Schniederjan Matthew J - Biopsy Interpretation of the Central Nervous System, 2e

BIOPSY INTERPRETATION SERIES

BIOPSY INTERPRETATION

OF THE CENTRAL

NERVOUS SYSTEM

Second Edition

Matthew J. Schniederjan, MD

Neuropathologist

Childrens Healthcare of Atlanta

Assistant Professor

Department of Pathology and Laboratory Medicine

Emory University School of Medicine

Atlanta, Georgia

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2nd edition

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Library of Congress Cataloging-in-Publication Data

Names: Schniederjan, Matthew J., author.

Title: Biopsy interpretation of the central nervous system / Matthew J. Schniederjan.

Other titles: Biopsy interpretation series.

Description: Second edition. | Philadelphia : Wolters Kluwer, [2018] |

Series: Biopsy interpretation series | Includes bibliographical references and index.

Identifiers: LCCN 2017039563 | ISBN 9781496397775

Subjects: | MESH: Central Nervous System Diseasesdiagnosis | Central

Nervous System Diseasespathology | Central Nervous Systempathology | Biopsymethods

Classification: LCC RC386.6.B55 | NLM WL 141 | DDC 616.8/04758dc23

LC record available at https://lccn.loc.gov/2017039563

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To my wife, Stephanie, whose patience and kind support made this work possible.

This new book carries on a strong tradition of diagnostically oriented texts established by the Biopsy Interpretation Series, in the present case focused on lesions of the central nervous system. Our purpose is to provide a practical guide and concise reference that can be a companion text for general surgical pathologists, trainees in pathology and neuropathology, and clinicians who treat patients with neurologic diseases that require surgical sampling. Given the heavy orientation of the Biopsy Interpretation Series to the busy and serious-minded diagnostician, we have taken this opportunity to create something new and, we think, useful. While there are certainly several excellent books on neuropathology and surgical neuropathology, the majority are reference texts that are comprehensive and encyclopedic, making them less than optimal on a daily basis to assist with interpretation. Because the central concern here is with establishing the correct diagnosis, the content is aimed at anticipating difficult diagnostic decisions and providing a direct and reliable guide to their resolution.

The text contains relatively little discussion of historical background, disease mechanisms, or basic research findings unless they are clinically relevant. Rather, the emphasis is on highlighting the distinguishing histologic features and helpful ancillary testing necessary to make a confident and competent diagnosis, as well as to place each lesion in the setting of its clinical significance. For the discussion of neoplastic diseases, we have relied on the most current World Health Organization Classification of the Central Nervous System, 4th edition, as our guide for classification and grading.

Current practice of surgical neuropathology, perhaps more than most pathologic subspecialties, requires knowledge of the clinical and neuroimaging features of a lesion to generate a differential diagnosis. The differential diagnosis of a sellar/suprasellar lesion in a teenaged girl is completely distinct from that of a frontal lobe lesion in a middle-aged man. While slapping the H&E-stained slide on the stage in the absence of clinical and imaging context may occasionally suffice for a correct diagnosis (craniopharyngioma comes to mind), in the long run this practice will almost certainly generate anxiety, uncertainty, and less than adequate diagnoses. To emphasize this necessity in practice, we have started the discussion of each individual entity with a section on Clinical Context, setting the stage for discussion of histopathologic features, ancillary studies, and differential diagnosis, maximizing the efficiency and utility of the book as both a reference and a tool for education.

Matthew J. Schniederjan, MD

Daniel J. Brat, MD, PhD

In the years since the publication of the first edition of this book, as a result of large-scale efforts to understand the genetics of brain tumors, surgical neuropathology has shifted further toward a multifaceted approach to tumor categorization, similar to the field of hematopathology. This is evident in the updated 4th edition of the