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Flashcards in Brain Tumors Deck (98)
1

What is the incidence of brain tumors?

1-2 / 10,000

2

What percent of brain tumors are primary? Secondary?

1' =50%
2' = 50%

3

What are the origins of brain tumors? (4)

-Meningeal
-Cells intrinsic to the brain (Gliomas/neuronal/others)
-CNS lymphoma
-Metastases

4

What is the order of incidence of mets in the brain?

1. Lung
2. Breast
3. GU
4. Osteosarcoma
5. Melanoma
6 GI

(LUBGOM)

5

Where are mets in the brain usually located? What are their characteristics?

Multiple, well circumscribed; usually present at the gray white junctions

6

What cells give rise to glioblastoma multiforme?

Astrocytes

7

What cells give rise to astrocytomas?

Astrocytes

8

What cells give rise to meningioma?

Meningothelial cells

9

What cells give rise to medulloblastomas?

Neural cell precursors

10

What cells give rise to schwannomas?

Schwann cells

11

Which usually has multiple lesions: primary brain tumors, or secondary?

Secondary

12

True or false: mets to the brain are usually well circumscribed masses

True

13

How often do primary tumors of the brain metastasize?

Rarely

14

True or false: even benign tumors of the brain are problematic

True--limited space in the skull

15

What are the s/sx of increased ICP? (6)

**-HA
-Vomiting
-Papilledema**
-Ocular palsies
-AMS
-Back pain

16

What is the drug of choice for emergent increased ICP?

Mannitol

17

What percent of childhood cancers are brain cancers?

20%

18

The majority of adult brain tumors are found where? Children?

Adults = supratentorial
Child = infratentorial (posterior fossa)

19

What are the 4 major childhood primary brain tumors?

1. Pilocytic
2. Medulloblastoma
3. Ependymoma
4. Craniopharyngioma

20

What are the top four adult brain cancers?

1. Glioblastoma
2. Meningioma
3. Hemangioblastoma
4. Schwannoma

21

Are astrocytomas benign or malignant tumors?

Malignant

22

What are the gross characteristics of astrocytomas?

Large, multicolored (red) mass with a central area of necrosis and hemorrhage

23

What are the histological characteristics of Glioblastoma multiforme? (4)

-Hypercellular
-Hyperchromatism
-Pleomorphism
-Palisading around necrosis

24

Histological slide of the brain with hypercellularity, hyperchromatism, pleomorphic cells, and palisading cells around a central area of necrosis = ?

Glioblastoma multiforme

25

What is the prognosis for Glioblastoma multiforme?

Poor

26

Is Glioblastoma multiforme benign or malignant?

Malignant

27

Where in the brain are Glioblastoma multiforme usually found?

Cerebral hemispheres, and can cross corpus callosum

28

What are butterfly gliomas?

Glioblastoma multiforme that crosses the corpus callosum

29

What is the stain that can be used to highlight Glioblastoma multiforme?

GFAP

30

What is GFAP? Where is it found?

Glial fibrillary acidic protein
intermediate filament that is expressed by numerous cell types in the CNS, including astrocytes, and ependymal cells

31

How can you identify meningiomas grossly?

White capsule that surrounds it

32

What are the histological characteristics of meningiomas?

Spindle cells in a Tight whorling tumors cells

33

Spindle cells in a Tight whorling tumors cells = what?

Meningiomas

34

Are meningiomas benign or malignant?

Benign

35

Where are meningiomas usually found?

Convexities of the hemispheres

36

What cells give rise to meningiomas?

Arachnoid cells external to brain parenchyma, that may have a dural attachment

37

True or false: meningiomas are often asymptomatic

True

38

What is the treatment for meningiomas ?

Resection

39

What are the 4 tumors that has psammoma bodies?

1. Papillary thyroid carcinoma
2. Papillary serous cystadenomas
3. Meningiomas
4. Papillary renal cell CA

40

What are the gross characteristics of hemangioblastomas?

large, exophytic red mass

41

What, generally, are hemangioblastomas composed of?

Vascular structures

42

What are the histological characteristics of hemangioblastomas?

Closely arranged, thin-walled capillaries with minimal interleaving parenchyma + foamy cells

43

Are hemangioblastomas malignant or benign?

Benign

44

Where are hemangioblastomas usually found in the brain?

Cerebellum

45

What diseases are associated with hemangioblastomas?

VHL syndrome if found with retinal angiomas

46

What is the hematological disorder that can be brought about 2/2 hemangioblastomas? Why?

Polycythemia 2/2 EPO production

47

Closely arranged, thin-walled capillaries with minimal interleaving parenchyma + foamy cells = ?

hemangioblastomas

48

Polycythemia 2/2 to a brain tumor point to what type of brain tumor?

hemangioblastomas

49

What is the genetic cause of VHL syndrome?

VHL suppressor gene on chromosome 3

50

What is the genetic cause of tuberous sclerosis?

TSC1, TSC2 genes which code for hamartin, tuberin respectively

51

What are the gross characteristics of Schwannomas?

"Fish flesh"--soft tan appearance

52

What is the antoni A pattern of Schwannoma?

Palisading nuclei surrounding pink areas

53

What is the antoni B pattern of Schwannoma?

Looser stroma, fewer cells, and myxoid changes

54

Where are Schwannoma usually found in the brain?

Cerebellopontine angle

55

What is the stain that can be used for Schwannoma?

S100

56

S100 is used to stain for what brain tumors? (3)

Schwannoma, neurofibromas, melanoma

57

Which CN is usually affected with Schwannomas?

CN VIII

58

Bilateral Schwannomas = what inherited disease?

NF2

59

Are Schwannomas benign or malignant?

Benign

60

What are the CT findings with oligodendroglioma?

Calcifications with a central mass

61

What are the gross characteristics of oligodendrogliomas?

Thickened corpus callosum and diffuse involvement

62

How fast do oligodendrogliomas grow?

Slowly

63

What are the histological characteristics of oligodendrogliomas?

Small, round nuclei with a *perinuclear halo*

*Chicken wire vasculature*

64

Small, round nuclei with a perinuclear halo + Chicken wire vasculature= ?

oligodendrogliomas

65

What age group do oligodendrogliomas usually present?

Middle aged

66

"Fried egg" cells with round nuclei and clear cytoplasm = ?

oligodendrogliomas

67

True or false: oligodendrogliomas usually have calcifications on a noncontrast CT

True

68

What is the most common pituitary adenoma?

Prolactinoma

69

What is the classic visual field deficit associated with pituitary adenomas?

Bitemporal hemianopia

70

What is the effect of a secreting prolactinoma on GnRH?

Decreases

71

What stimulate prolactin release, and which inhibits?

Stimulate = TSH
Inhibits = dopamine

72

What is the typical appearance of a pilocytic astrocytoma?

Cystic structure

73

What is the prognosis for pilocytic astrocytomas?

Good

74

What are the histological characteristics of pilocytic astrocytomas?

Small

75

What are the rosenthal fibers that can be found in pilocytic astrocytomas?

Thick, elongated, worm-like or corkscrew eosinophilic bundles

76

Where in the brain are pilocytic astrocytomas usually found?

Cerebellum

77

What is the stain that is useful for highlighting pilocytic astrocytomas?

GFAP

78

Are pilocytic astrocytomas usually malignant or benign?

Benign

79

What are the histological characteristics of pilocytic astrocytoma?

Rosenthal fibers

80

Homer wright Rosettes are found in what brain tumor?

Medulloblastoma

81

What are Homer wright Rosettes?

Small, blue cells cells

82

Are Medulloblastoma malignant or benign?

Malignant

83

What are the cells that give rise to Medulloblastomas?

Neuroectodermal cells

84

What are the mass effect problems associated with Medulloblastomas? (2)

Compression of 4th ventricle

Spinal drop mets to the spinal cord

85

What are the histological characteristics of medulloblastomas?

Homer-Wright rosettes

86

What are the histological characteristics of Ependymomas?

-*Perivascular pseudorosette*
-Rod shaped blepharoplasts found near nucleus

87

Where are Ependymomas usually found in the brain?

4th ventricle

88

What is the major sequelae of Ependymoma? Why?

Hydrocephalus--usually invades the 4th ventricle

89

What is the prognosis for Ependymomas?

Poor

90

What are the blepharoplasts found in Ependymomas?

Modified centriole

91

Are craniopharyngiomas malignant or benign?

Benign

92

What are the mass effect problems associated with craniopharyngiomas?

Bitemporal hemianopsia

93

What is the most common childhood supratentorial tumor?

craniopharyngiomas

94

What cells give rise to craniopharyngiomas?

Cells from Rathke's pouch

95

True or false: calcification is common with craniopharyngiomas?

True

96

Closely arranged, thin-walled capillaries with minimal interleaving parenchyma + foamy cells = what brain tumor?

Hemangioblastoma

97

Rosenthal fibers are found in what brain tumor?

Pilocytic tumors

98

-*Perivascular pseudorosette* + Rod shaped blepharoplasts found near nucleus = what brain tumor?

Ependymoma