Here are some gross and micro pictures for you to practise your diagnostic and observational skills on. Click on the accordions to view sample descriptions.
1. 38 year old man with headache, nausea and high fever.
This is a coronal section of the brain. There is an irregular cavity in the right cerebral hemisphere. The inner lining appears to be covered by a creamy pale tan exudate. (This would have been yellowish green in the fresh specimen, and the cavity would have contained purulent material).
Diagnosis: Cerebral abscess
2. 46 year old man. Progressively severe headaches.
This is a coronal slice of the brain, showing a large, relatively well defined mass between the cerebral hemispheres. The edges of the mass are sharply circumscribed and show no demonstrable invasion into the brain parenchyma. The cut surface of the mass is pale tan and whorled, and there is no haemorrhage or necrosis.
Diagnosis: Meningioma
3. A 58 year old lady with seizures.
This a coronal slice of the brain, showing an ill-defined mass in the right cerebral hemisphere just deep to the cortex. The mass is irregular and exhibits a friable cut surface, suggestive of areas of necrosis.
Microscopy would show areas of pseudopalisading necrosis (circled below).
Diagnosis: Glioblastoma multiforme
Note:
-The appearance suggests a high grade or aggressive tumour. In the brain, for primary tumours, possibilities include high grade glial tumours such as GBM).
-Metastases are more likely to be multiple, though occasionally they can be single.
4. A 72 year old man presented at the emergency department with confusion which progressed to loss of consciousness. He is a chronic hypertensive. This is a section from his brain. Try describing thie microscopic features and what is the diagnosis?
There are sheets of foamy macrophages on a background of pink amorphous material. Features are those of liquefactive necrosis.
Dx: Cerebral infarction
See also the Talking Pot and Slide for this case.