Neuropathology Practice Questions

Q: All of the following are true statements about glioblastoma, except which of the following?

Perineuronal satellitosis. ***Perineuronal satellitosis*** - This is an observed phenomenon in glioblastoma, but it is not a defining feature of the tumor itself. - It reflects a specific response of **neuronal cells** to nearby glioma cells, rather than a characteristic of glioblastoma. *WHO grade IV tumour* - Glioblastoma is classified as a **WHO grade IV tumor**, indicating its aggressive nature and poor prognosis [1]. - This classification is based on **molecular and histological features** typical of high-grade astrocytomas. *Pseudo-palisading necrosis* - This feature describes the arrangement of tumor cells around necrotic areas, which is a common characteristic of glioblastoma [1]. - It reflects the aggressive behavior and high **cellular density** in areas of necrosis. *Microvascular proliferation* - This refers to the formation of numerous small blood vessels and is a hallmark of glioblastoma's **vascularity and aggressiveness** [1]. - Such proliferation is crucial for providing oxygen and nutrients to the tumor, contributing to its growth. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1308-1311.

Q: The most common calcifying brain tumor in a child is:

Craniopharyngioma. ***Craniopharyngioma*** - This tumor is known for its **cystic and solid components** and a high propensity for **calcification**, making it the most common calcifying brain tumor in children. - It arises from **Rathke's pouch remnants**, typically located in the **suprasellar region**, which often leads to **endocrine dysfunction** and visual disturbances. *Medulloblastoma* - While it is a common pediatric brain tumor [1], primarily located in the **cerebellum** [1], [2], it is less commonly associated with significant calcification. - It is a highly malignant tumor originating from **neuroectodermal cells** and is known for its propensity to **disseminate** via CSF pathways [2]. *Glioma* - This is a broad category of tumors arising from **glial cells**, and while some types can calcify (e.g., oligodendroglioma), calcification is not a defining or most common feature across all pediatric gliomas. - The most common pediatric gliomas, such as **pilocytic astrocytomas**, are typically cystic [1] with a mural nodule and often do not show extensive calcification. *Meningioma* - These tumors arise from the **meninges** [3] and are more prevalent in adults, with pediatric cases being relatively rare. - While meningiomas can calcify, especially psammomatous types, they are not the most common calcifying brain tumor in the pediatric population compared to craniopharyngiomas. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 725-726. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1314-1315. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1319-1320.

Q: In which location is spinal muscular atrophy primarily observed?

Anterior horn. ***Anterior horn*** - **Spinal muscular atrophy (SMA)** is a genetic disorder caused by mutations in the **SMN1 gene** leading to degeneration of **alpha motor neurons** in the **anterior horn** of the spinal cord [1]. - This results in progressive **muscle weakness and atrophy** due to loss of motor neuron innervation to skeletal muscles [2]. - The pathology is specifically localized to the **anterior horn cells**, making this the primary site of disease [1]. *Peripheral nerve* - Peripheral neuropathies involve primary pathology of **axons or myelin sheaths** in peripheral nerves outside the CNS [1]. - While peripheral nerve function is compromised in SMA due to absent innervation, the **primary lesion is at the motor neuron cell body** in the anterior horn, not the peripheral nerve itself [2]. *Neuromuscular junction* - Disorders like **myasthenia gravis** affect signal transmission at the neuromuscular junction, causing fluctuating weakness. - In SMA, the defect is **upstream** at the motor neuron level, not at the junction where nerve meets muscle [2]. *Dorsal root ganglion* - The **dorsal root ganglion** contains **sensory neuron cell bodies**, not motor neurons. - Sensory function is typically **preserved in SMA**, distinguishing it from mixed sensorimotor disorders. - Diseases affecting dorsal root ganglia (e.g., sensory neuronopathies) present with sensory loss, not pure motor weakness. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 730-731. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1247-1248.

Q: What is the histological appearance of the brain in Creutzfeldt-Jakob disease?

Spongiform changes. ***Spongiform changes*** - The hallmark histological feature of **Creutzfeldt-Jakob disease (CJD)** is **spongiform degeneration**, characterized by vacuolation of neuronal cell bodies [1]. - It results in a **spongy appearance** of the affected brain regions, particularly in the **cerebral cortex** and **basal ganglia** [1]. *Neuronophagia (can occur in various contexts, not specific to CJD)* - Neuronophagia refers to the phagocytic activity involving **dying neurons**, which can occur in various conditions but is not a defining feature of CJD [2]. - It indicates the presence of **inflammation** or a response to neuronal injury rather than specific changes seen in CJD. *Demyelination (associated with multiple sclerosis)* - Demyelination is primarily associated with conditions like **multiple sclerosis** and is characterized by loss of **myelin sheaths** around neurons. - This is not related to CJD, which involves **prion protein accumulation** and subsequent neuronal degeneration. *Micro abscess (indicative of bacterial infections)* - Micro abscesses indicate localized collections of **pus** typically seen in **bacterial infections**, which is incongruent with the pathophysiology of CJD. - In CJD, there are no signs of **inflammation** or **neutrophilic infiltration** associated with abscess formation [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1284-1286. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1255-1256.

Q: Which of the following statements about primary CNS lymphoma is true?

It is primarily a B-cell type.. ***abc*** - Primary CNS lymphoma is predominantly a **B-cell malignancy** [1], which supports the correct representation of statement (b). - It has a significant **association with Epstein-Barr virus (EBV)**, particularly in immunocompromised individuals [1], making (c) accurate as well. *bcd* - Though (b) and (c) are correct, statement (d) is false; **primary CNS lymphoma** is typically an **aggressive disease** with a poor prognosis [1]. - Hence, the inclusion of (d) makes this option incorrect. *ab* - While (b) is true regarding its classification as a B-cell tumor, statement (a) is misleading; **reticulin staining** is not a standard diagnostic tool for this condition. - Only having two correct statements makes this option incomplete. *acd* - Statement (a) is incorrect as **reticulin staining** is not used for this lymphoma, making the option false overall. - Additionally, (d) misrepresents the disease as primary CNS lymphoma is rather **aggressive**, not indolent. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1315-1316.

Q: Fatal familial insomnia is associated with -

Prion disease. ***Prion disease*** - **Fatal familial insomnia (FFI)** is a rare, inherited neurodegenerative disorder caused by a mutation in the **PRNP gene**, leading to the misfolding of the prion protein [1]. - The accumulation of these misfolded proteins primarily affects the **thalamus**, disrupting sleep and leading to progressive insomnia, autonomic dysfunction, and motor deficits. *Degenerative disease* - While FFI is a **neurodegenerative disease**, this option is too broad and does not specify the unique underlying cause, which is a prion protein [1]. - Other degenerative diseases like Alzheimer's or Parkinson's are not caused by prions and have different pathogenetic mechanisms and clinical presentations [1]. *Neoplastic disease* - **Neoplastic diseases** involve the uncontrolled growth of abnormal cells, leading to tumors (cancers). - FFI is not characterized by tumor formation or abnormal cell proliferation; instead, it is caused by protein misfolding. *Vascular disease* - **Vascular diseases** affect the blood vessels, such as stroke or atherosclerosis, leading to tissue damage due to impaired blood flow. - FFI does not involve damage to blood vessels or issues with blood supply; its pathology is centered on prion protein accumulation in brain tissue. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1284, 1288-1289.

Q: What is the most common type of optic nerve glioma?

Pilocytic. ***Pilocytic*** - **Pilocytic astrocytoma** is the most common histological type of optic nerve glioma, particularly in children. - These tumors are generally low-grade and have a relatively good prognosis. *Gemistocytic* - **Gemistocytic astrocytomas** are a type of astrocytoma characterized by large, plump cells with abundant cytoplasm and eccentric nuclei. - While they can occur in the central nervous system, they are not the most common subtype for optic nerve gliomas. *Fibrous* - **Fibrous astrocytomas** are another subtype of astrocytoma, but they are less common in the optic nerve compared to pilocytic astrocytomas. [1] - The term "fibrous" refers to their histological appearance, which is not the predominant form of optic nerve glioma. *Protoplasmic* - **Protoplasmic astrocytomas** are a rare subtype of astrocytoma. - Their presence in the optic nerve is extremely uncommon, making them an unlikely answer for the most common type of optic nerve glioma. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 725-726.

Q: The most common site of glioblastoma multiforme is

Frontal lobe. ***Frontal lobe*** - The **frontal lobe** is the most common site for **glioblastoma multiforme (GBM)**, a highly aggressive primary brain tumor. - GBM frequently arises in the **cerebral hemispheres** and has a predilection for the frontal and temporal lobes. *CP angle* - The **cerebellopontine (CP) angle** is a common location for **acoustic neuromas (vestibular schwannomas)** and **meningiomas**, not typically glioblastoma. - Tumors in this region often present with **cranial nerve deficits**, particularly hearing loss and facial numbness. *Brain stem* - The **brainstem** is a common site for **gliomas in children** (e.g., diffuse intrinsic pontine glioma), but **glioblastoma multiforme** in adults rarely originates here. - Brainstem tumors often cause significant neurological deficits due to vital control centers located in this area. *Occipital lobe* - While GBM can occur in any cerebral lobe, the **occipital lobe** is **less commonly affected** compared to the frontal and temporal lobes. - Tumors in the occipital lobe typically present with **visual field defects**.

Question 1

All of the following are true statements about glioblastoma, except which of the following?

Accepted Answer

Perineuronal satellitosis

Answer

Pseudo-palisading necrosis

Answer

Microvascular proliferation

Answer

WHO grade IV tumour

Question 2

The most common calcifying brain tumor in a child is:

Accepted Answer

Craniopharyngioma

Answer

Glioma

Answer

Medulloblastoma

Answer

Meningioma

Question 3

In which location is spinal muscular atrophy primarily observed?

Accepted Answer

Anterior horn

Answer

Peripheral nerve

Answer

Neuromuscular junction

Answer

Dorsal root ganglion

Question 4

What is the histological appearance of the brain in Creutzfeldt-Jakob disease?

Accepted Answer

Spongiform changes

Answer

Neuronophagia

Answer

Micro abscess

Answer

Demyelination

Question 5

All of the following are causes of vasogenic-type cerebral edema except which of the following?

Accepted Answer

Hydrocephalus

Answer

Tumors

Answer

Cerebral hemorrhage

Answer

Infections

Question 6

Which of the following statements about primary CNS lymphoma is true?

Accepted Answer

It is primarily a B-cell type.

Answer

It has an association with EBV.

Answer

Reticulin staining is performed.

Answer

It is an indolent disease with a good prognosis.

Question 7

Fatal familial insomnia is associated with -

Accepted Answer

Prion disease

Answer

Neoplastic disease

Answer

Degenerative disease

Answer

Vascular disease

Question 8

All of the following statements are true regarding central nervous system infections, except:

Accepted Answer

Cytomegalovirus is a common cause of bilateral temporal lobe hemorrhagic infarction

Answer

Prions infection causes spongiform encephalopathy

Answer

JC virus is causative agent for progressive multifocal leucoencephalopathy

Answer

Measles virus is the causative agent for subacute sclerosing pan encephalitis (SSPE)

Question 9

What is the most common type of optic nerve glioma?

Accepted Answer

Pilocytic

Answer

Gemistocytic

Answer

Fibrous

Answer

Protoplasmic

Question 10

The most common site of glioblastoma multiforme is

Accepted Answer

Frontal lobe

Answer

CP angle

Answer

Brain stem

Answer

Occipital lobe

Neuropathology — MCQs

Neuropathology — MCQs

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