CNS Tumor Cases - Cochran, Connelly, Bovi

Question 1

A young patient present with a brain mass. A biopsy shows the following:

What type of cancer is shown here?

What is most concerning about this tumor?

Answer 1

Low Grade Astrocytoma (Grade 2)

1. Low Cellularity
2. Few Mitoses
3. No Necroses

Astrocytomas are EXTREMELY likely to recur.

Question 2

A patient presents with a brain mass. The biopsy is shown below.

What cancer is this?

What relevant history might the patient have?

Answer 2

Glioblastoma Multiforme

(AKA high grade astrocytoma)

1. Highly Cellular
2. Necroses
3. Pseudo-pallisading surrounding the necrosis

This patient likely has a history of a low grade astrocytoma or has been tolerating symptoms for a very long time.

Question 3

What is seen in picture below?

What cancer is it associated with?

Answer 3

Hyperplastic Blood Vessel

Associated with High Grade Astrocytoma (AKA Glioblastoma Multiforme)

Question 4

Patient presents with a brain tumor. The biopsy is shown below.

What type of tumor is this?

What genetic mutations influence the prognosis?

Answer 4

This is an oligodendrocyte. Notice the fried egg cells.

1p and 19q deletions are good prognostic signs!

Question 5

How does a glioblastoma multiforme appear grossly?

What structures is it likely to infect?

Answer 5

Dark brown tissue.

Nicknamed the butterfly tumor because it commonly follows the corpus callosum across the hemispheres.

Question 6

A patient comes in with a brain tumor. The biopsy is shown below.

What tumor is this?

What concerns should you have about treatment?

Answer 6

This is a medulloblastoma. The Homer-Wright rosettes are pathognomonic and easy to identify here.

Medulloblastomas spread through the CSF, so it is extremely important to treat with chemotherapy to prevent local metastasis.

Question 7

An adult comes in with a brain tumor. The biopsy is shown below.

What tumor is this?

How does it appear grossly?

Answer 7

This is a meningioma. The biopsy shows whorls and psamomma bodies, both of which are unique to meningiomas.

Grossly, it would be a well-circumscribed mass compressing the grey matter and growing from the meninges.

Question 8

A patient presents with neuro symptoms. His MRI is shown below.

What should you suspect?

How should this patient be treated?

Answer 8

Metastasis!

Primary brain tumors are rare, so if multiple tumors are seen, it is almost definitely metastasis from another site.

Treatment of the primary tumor site, followed by gamma knife or radiation for the brain mets.