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Flashcards in CNS Neoplasms Deck (62):
1

(T/F) Neurological neoplasms usually only present with a limited set of symptoms and are easy to identify.

False. Neurological neoplasms are highly variable depending on their location within the brain and their aggressiveness. This can make them difficult to identify.

2

Infiltrating or diffuse tumors may be identified by testing for ______________ 1 & 2.

Isocitrate dehydrogenase

3

Grade I pilocytic astrocytomas may also possess ________ mutations.

BRAF

4

(T/F) Neurological neoplasms tend to be heterogeneic. A sample from one area of the tumor may present a different grade than a sample taken from another area of the tumor.

True.

5

What abnormality is present in the following histology slide?

Q image thumb

  • Cytoplasms of cells are an irregular, spindle-like, triangular shape.
  • All visible nuclei have different morphologies and point in different directions.
  • Astrocytoma WHO Grade I

6

Where is the tumor located in the following image?

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  • Located in and around the hippocampal area.
  • Appears as diffuse thickening of brain tissue (compare to other side).

A image thumb
7

What attributes does a glial neoplasm need to develop in order to graduate to a higher classification in the WHO scale?

  • Necrosis
  • Vascular proliferation
  • Mitotic activity

8

Whenever an astrocytoma develops _________________, it usually graduates to WHO grade III from grade II.

Mitotic activity

9

Whenever an astrocytoma develops _________________ and _____________, it usually graduates to WHO grade IV from grade III and becomes a glioblastoma.

Vascular proliferation and necrosis

10

High-grade glial neoplasms typically possess a(n) ______________ lesion which necrotically encompasses both hemispheres and involves the corpus callosum.

Butterfly lesion

11

Point out the abnormal changes in the following histological slide of a glioblastoma.

Q image thumb

  • Geographic necrosis outlined in red.
  • Crowded layer of pseudopalisading cells outlined in yellow.
  • Vascular proliferation outlined in dark red.
    • (Note: A palisade is a fence used to create an enclosure.)
  • Glioblastoma

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12

Point out the abnormal change in the following histological slide of a glioblastoma.

Q image thumb

Vascular proliferation within the tumor, outlined in red.

A image thumb
13

What can be seen in the following histological slide of a glioblastoma multiforme (GBM)?

Q image thumb

  • Typical appearance of a GBM outlined in red.
  • Vascular proliferation outlined in yellow.
  • Toxic radiologic changes outlined in dark red.

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14

What post-radiologic changes can be seen in the following histological slide of a GBM cell?

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  • Abnormally large, swollen cell outlined in red.
  • Smudged, uncharacteristic appearance of chromatin outlined in yellow.

A image thumb
15

Most primary or de novo glioblastomas present with mutations in (p53 and PDGF receptors/EGFR).

EGFR

16

Most secondary or later-development glioblastomas present with mutations in (p53 and PDGF receptors/EGFR).

p53 and PDGF receptors

  • Remember: P (p53 and PDGF) comes after E (EGFR)

17

You can expect a better response from a patient to chemotherapy if you discover that the gene for the enzyme _______________ is methylated within the patient's tumor.

Methyl guanine DNA methyl transferase (MGMT)

  • This enzyme exists to repair damage to DNA, such as alkylation made by chemotherapy agents. Discovering methylation of the MGMT gene means the tumor does not possess this enzyme.

18

A(n) _____________ is a swollen, reactive astrocyte that usually appears after acute injury and gradually shrinks in size.

Gemistocyte

19

(T/F) Presence of gemistocytes with a glial neoplasm is usually an indicator of a poor prognosis.

True.

20

What abnormal features are present in the following histological slide?

Q image thumb

  • Rosenthal fibers outlined in red.
  • Pilocytic astrocytoma (WHO Grade I)

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21

Rosenthal fibers are deposits of _______________ within glial neoplasms.

GFAP (Glial fibrillary acidic protein)

22

Based upon the presence of rosenthal fibers, what glial neoplasm would you classify the following picture as?

Q image thumb

Pilocytic astrocytoma.

  • Rosenthal fibers outlined in red. These are characteristic of a pilocytic astrocytoma.

23

__________________ are slow-growing glial neoplasms that typically form in the cerebral white matter. Patients usually have a long period of complaints before diagnosis.

Oligodendrogliomas

24

What abnormalities are present in the following histological slide of a glial neoplasm?

Q image thumb

  • Fried egg appearance of cytoplasm outlined in red.
  • Delicate network of capillaries (termed chicken wire) outlined in dark red.
  • Oligodendroglia (WHO Grade II)

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25

Which type of glial neoplasm would you diagnose the following histological slide as?

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  • Fried egg appearance of cellular cytoplasms outlined in red.
  • "Chicken wire" capillary networks outlined in dark red.
  • Infiltrating neoplasm cells outlined in blue. Easy to distinguish because of fried egg appearance.

These are all characteristic of an oligodendroglioma (WHO Grade II)

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26

Deletion of chromosomal areas _____ and _____ in oligodendrogliomas points to better response of the tumor to chemotherapy and radiation, as well as better prognosis.

1p and 19q

  • Note: These areas may be deleted separately, but the prognosis is much better if there is a co-deletion of both.

27

A(n) ________________ is a glial neoplasm that forms in the cerebrospinal fluid-producing cells of the central nervous system.

Ependymoma

28

What abnormalities may be seen in the following histological slide of a glial neoplasm?

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  • True rosettes outlined in red.
  • Perivascular pseudorosettes outlined in blue.
  • Ependymoma

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29

(Rosettes/Pseudorosettes) consist of tumor cells surrounding an empty lumen. These cells are thought to be attempting to recreate a ventricle or structure that their original purpose was designed for.

Rosettes

Characteristic of ependymomas

30

(Rosettes/Pseudorosettes) consist of tumor cells surrounding a non-tumor structure, such as a blood vessel. They typically possess an anuclear zone at their center.

Pseudorosettes

Characteristic of ependymomas

31

What type of glial neoplasm would you diagnose the following histological slide as?

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  • True rosettes outlined in red.
  • Perivascular pseudorosettes outlined in blue.

These things are characteristic of an ependymoma.

A image thumb
32

(Gangliocytomas/Dysembryoplastic neuroepithelial tumors/Central neurocytomas) are low-grade neoplasms within and adjacent to the ventricular system.They are most commonly found in the lateral or third ventricles, and present with evenly spaced, round, uniform nuclei with neuropil islands.

Central neurocytomas

33

(Gangliocytomas/Dysembryoplastic neuroepithelial tumors/Central neurocytomas) are tumors with a mix of glial elements, low grade astrocytomas, and mature appearing neurons.

Gangliocytoma

  • Note: Contents of tumor form a "gang".

34

(Gangliocytomas/Dysembryoplastic neuroepithelial tumors/Central neurocytomas) are low-grade childhood tumors that are slow-growing. They typically have a good prognosis post-resection. These tumors are also associated with seizure disorders, and as such, are commonly found within the superficial temporal lobe. They present as small round neuronal cells and columns around central cores of processes.

Dysembryoplastic neuroepithelial tumors

35

A primitive neuroectodermal tumor (PNET) that is found within the cerebral hemisphere is termed a(n) _____________________.

Supratentorial PNET

36

A primitive neuroectodermal tumor (PNET) that is found within the pineal gland is known as a(n) ______________________.

Pineoblastoma

37

A primitive neuroectodermal tumor (PNET) that shows rosette formation and ependymal characteristics is known as a(n) _____________________.

Ependymoblastoma

38

A primitive neuroectodermal tumor (PNET) that is found within the cerebellum is termed a(n) _______________________.

Medulloblastoma

39

(T/F) PNETs are similar to germinal matrix cells and have no characteristic markers of traditional glial cells such as GFAP.

True.

40

_________________ are PNETS of the cerebellum that typically respond well to radiation therapy. However, these types of tumors also disseminate to the CSF, involving the brainstem.

Medulloblastomas

41

All medulloblastomas (PNETS of the cerebellum) are grade ___ on the WHO scale.

Grade IV

42

Medulloblastomas are typically associated with a chromosomal deletion of _____.

17p

43

What is abnormal about the following histological slide?

Q image thumb

Largely undifferentiated cells with no cytoplasm are outlined in red.

Medulloblastoma (WHO Grade IV)

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44

What may be seen in the following histological slide?

Q image thumb

  • Granular layer of cerebellum outlined in yellow.
  • Purkinje cell outlined in blue.
  • Molecular layer of cerebellum outlined in light blue.
  • Invasion of PNET cells into leptomeninges outlined in orange at top.

Note: Leptomeninges means inner two layers of meninges, or the arachnoid and pia.

Medulloblastoma (WHO Grade IV)

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45

______ is a gene involved in chromatin remodeling that is present in all cells of the body. However, in tumors such as atypical teratoid/rhabdoid tumors (ATRT), it is deleted.

INI 1

46

Over 95% of neural lymphomas are _________________ lymphomas.

Diffuse large B-cell lymphomas (DLBCL)

47

Lymphomas are very responsive to ______________.

Corticosteroids

48

____________ tumors are typically found in the midline, most commonly in the pineal gland or suprasellar region. They usually respond well to radiation treatment.

Germ cell

49

What type of tumor is shown in the following slide?

Q image thumb

Meningioma

Outcropping of dura outlined in red.

A image thumb
50

What abnormalities are seen in the following histological slide?

Q image thumb

  • Whorls are outlined in red.
  • Psammoma bodies are outlined in blue.
  • Meningioma

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51

_____________ are circular collections of cells found in some glial neoplasms.

Whorls

Common in meningiomas

52

____________ are circular deposits of calcium seen microscopically within cells.

Psammoma bodies

Common in meningiomas

53

Based on abnormalities present, what is the most likely tumor in the following histologic slide?

Q image thumb

  • Whorls are outlined in red.
  • Psammoma bodies are outlined in blue.

These findings are characteristic of a meningioma.

A image thumb
54

What are the five most common neoplasms that metastasize to the brain?

  1. Lung
  2. Breast
  3. Melanoma
  4. Renal cell carcinoma
  5. Gastrointestinal adenocarcinoma

55

If a patient presents with a ring-enhancing lesion (usually older individuals presenting with seizures, rapid progression), what are the most likely differential diagnoses?

  1. Glioblastoma
  2. Metastatic carcinoma
  3. Lymphoma
  4. Abscess

56

If a patient presents with a butterfly (or corpus callosum) lesion, what are the most likely differential diagnoses?

  1. Glioblastoma 
  2. Metastatic carcinoma
  3. Lymphoma

57

If a patient presents with a cyst and mural nodule formation (usually a long history of seizures, slow growing), what are the most likely differential diagnoses?

  1. Pilocytic astrocytoma
  2. Ganglioglioma
  3. Pleomorphic xanthoastrocytoma
  4. Hemangioblastoma

58

If a patient presents with a dura-based lesion (usually long and vague history, headaches), what are the most likely differential diagnoses?

  1. Meningioma
  2. Soft tissue neoplasm
  3. Hematolymphoid lesion
  4. Metastases

59

If a child presents with a posterior fossa mass (usually with increased ICP, papilledema, threatened cerebellar tonsilar herniation, coma), what are the most likely differential diagnoses?

  1. Medulloblastoma
  2. Pilocytic astrocytoma
  3. Ependymoma
  4. Choroid plexus neoplasm

60

If patients diagnosed with a lymphoma are immunosuppressed, then _______________ virus is often present.

Epstein barr virus

61

The most common tumor in the brain is a __________________.

Metastatic carcinoma

62

What antibodies are associated with Paraneoplastic Syndromes and other cancers that can show up before identification of the neoplasm?

  • Anti-hu
  • Anti-yo