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Flashcards in Brain Neoplasms II Deck (21):

What are the most common embryologic origins/sources and general location of adult brain tumors?

generally adult tumors are supratentorial
most primary tumors arise from neuroectoderm- most common of neuroectodermal orgin are astrocytomas
Meningiomas are 2nd most common tumor- mesodermal origin
15-25% are metastases (esp. of lung and breast tumors)


What are the astrocytomas in adults? genetics?

diffuse/fibrillary astrocytoma (general group):
astrocytomas, anaplastic astrocytomas, and gliobastoma multiforme (very bad prognosis)
often have p53 mutations/EGFR mutations


When are fibrillary astrocytomas most common and where do you see them?

3rd and 4th decade of life in the cerebral hemispheres by far most common.


What is gliomatosis cerebri? sites, age, prognosis

diffuse neoplastic transformation of poorly differentiated astrocytes. usually seen in at least 2 lobes. occurs at any age. fatal.


Age, sites, prognosis, detection of anaplastic astrocytoma

age: 4th-5th decade
cerebral hemisphers
prognosis: 50% 2-5 yr survival
detect when formerly non-anaplastic astrocytomas begin to show contrast enhancement


Glioblastoma multiforme: age, site, prognosis, genetics

age: 45-55 (or 5th and 6th decades, according to another part of the notes)
site: front lobe white matter, though anywhere possible
prognosis: about 15 mo. with aggressive surgery, radiation, and chemo :-(
EGFR mutation


Classic features of glioblastoma multiforme.

extend across the corpus callosum to give a BUTTERFLY distribution. often heterogenous and with hemorrhage, NECROSIS, and VASCULAR PROLIFERATION. Histologically, you see PSEUDOPALISADING or PALISADING around the necrotic areas. very hypercellular (duh, it's cancer...)


What tumors give butterfly lesions?

Glioblastoma multiforme, lymphoma, and metastatic tumors


Oligodendrogliomas: site

frontal lobes/ frontotemporal white matter. Infiltrate the cortex. Cacifcations of blood common


What are the histologic featuures of oligodendrogliomas?

FRIED EGG appearance. Not very fibrillary. nuclei quite round.
calcification of blood


What should I know about pontine gliomas?

usually an infilltrating astrocytoma (not a pilocytic structure, which usually occur in the medulla or midbrain if seen in the brainstem). usually proceed without biopsy confirmation because imaging and clinical features so specifc


What should I know about adult ependymomas?

often seen in spinal cord and filum terminale. can be seen in the floor of the 4th ventricle.
better demarcated than astrocytomas
Perivascular pseudorosettes seen. anaplastic ependymomas also show incr. cell densitym pleomorphis, and mitotic activity


What should I know about meningiomas?

2:1 F:M in brain; 10:1 F:M in spinal cord. My be because progesteone is a growth factor.
Half show monosomy at 22q12, like acoustic shwannomas. Associated with neurofibromatosis type II. Arise form arachnoid cells, esp. parasagittal arachnoid, or in the thoracic region.
if malignant, occasionally seed CSF/distant metastasis


Histologic and gross features of meningiomas

very diverse, but classically a WHORL with INTRANUCLEAR OCCLUSIONS. Often have meningial TAIL. Occasionally invades the bone or dural sinuses.


What should I know about schwannomas?

benign. May also be an intraspinal tumor. often associated with the vestibular branch of the acoustic nerve (or the trigeminal nerve, slightly less commonly). Multiple central schwannomas, esp. bilateral acoustic schwannomas, are diagnostic of neurofibromatosis type II.


Histologic features of schwannomas

biphasic patter. Compact spinlde areas are ANTONI A. Loose stellate cells are Antoni B (less cellular).
Antoni A have VEROCAY bodies. parallel alignment of Schwann cell nuclei separated by eosinophilic matrix.


Clinical presentation of acoustic schwannomas.

1. Tinnitis
2. Unilteral hearing loss
3. Balance problems


Where do most metastatic brain lesions come from? Which are most likely to bleed?

Breast, lung, GI (colon), GU (renal), melanoma.
Renal and melanoma most likely to bleed.


Where do we most often see metastasizes to the brain? Complication?

juntions of cortex and white matter in the middle cerebral artery distribution. Or cerebellar lesions in adults. Or the thoracic cord. Often cause vasogenic edema.


What should I know about craniopharyngeomas? growth, what type of cell, derivation, site, affected sites

slow growing
derived from Rafke's pouch
often in the infundibular/pituitary region.
solid and cystic areas
often cause compression of the optic chiasm


Histo features of craniomeningiomas. Prognosis.

cystic and solid. cacifications seen in a kid. also keratin areas (from squamous cells). some pallisading at the very edges.
Prognosis usually good- circumscribed and can be excised.