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CNS Tumors Flashcards

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1
Q

The most common intracranial tumor worldwide is the?

A

Glioma
- Astrocytoma
- oligodendrogliomas
- ependymoma

Followed by
- meningioma
- pituitary adenoma

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2
Q

Classification of CNS tumors

A
  • Gliomas
  • Embryonal neoplasms; medulloblastoma
  • Neuronal tumors; central neurocytoma, ganglioglioma
  • Meningioma
  • Metastatic tumors
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3
Q

Types of Astrocytoma

A

Derived form astrocytes
- Diffuse Astrocytoma (80% of primary brain tumor)
- Pilocytic Astrocytoma

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4
Q

Most common site and age for diffuse Astrocytoma?

A

Site
- cerebral hemispheres
- cerebellum
- brainstem
- Spinal cord
Age
- 4th -6th decade of life

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5
Q

Classification of diffuse astrocytoma ?

A
  • Well differentiated astrocytoma (grade 2)
  • Anaplastic astrocytoma (grade 3)
  • Glioblastoma (grade 4)
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6
Q

Gross and microscopy features of well differentiated diffuse astrocytoma?

A

Gross
- Poorly demarcated infiltrating tumor
- grey, firm/soft, gelatinous
- may show cystic degeneration
Microscopy
- increase in astrocytic glial tumor cells (mild to moderate cellularity)
- Fibrillary background (due to cytoplasmic processes of astrocytes)
- variable degrees of nuclear pleomorphism
Immunohistochemistry
- Glial finrillary acid protein (GFAP) positive

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7
Q

Anaplastic astrocytoma features

A
  • Increased cellularity
  • Cellular and nuclear pleomorphism
  • Anaplasia
  • Presence of mitotic figures
  • Rapid growth of the tumor
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8
Q

Glioblastoma gross features (grade 4)

A
  • Variegated appearance (white and firm areas with soft and yellow necrosed areas)
  • cystic degeneration
  • colors represent multiple areas of recent (red) and old (yellow) hemorrhage
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9
Q

Microscopic features of Glioblastoma

A
  • Increased cellularity
  • Marked cellular and nuclear pleomorphism
  • Frequent mitosis
  • Anaplasia
  • Necrosis
  • Endothelial cell proliferation (forming tufts of piled up cells)
  • May be glomeruloid body (marked endothelial cell proliferation
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10
Q

Types of necrotic patterns in Glioblastoma?

A
  • Serpentine pattern of necrosis
  • Pseudo-palisading (garlanding)
    • edges of the necrotic area is surrounded by the palisading tumor cells
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11
Q

What are the two forms of Glioblastoma ?

A

Primary;
- Arises de novo (no preexisting low grade astrocytoma)
- occur in older patients
Secondary;
previously had low grade astrocytoma
Occur in younger patients

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12
Q

Acquired mutations in Glioblastoma ?

A
  • P53, RB
  • Clinical features: seizures and headaches
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13
Q

Radiological features of Glioblastoma?

A
  • Shows mass effect and Edema of brain adjacent to the tumor
  • Abnormal vessels that are leaky demonstrate contrast enhancement on imaging
  • Grave 4 ; poor prognosis
  • grade 2; remain static or progress slowly over a number of years
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14
Q

Pilocytic astrocytoma features ?

A

In children and young adults
Good prognosis
Site
- site located in the cerebellum, floor and walls of the third ventricles
- well circumscribed

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15
Q

Microscopic features of Pilocytic astrocytoma ?

A
  • Biphasic pattern
  • loose microcystic areas
  • rosenthal fibers and eosinophilic granular bodies
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16
Q

Oligodendroglioma (grade 2)

A
  • Site; common in white mater of cerebral hemisphere
  • Well circumscribed
  • better prognosis than astrocytoma
  • Deletion of chromosomes 1p 19Q
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17
Q

Microscopic features of oligodendrocytoma ?

A

Sheets of round, small l, regular cells
- Nuclei: spherical, with fine granular chromatin
- Cytoplasm: clear halo of cytoplasm surrounding the nuclei (fried egg appearance )
- Stroma: anastomosing capillaries (chicken wire appearance)
- Calcification (calcospherites) common
- mitotic figures is usually not seen

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18
Q

What are the three cs of oligodendrocytoma?

A
  • Clear holo of cytoplasm surrounding the nuclei (fried egg appearance)
  • Chicken wire appearance (anastomosing capillaries)
  • Calcification
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19
Q

Ependymoma features

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A

Site
- first 2 decades; 4th ventricle
- adults: Spinal cord associated with NF2

20
Q

Gross and microscopic features of ependymoma

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A
  • well demarcated from adjacent brain parenchyma
  • resemble normal ependymal cells
  • cells have well defined cell membrane
  • EPENDYMAL ROSETTES
  • PERIVASCULAR PSEUDO-ROSETTES; tumor cells are arranged around vessels.
21
Q

Special stain and immunochemistry for ependymoma

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A

Stain
- PTAH stain
- PTAH positive blepharoplasts (basal bodies of cilia of Ependymal cells)
Immunohistochemistry
- GFAP positive

22
Q

Embryonal tumors are of what origin?

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A

Neuroectodermal origin (consisting of primitive, undifferentiated cells)
Most common - medulloblastoma

23
Q

Medulloblastoma

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A
  • Neuronal and glial markers may be expressed
  • children mostly (20% brain tumors in children)
  • exclusively in cerebellum
    Children: midline cerebellum
    adults: lateral cerebellar hemispheres
    Gross
  • well circumscribed, gray and friable
24
Q

Microscopic features of medulloblastoma?

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A
  • Ana-plastic small blue cells
  • numerous mitotic figures
  • HOMER-WRIGHT rosette: central neutrophil (pink material) surrounded by primitive tumor cells
    gFAB positive
25
Drop metastases of medulloblastoma is seen in?
- Metastasis from the cerebellum to **the cauda equina** - Spread through CsF - spread may present as modular masses anywhere in the CnS
26
Clinical features and prognosis of medulloblastoma
**Poor prognosis** in untreated patients **MYC application** - Poor prognosis Clinical features; - cerebellar dysfunction - hydrocephalus (occlusion of csf flow )
27
Meningiomas features?
- Benign tumor arising from meningothelial cell of the arachnoid matter - 20% of all primary intracranial neoplasms - 5th and 6th decade - 3:2 (female:male)
28
Molecular genetics of meningioma?
- Sporadic: NF2 mutation - Iatrogenic; prior radiation to the cranium - Associated with genetic disorder: Gorlin syndrome, NF2
29
Most common sites of meningiomas include?
- Parasagittal regions of the Cerebral hemispheres - Dura over the lateral con exits - Olfactory groove etc Can occur anywhere in the intracranium even within the ventricular system.
30
CmGross description of meningioma ?
- Usually well circumscribed Encapsulated, smooth, rounded, bosselated, or polyploid mass. - usually attached to the dura, compressing underlying brain structures
31
Microscopic features of meningiomas
- Whorled pattern of arrangement of meningoepithelial cells - presence of **psammoma bodies** (laminated, spherical calcospherites)
32
Histological variants of meningioma ?
**Syncytial (meningothelial)**; whorled clusters of polygonal cells without visible cell membranes (syncytial) . With **centrally placed nuclei** **Fibroblastic**; spindle shaped elongated cells which are arranged in interlacing or parallel bundles with abundant collagen deposition in between the cells **Transitional/mixed**; features of both . Whorls pattern around a central capillary blood vessel Center of some whorls may show psammoma bodies
33
Meningioma types (part 2)
- **Psammomatous**: Numerous psammoma bodies - **Secretory**; contains gland like PAS positive eosinophilia secretions (**pseudopsammoma bodies**) - **Microcystic;** microcystic soaces with a loose spongy appearance - **Angiomatous**; numerous blood vessels
34
Immunohistochemistry for meningioma
**GFAP negative** Keratin negative **Epithelial membrane antigen (EMA) positive** - WHO grade I/IV.
35
WHO grading of meningioma (1-3)
Majority of meningiomas are WHO **grade 1** **Grade 1** - meningothelial - fibroblastic - microcystic - transitional - psammomatous - Angiomatous (hemangioblastic, angioblastic) - secretory subtypes - mataplastic - lymphoplasmacyte rich
36
Grade 2 classification of meningioma
- Clear cell - chordoid subtypes - **Atypical by criteria** — 4 -19 mitotic figures — Brain invasion — Three of the following histological features —— increased cellularity —— small cells with high N/C ration —— large and prominent nucleoli —— patternless or sheet like growth —— foci of spontaneous or geographic necrosis
37
Grade 3 classification of meningioma ?
- Rhabdoid - Papillary subtypes - **Anaplastic by criteria** —- 20 or more mitotic figures —- display Frank sarcomatous or carcinomatous histology
38
Things that do not affect the grading of meningioma regardless?
- Invasion of dura, bone or soft tissue - pleomorphic or atypical nuclei - Ki67 is not a true diagnostic criteria (can be greater than 4% and uo 20%)
39
Immunochemistry of secretory meningioma?
- Psudoosammoma bodies are - CEA positive - Surrounding tumor cells - CEA, cytokeratin positive - KLF4 K409Q and TRAF7 mutations
40
Clinical features do meningioma?
- Slow growing - Produce symptoms by compressing underlying brain tissue and depend on site
41
Which brain tumors are commonly associated with the following. Histologic findings??
1) Rosenthal fibers and eosinophilic granular bodies - **Pilocytic astrocytoma** 2) Perivascular pseudorosettes - **ependymoma** 3) pseudopalisading necrosis - **Glioblastoma** 4) Homer wright rosettes- **Medularryblastoma** 5) Fried egg appearance and chicken wire vasculature - **oligodendrocytoma** 6) numerous psammoma bodies - **psammomatous meningioma
42
The most common primary site of tumors that metastasize to the brain are ?
1. Lung 2. Breast 3. Skin (melanoma) 4. Kidneys 5. Gastrointestinal tract Mostly carcinomas Spread through the bloodstream
43
The most common intracranial neoplasms are?
**Metastatic tumors**
44
Choriocarcinoma has a high likelihood of mestasatsizing to ? And Protestant carcinoma ?
- **The brain** - Prostate carcinoma almost never grow in the brain
45
Gross features of primary CNS tumors ?
- Sharply demarcated masses, surrounded by a prominent edmatous zone (boundary is sharp and well defined) - usually seen at the junction of GM and WM - ***microscopy - similar to that of the primary tumor***
46
Central neurocytoma affects which part of the brain?
The **intraventricular location**
47
Tumors of pediatric age groups ?
**Medulloblastoma** **Pilocytic astrocytoma** *Glioblastoma and lymphoma in older patients*

Anatomic Pathology (12 decks)

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