Neuropathology Practice Questions

Q: Cork screw inclusion bodies in brain biopsy specimen are seen in:

Pilocytic astrocytoma. ***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.

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

Association with NF-1. ***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.

Q: 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?

Antony B pattern. ***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.

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

Rabies encephalitis. ***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

Question 1

The following histological biopsy image shows presence of:

Accepted Answer

Henderson-Peterson bodies

Answer

Pappenheimer bodies

Answer

Negri bodies

Answer

Neurofibrillary tangles

Answer

Cowdry bodies

Question 2

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

Accepted Answer

Pilocytic astrocytoma

Answer

Medulloblastoma

Answer

Ependymoma

Answer

Pinealoma

Answer

Glioblastoma

Question 3

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

Accepted Answer

Medulloblastoma, Pseudorosettes

Answer

Cerebellar astrocytoma, Pseudorosettes

Answer

Meningioma, Psammoma bodies

Answer

Ependymoma, Perivascular pseudorosettes

Answer

Pilocytic astrocytoma, Rosenthal fibers

Question 4

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

Accepted Answer

Association with NF-1

Answer

Most frequent cytogenetic abnormality is deletion of 22q

Answer

Intracranial calcification

Answer

Psammoma bodies

Answer

Most common extra-axial tumor in adults

Question 5

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?

Accepted Answer

Antony B pattern

Answer

Antony A pattern

Answer

Antony C pattern-Verocay cells

Answer

Antony D pattern-Verocay cells

Answer

Verocay bodies

Question 6

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

Accepted Answer

Rabies encephalitis

Answer

Herpes simplex encephalitis

Answer

Creutzfeldt-Jakob disease

Answer

Japanese encephalitis

Answer

Acute disseminated encephalomyelitis

Neuropathology — MCQs

Neuropathology — MCQs

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