diseases and are not viral inclusion bodies [2]. *Cowdry bodies* - These are **nuclear inclusion bodies** seen in cells infected with **herpesviruses** (e.g., HSV, CMV, VZV). - **Type A (Cowdry A)**: Large eosinophilic nuclear inclusions with a clear halo, surrounded by marginated chromatin — seen in herpes simplex and varicella-zoster. - **Type B (Cowdry B)**: Smaller inclusions without halo — seen in poliovirus and adenovirus infections. - They are nuclear (not cytoplasmic) inclusions, distinguishing them from Henderson-Peterson bodies. **References:** [1] Kumar V, Abbas AK, et al. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1279-1280. [2] Kumar V, Abbas AK, et al. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1292-1293.

Question 12: Cork screw inclusion bodies in brain biopsy specimen are seen in:

A. Medulloblastoma
B. Pilocytic astrocytoma (Correct Answer)
C. Ependymoma
D. Pinealoma
E. Glioblastoma

Explanation: ***Pilocytic astrocytoma*** - **Rosenthal fibers**, which have a **corkscrew appearance**, are characteristic histological findings in pilocytic astrocytomas. - These are **eosinophilic, elongated, glial inclusions** often found in the processes of tumor cells. - Pilocytic astrocytomas are typically **benign (WHO Grade I)** tumors commonly found in children and young adults. *Medulloblastoma* - Characterized by **small, round blue cells** and a high mitotic index, often forming **Homer-Wright rosettes**. - **Rosenthal fibers** are not typically associated with medulloblastoma. *Ependymoma* - Characterized by **ependymal rosettes** (tumor cells arranged around a central lumen) and **perivascular pseudorosettes** (tumor cells radiating around blood vessels). - Lacks the presence of **corkscrew inclusion bodies (Rosenthal fibers)**. *Pinealoma* - This is a general term for tumors of the pineal gland, which can include pineocytomas and pineoblastomas. - While various histological features can be seen depending on the specific type, **Rosenthal fibers** are not a characteristic finding for these tumors. *Glioblastoma* - The most common malignant primary brain tumor in adults, characterized by **pseudopalisading necrosis** and **microvascular proliferation**. - Histologically shows pleomorphic cells, not the organized **Rosenthal fibers** seen in pilocytic astrocytoma.

Question 13: A 5-year-old child presented with gait ataxia and tremors in left hand. The image shows:

A. Medulloblastoma, Pseudorosettes (Correct Answer)
B. Cerebellar astrocytoma, Pseudorosettes
C. Meningioma, Psammoma bodies
D. Ependymoma, Perivascular pseudorosettes
E. Pilocytic astrocytoma, Rosenthal fibers

Explanation: ***Medulloblastoma, Pseudorosettes*** - **Medulloblastoma** is the most common **malignant brain tumor in children**, arising in the cerebellum and presenting with **gait ataxia** and cerebellar signs [1]. - The hallmark histological feature is **Homer-Wright pseudorosettes**: rings of small round blue tumor cells (SRBC) with hyperchromatic nuclei surrounding a central anuclear **fibrillary/neuropil core**. *Cerebellar astrocytoma, Pseudorosettes* - While cerebellar astrocytomas can cause ataxia, they are typically **benign (WHO grade I–II)** and do not characteristically form **Homer-Wright pseudorosettes**. - Pseudorosette formation is a feature of primitive neuroectodermal tumors like medulloblastoma, not astrocytic tumors. *Meningioma, Psammoma bodies* - **Meningiomas** are predominantly **adult tumors** and are rare in the pediatric age group. - Their histological hallmark is **psammoma bodies** (whorled, concentrically calcified lamellations), not rosettes. - The clinical setting of ataxia and tremors in a 5-year-old child is not consistent with meningioma. *Ependymoma, Perivascular pseudorosettes* - **Ependymomas** can occur in children and arise from the **4th ventricle floor**, potentially causing cerebellar symptoms. - Their characteristic histological feature is **perivascular pseudorosettes** (tumor cells with fibrillary processes tapering toward blood vessel walls), which is distinct from Homer-Wright pseudorosettes. - Ependymomas do not exhibit the densely packed SRBC morphology seen in medulloblastoma. *Pilocytic astrocytoma, Rosenthal fibers* - **Pilocytic astrocytoma** (WHO grade I) is a common benign pediatric cerebellar tumor, but its histological hallmarks are **Rosenthal fibers** (elongated eosinophilic corkscrew structures) and **eosinophilic granular bodies**. - It is a **biphasic tumor** with compact bipolar areas and loose microcystic areas — it does not form Homer-Wright pseudorosettes. **References:** [1] Kumar V, Abbas AK, et al. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1314–1315.

Question 14: All are true about the brain tumour associated with the below mentioned histopathological findings except:

A. Most frequent cytogenetic abnormality is deletion of 22q
B. Association with NF-1 (Correct Answer)
C. Intracranial calcification
D. Psammoma bodies
E. Most common extra-axial tumor in adults

Explanation: ***Association with NF-1*** - The histopathological findings described (likely referring to **meningioma** based on the other options) are not typically associated with **Neurofibromatosis type 1 (NF-1)** [1]. - **NF-1** is more commonly linked to **optic nerve gliomas**, neurofibromas, and other peripheral nerve sheath tumors. *Most frequent cytogenetic abnormality is deletion of 22q* - **Deletion of 22q** is the most common cytogenetic abnormality found in **meningiomas** [2]. - This deletion often involves the **NF2 gene**, which is a tumor suppressor gene [2]. *Intracranial calcification* - **Intracranial calcification** is a common finding in **meningiomas**, particularly in older lesions [2]. - These calcifications can be seen on imaging studies like CT scans. *Psammoma bodies* - **Psammoma bodies** are characteristic histological features of **meningiomas**, especially the meningothelial and transitional subtypes [1][2]. - They are concentric, lamellated calcified structures formed from degenerating cells. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 727-728. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1316-1317.

Question 15: The following microscopic appearance is that of a schwannoma which most commonly involves the cerebellopontine angle. What does the area marked with the arrow represent?

A. Antony A pattern
B. Antony B pattern (Correct Answer)
C. Antony C pattern-Verocay cells
D. Antony D pattern-Verocay cells
E. Verocay bodies

Explanation: ***Antony B pattern-Verocay cells*** - The area marked with the arrow represents **Antony B pattern**, which is characterized by **hypocellularity** and a **myxoid matrix** [1]. - **Verocay bodies** are specific to schwannomas and are formed by palisading nuclei surrounding an anucleate zone, typically found within the **Antony A pattern** [1]. *Antony A pattern* - **Antony A pattern** is characterized by **dense cellularity** with palisading nuclei and often contains **Verocay bodies** [1]. - This pattern is typically more organized and compact compared to the area shown. *Antony C pattern-Verocay cells* - There is no recognized **Antony C pattern** in the histological classification of schwannomas. - The primary patterns described are **Antony A** and **Antony B**. *Antony D pattern-Verocay cells* - Similar to Antony C, there is no recognized **Antony D pattern** in the histological classification of schwannomas. - This option is a distractor based on an incorrect classification. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, p. 1250.

Question 16: The following brain biopsy of patient who presented with marked psychomotor agitation is diagnostic of?

A. Rabies encephalitis (Correct Answer)
B. Herpes simplex encephalitis
C. Creutzfeldt-Jakob disease
D. Japanese encephalitis
E. Acute disseminated encephalomyelitis

Explanation: ***Correct: Rabies encephalitis*** - The brain biopsy showing **Negri bodies** (pathognomonic eosinophilic intracytoplasmic inclusions in pyramidal neurons of hippocampus and Purkinje cells of cerebellum) is diagnostic of **rabies encephalitis** - Clinical presentation of **marked psychomotor agitation** is characteristic of the furious form of rabies - Histopathology shows **perivascular lymphocytic cuffing** and neuronal degeneration along with Negri bodies - Rabies is caused by a **neurotropic RNA rhabdovirus** transmitted through animal bites *Incorrect: Herpes simplex encephalitis* - HSV encephalitis primarily affects the **temporal lobes** (hemorrhagic necrotizing encephalitis) - Histology shows **Cowdry type A intranuclear inclusions**, not cytoplasmic Negri bodies - Clinical features include fever, altered sensorium, and temporal lobe signs (olfactory/gustatory hallucinations) *Incorrect: Creutzfeldt-Jakob disease* - CJD is a **prion disease** showing **spongiform changes** (vacuolation) in the brain parenchyma - No viral inclusion bodies are seen - Clinical presentation includes rapidly progressive dementia, myoclonus, and ataxia *Incorrect: Japanese encephalitis* - JE causes **basal ganglia and thalamic involvement** (seen on neuroimaging) - Histology shows **neuronal necrosis and neuronophagia** but no characteristic inclusion bodies like Negri bodies - Clinical features include parkinsonian features and movement disorders *Incorrect: Acute disseminated encephalomyelitis* - ADEM is a **post-infectious demyelinating disease** showing perivenular demyelination - Histology shows demyelination with preservation of axons, not viral inclusions - Usually follows viral infection or vaccination

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Cerebrovascular diseases

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CNS trauma

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CNS infections

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Demyelinating diseases

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Neurodegenerative diseases

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Alzheimer's disease pathology

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Parkinson's disease pathology

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Amyotrophic lateral sclerosis

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Primary CNS tumors

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Metastatic CNS tumors

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Peripheral nerve disorders

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Skeletal muscle diseases

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Congenital CNS malformations

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