A 64-year-old man is being evaluated for nausea and a new-onset headache that worsens when he bends over. Brain imaging shows a hemispheric cerebral mass that is subsequently biopsied. Light microscopy of the tissue specimen is shown in the image below. Which of the following histologic findings is most characteristic of this lesion?

Question

A 64-year-old man is being evaluated for nausea and a new-onset headache that worsens when he bends over.  Brain imaging shows a hemispheric cerebral mass that is subsequently biopsied.  Light microscopy of the tissue specimen is shown in the image below.  Which of the following histologic findings is most characteristic of this lesion?

Quizplus · Accepted Answer

11ec160b_39ad_69d1_9249_6bcdfa62f342_MD0001_00 This image shows an area of necrosis surrounded by columns of tumor cells (ie, pseudopalisading necrosis) with capillaries at the periphery (vascular proliferation). These histologic features are characteristic of glioblastoma multiforme (GBM), a malignant glioma that is the most common primary brain neoplasm in adults. GBM is usually located within the cerebral hemispheres (eg, frontal lobe, temporal lobe) and often presents with new-onset headache that worsens with bending over (increases intracranial pressure). Nausea/vomiting, focal neurological defects, and/or seizures are also frequently seen. The prognosis for patients with GBM is poor, with median survival at 10-12 months. (Choice A) Cyst formation and rare mitoses indicate a colloid cyst, a pathologically benign tumor usually found in the third ventricle. Although colloid cysts are usually asymptomatic, they can cause lethal obstructive hydrocephalus. (Choice B) Reticulin deposits and chronic inflammatory infiltrates are seen in pleomorphic xanthoastrocytomas. Although they can rarely progress to GBM, these tumors are usually found in children and young adults. (Choice C) Meningiomas are tumors of the meninges that have a whorled pattern of growth. Although they are not always present, laminar calcifications called psammoma bodies are characteristic of benign meningiomas. (Choice E) Ependymomas also display prominent vascular proliferation. However, these tumors are usually infratentorial (eg, fourth ventricle, spinal cord), rare in adults, and characterized histologically by proliferating ependymal cells surrounding blood vessels (perivascular pseudorosettes) rather than prominent areas of necrosis. Educational objective: Glioblastoma multiforme is the most common primary brain tumor in adults. Histopathology showing increased vascularity and pseudopalisading tumor cells around areas of necrosis is diagnostic. __________ References: 'Pseudopalisading' necrosis in glioblastoma: a familiar morphologic feature that links vascular pathology, hypoxia, and angiogenesis. (http://www.ncbi.nlm.nih.gov/pubmed/16783163)

A 64-Year-Old Man Is Being Evaluated for Nausea and a New-Onset