6/16- Neuro-oncology III Flashcards Preview

Term 5: Neuro > 6/16- Neuro-oncology III > Flashcards

Flashcards in 6/16- Neuro-oncology III Deck (42):
1

Meningiomas are typically what grade?

Grade 1

- Well-circumscribed

- Surgically resectable (although over convexity is much easier than in cavernous sinus...)

They can progress to a higher grade (there is such a thing as a malignant meningioma), but they're rare

2

What is this?

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Meningioma

3

What is this?

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Meningioma

4

What kind of cells form meningiomas? Where are they located?

Meningoethelial cells

- Located in dura and arachnoid caps?

5

What is this?

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Meningioma???

6

Where can a Schwannoma occur? Common?

Anywhere there are Schwann cells

- Peripheral nerves

- Any cranial nerves

- Very common = CN 8 (cerebro-pontine angle/ponto-medullary junction)

7

What is this?

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Meningoethelial cells

8

What is this? 

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Meningioma of the lateral convexity

9

What is this?

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Meningioma

10

What is this? Origin? 

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Meningioma of the optic nerve

- Arises from dural sheath of the nerve

11

Symptoms of CP angle Schwannoma

(auditory neuroma - bad terminology)?

- Unilateral hearing loss

- Tinnitus possible

- Nystagmus and vertigo if vestibular n. involved

- Can compress adjacent nerves (e.g. 5 and 7) if it enlarges

12

Compare these two tumors of the optic nerve. What are they?

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L = Meningioma

R = Pilocytic __?

13

What is this? 

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Meningioma histopathology

(Little Orphan Annie cells??)

14

What is this? 

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Meningioma histopathology

15

What is this? 

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Meningioma histopathology

- Hurricane/tropical storm cells

- Psammoma bodies

- Little Orphan Annie cells??

16

What can be used to confirm that something is a meningioma?

- Epithelial membrane antigen

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17

What can be seen ultrastructurally in meningioma?

Desmosomes 

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18

What is a useful feature that can be used to characterize a Schwannoma (1)?

Two different types of architecture

- Antoni A (dense)

- Antoni B (less dense) 

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19

What is another useful feature that can be used to characterize a Schwannoma (2)?

Verocay body

- nuclei adjacent to area without nuclei 

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20

What is this? Treatment options?

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CP Angle Schwannoma

- Can see "ice cream sign" as it spreads into internal auditory canal

Treatment:

- Surgical resection

- Stereotactic radiosurgery

21

Genetic predisposition to CP Angle Schwannoma?

NF2

- Bilateral tumors

- Chromosome 22

- Merlin gene (schwannoma, meningioma, glioma)

22

Genetic predisposition to Neurofibroma?

NF1

- Neurofibramin -> neurofibroma spindle cell

- Chromosome 17

23

What is this? 

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Neurofibroma

24

What are two common settings in which you will see primary CNS lymphomas (PCNSL)?

- Immunocompromised patients (most)

- Elderly patients

25

- Can Schwannomas be fatal?

- Can Neurofibromas be fatal?

??

- Schwannomas typically not bad

- Neurofibromas may become malignant

26

What is this?

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Primary CNS lymphoma (PCNSL)

- Angiocentric accumulation of cells

- Prominent nucleolus (look like immature lymphocytes)

- Most PCNSLs are large cell lymphomas (like this)

- Infiltrates tissue (like gliomas); no distinct tumor/mass

27

What immunohistochemistry marker can be used for Primary CNS Lymphomas (PCNSL)?

CD20- usually B cell lymphomas

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28

What is this? Effects? 

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Metastatic tumors

- Tend to loosen up vascular junctions, leading to edema

- Multiple lesions (pretty typical); results in multiple focal neurological deficits

29

What is this?

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Metastases (3)

- Multiple discrete lesions with surrounding edema

- Often occur at grey matter- white matter junction, but may occur anywhere

- Some pushing over of the cingulate (swollen hemisphere)

30

T/F: PCNSL tumors are surgically resectable?

False

- Typically not, because infiltrate tissue (like gliomas)

- Not a clear mass

31

T/F: People with PCNSL tumors typically don't have lymphomas anywhere else

True

- Only about 3% will have systemic lymphoma (although eye sometimes involved)

32

What is this? 

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Metastasis to midbrain

33

What is this? Symptoms?

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Meningeal carcinomatosis

- Spread to CSF

- Can see little lumps all along the cauda equina: tumor implants on the spinal roots

- May result in multiple radiculopathies (spinal nerve root symptoms)

- Disturbances of higher cortical function or other problems

34

What virus may cause PCNSLs?

Especially in what population?

- Ebstein-Barr virus (EBV) driven

- Especially in AIDS patients

35

What is this? Symptoms?

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Top (under 10mm)- microadenoma

- Little microadenoma can only present with endocrine symptoms

Bottom (>10mm)

- Endocrine effects + chiasm compression

- May result in bitemporal visual field defect

36

What are some autosomal dominant disorders causing hereditary brain tumor syndromes?

- Neurofibromatosis (NF1 and NF2)

- Tuberous sclerosis

- von Hippel Lindau disease

37

What tumors does neurofibromatosis cause? Which type?

NF1 (chromosome 17)

- Neurofibromas

- Neurofibrosarcomas

NF2 (chromosome 22)

- Schwannomas

- Meningiomas

- Gliomas

38

What tumors does tuberous sclerosis cause?

- Subependymal giant cell astrocytoma

(with rare malignant degeneration to:)

- Glioblastoma multiforme

- "Tubers"- heterotopias

39

What tumors does von Hippel Lindau cause?

Genetic mechanism?

(oncogene knocked out on chromosome 3)

- Hemangioblastoma

- Metastatic renal cell carcinoma

40

What is this? 

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Hemangioblastoma

41

What is this? Cellular origin?

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Hemangioblastoma

- Very bloody tumor (many vascular channels)

- Cells making up tumor have foamy cytoplasm with clear areas

- Hemangioblast origin (circular cell from bone marrow that is repairing endothelial cells of BVs)

- Once seen, then have to worry about them develping a renal carcinoma

42

What are the most common cancers causing metastases in the brain?

Most (80%):

- Lung

- Breast

Then:

- Melanomas

- Renal

- GI