11-05 Nervous System Tumors Flashcards
1 most important prognostic feature in CNS tumors
tumor’s “grade” as determined by Path
define the different grades of CNS tumors
I – benign, unlikely to recur or spread II – slow growing, but will come back III – aggressive, requires therapy more than surgery alone IV – anaplastic, malignant, lethal
most common intracranial tumor
meningioma
germ cell tumors
any tumor that can occur in testes or ovaries can occur in CNS as a 1° tumor!
consequences of brain hernations
—Necrosis of that area
—infarction b/c blood supply compressed
—nerve compression (esp CNs)
—death due to b.s. compression in tonsillar hernia
When CN III is compressed what f(x) 1st affected?
para-sympathetics are on the outside so blown pupils?
What syndrome is associated with CN VIII Schwannoma?
NF2
What syndrome is associated with Cerebellar Gangliocytoma?
Cowden’s syndrome (tumors in many different systems)
What syndrome is associated with Cerebellar Hemangioblastoma?
von Hippel-Lindau syndrome: a rare, autosomal dominant genetic condition that predisposes individuals to benign and malignant tumours most commonly: —CNS and retinal hemangioblastomas —clear cell renal carcinomas —pheo —pancreatic neuroendocrine —pancreatic cysts —endolymphatic sac tumors —epididymal papillary cystadenomas
Astrocytomas 101
—Some low-grade, some high-grade
—Astrocytes = cell type of the tumor
—Diffuse, infiltrative tumor boundry; No surgical border (true of all glial tumors)
—“Naked nuclei” (large irreg nuc; cell has seemingly no cytoplasm)
—production of GFAP (glial fibrillary acidic protein)
Gradient of WHO Grades of Astrocytomas:
—Grade I: Pilocytic (“thread-like”) type (w/ “Rosenthal material” = fibers) are usually very low-grade and are common in KIDS
—Grade IV: GBM (see sep slide)
Glioblastoma Multiforme Astrocytoma 101
AS WITH ALL ASTROCYTOMAS:
—Naked nuclei
—No tumor boundries
UNIQUELY: —Necrosis with pseudopallisading —Endothelial proliferation —Highly anaplastic (wild, wild cell types) —Diffuse brain infiltration
WHO GRADE IV =(
Oligodendroglioma
—”Fried egg” morph
—Delicate “chicken wire” capillaries
—Monomorphic cell forms (vs. highly anaplastic GBM)
—Co deletion of 1p & 19q —> better prognosis that it will respond to chemo
WHO GRADE II-III
Ganglioglioma
Tumor of 2 cell types:
—glial tumor in background plus
—Big, funny, occasionally binucleate neuronal forms in tumor
—causes seizures, but favorable outcome w/ surg
WHO GRAD I
Ependymoma
—very boring, monomorphic, monotonous cells (not very dysplastic); round, easy to confuse w/ oligodendroglioma or pit. adenoma
—Cells form perivascular formations with nuclear-free area around vessels
PNETs
Primitive NeuroEctodermal Tumors (the MEDULLOBLASTOMA family of tumors)
—”small blue cell” CNS tumors
—debate as to how different each type is
Medulloblastomas common in kids
—posterior fossa
—show rosettes histo
**also in this fam: retinoblastoma, pineoblastoma
