CNS Space Occupying Lesions

Question 1

Astrocytoma

Radiological appearance in adults

Answer 1

• Supratentorial
• Infiltrative border
• Causes midline shift
• Ring shaped lesion surrounded by area of edema

Question 2

Astrocytoma

Gross appearance in adults

Answer 2

• Vague ie cant tell it apart from normal surrounding parenchyma
• Affects supratentorial cerebrum
• Hemorrhagic?

Question 3

Astrocytoma

Microscopic appearance in adults

Answer 3

Fibrillary cytoplasmic background with vascular proloferation

Question 4

Astrocytoma

Gross appearance in children

Answer 4

• Infratentorial
• Polycytic
• Well circumscribed
• Gelatinous
• Cystic

Question 5

Astrocytoma

Microscopic appearance in children

Answer 5

• Elongated, loosely knit stellate, bipolar astrocytes
• Fibrillar background
• Microcysts
• Rosenthal fibers

Question 6

Grade 1

Answer 6

Pilocytic astrocytoma

Question 7

Grade 2

Answer 7

Diffuse astrocytoma and nuclear atypia

Question 8

Grade 3

Answer 8

Anaplastic astrocytoma with nuclear atypia and mitosis

Question 9

Grade 4

Answer 9

Glioblastoma with nuclear atypia, mitosis ans microvascular proliferation, hemorrhage

Question 10

Glioblastoma epidemiology and prognosis

Answer 10

Most aggressive of all brain tumors

> 60

Prognosis <1yr

Question 11

Glioblastoma gross appearance

Answer 11

Ill defined

Infiltrative

Hemorrhage, necrosis

Midline shift

Question 12

Glioblastoma microscopic appearance

Answer 12

Pseudopalisade (lines of atypical cells around areas of necrosis)

Necrosis

Vascularization

Atypia

Question 13

Oligodendroma

Affects which part of brain

Answer 13

Cerebrum

Question 14

Oligodendroglioma

Microscopic appearance

Answer 14

• Uniform round oligodendrocytes with round nuclei
• Surrounded by clear halo
• CALCIFICATION
• Range from grade 1-3

Question 15

Ependymoma

Gross appearance

Answer 15

Well differentiated

Invades adjacent CNS tissue

Projects into cerebellum—>obstruct ventricular system—>HYDROCEPHALUS

Question 16

Ependymoma

Microscopic appearance

Answer 16

PSEUDOROSETTE

Eosinophilic cells

Fibrillary background

Central bv

Question 17

Spinal ependyoma prognosis

Answer 17

Benign

Question 18

Spinal ependymoma

Affects which part of CNS

Answer 18

Cauda equina (filum terminale)

Question 19

Spinal ependymoma

Microscopic appearance

Answer 19

Myxopapillary formation

“Myxoid areas”

Question 20

Schwannoma microscopic appearance types

Answer 20

Antoni A

Antoni B

Question 21

Antoni A (schwannoma)

Answer 21

• More cellular

- Cellular lines alternating with hypocellular areas—>palisading nuclei surrounding VEROCAY BODY

Question 22

Antoni B (schwannoma)

Answer 22

Looser stroma with less cells

Myxoid changes

Question 23

Acoustic schwannoma affects which area

Answer 23

CEREBELLO-PONTINE angle

Facial vestibule cochlear folliculonodular

Question 24

Schwannoma affects

Answer 24

Spinal roots

Posterior peripheral nerves

Vestibular branch of CN8

Question 25

Neurofibroma affects

Answer 25

Dorsal nerve roots Peripheral nerves

Question 26

Glial origin tumors

Answer 26

1. Astrocytoma +Glioblastoma (pseudopalisade and necrosis) 2. Oligodendroglioma (calcification with round eosinophilic nuclei surrounded by clear halo) 3. Ependymoma (Psuedorosette with fibrillary body) Spinal ependymoma (myxoid area with myxopapillary formation) 4. Shwannoma (antoni A—> palisading nuceli and verocay body,, B—> myxoid change with loose stroma) 5. Neurofibroma 6. Malignant peripheral nerve sheath tumor

Question 27

Meningioma Origin

Answer 27

Meningothelial cells of arachnoid granulations

Question 28

Meningioma Occurs in which regions most

Answer 28

1. Parasagittal 2. Wing of sphenoid 3. Olfactory nerve

Question 29

Meningioma Age affected, prognosis

Answer 29

20-30 BENIGN

Question 30

Gross appearance of meningioma

Answer 30

Dura based there4 easily inoculated Nodular Exerts pressure on adjacent brain tissue

Question 31

Microscopic appearance of meningioma

Answer 31

Meningothelial cells (fibroblast like) arranged in whirls PSAMOMA BODIES (concentric calcification)

Question 32

Medulloblastoma Brain part affected

Answer 32

-Vermis of cerebellum—>hydrocephalus? -Meningeal infiltration, csf seeding, subarachnoid dissemination

Question 33

Microscopic appearance of medulloblastoma

Answer 33

Small blue undifferentiated blast cells HOMER-WRIGHT ROSETTES

Question 34

Ganglioneuroma affects...

Answer 34

Mediastinum

Question 35

Primary lymphoma of cns occurs in which population group

Answer 35

AIDS due to ebv infection

Question 36

Primary lymphoma of CNS most common type

Answer 36

NHL B cell type Poor prognosis

Question 37

Metastatic tumors originate from

Answer 37

``` Breast Lung Kidney Colon Melanoma ```

Question 38

Characteristic of metastatic tumors

Answer 38

Affect boundary (junction) of grey-white matter