Flashcards in CNS Tumors Deck (51)
1
What are the 3 types of gliomas?
astrocytomas
oligodendrogliomas
ependymoma
2
Are most tumors of the CNS primary or metastatic?
metastatic - 70%!
3
What is the most common primary brain tumor in adults?
glioblastoma multiforme
4
What are the general characteristics of a metastatic tumor to the brain?
generally well circumscribed
often multiple
usually located in junction between gray and white matter
5
What are the general characteristics of a primary brain tumor?
poorly circumscribed
usually single
location varies by type
6
Where do metastatic brain tumors often come from?
lung, bladder, breast, melanoma and others
7
What does pleomorphic mean?
It means the cells come in many different odd shapes - it's generally not a good sign
8
How common are CNS tumors in children? Which are most common in children?
In general, CNS tumors are the 2nd most common neoplasia in children
medulloblastoma and astrocytoma are the most common types
9
As for the location in the CNS, where do adult CNS tumors occur and where to childhood CNS tumors occur?
children - 70% posterior foss
adults - 70% supratentorial
10
What does the WHO base it's grading scale on?
mostly histological appearance
11
What are the 4 WHO grades?
1 - low proliferative potential, possible to cure wiht resection
2 - infiltrative, but low proliferative activity
3- evidence of malignancy = nuclear atypia and much mitotitc activity
4 - cytologically malignant, mitotically active, necrosis prone
12
What are the survival estimates for grade 2, 3, and 4?
2 = greater than 5 years
3: 2-3 years
4 = depends on treatment, but often not more than a year
13
What do gliomas arise from?
ASTROCYTES
oligodencrocytes
ependymal cells
14
what is the highest-grade astrocytoma?
glioblastoma
15
What are the most common symptoms of a glioma
it depends on location of tumor obviously, but headaches, seizures, memory loss and changes in behavior are common
16
What do you call a grade 1 astrocytoma?
pilocytic astrocytoma
(low proliferative potential)
17
Are pilocytic astrocytomas more common in chidlren or adults, and where in the brain d they usually occur?
children - frequently posterior fossa - cerebellum
18
What are the morphologic features of pilocytic astrocytomas?
ofen cystic
bipolar cells with long hair-like processes
rosenthal fibers****
biphasic
19
What genetic point is associated with pilocytic astrocytoma?
a BRAF and KIAA fusion/duplication - diagnosed with FISH
they have a worse prognosis
20
What is a grade 2 astrocytoma?
diffuse astrocytoma
21
What is the main characteristic of a diffuse astrocytoma?
it's actually very slowly progressive, but it will almost always eventually become anaplastic
22
Which type of diffuse astrocytoma is most likely to progress to a grade 3?
gemistocytic astrocytoma
23
What is the grade 3 astrocytoma called?
anaplastic astrocytoma
24
What are the characteristics of an anaplastic astrocytoma?
Starting to be much more cellular and pleomorphic. Often has GFAP (glial fibrillary acidic protein) as an intermediate filament
25
What is a grade 4 astrocytoma?
a blioglastoma
26
What are the usual signs and symptoms of a GBM?
slowly profressiv neuro defect, headache, symptoms of increased ICP - headaches, nausea, vomiting, cognitive impariemtn, seizures
27
What age group in particular developes GBMs?
60-69 is the most common
28
Are oligodendrogliomas usually in adults or kids?
adults
29
How do patients with oligodendrogliomas usually present?
with seizures
30
What is the mean survival for an oligodendroglioma?
5-10 years
31
What genetic deletions actually IMPROVE survival of oligodendoglioma?
deletion of both 1p and 19q
32
What are the morphological features of oligodendroglioma?
- shaprly circumscribe hemispheric masses
- round nuclei with cytoplasmic halos
- delicate capillary network
- most calcified
33
What does the perinuclear halo seen in oligodendrogliomas look like?
a fried egg
34
Who usually gets ependymomas? where?
children - usually near the 4th ventricle (but in adults there is a spinal cord variant)
35
What is the prognosis for an ependymoma?
the tumor is slow growing, but prognosis is will porr - 4 years
36
What are the main morphological features of ependymomas?
solid or papillary mass
round nuclei
dense fibrillary background
canals, pseudorosettes, rosettes
37
What do pseudorosettes have in their center?
a blood vessel
38
What WHO grade do medulloblastomas receive?
grade 4
39
Are medulloblastomas more common in adults or children?
children
40
where in the brain do medulloblastomas usually occur?
cerebellum
41
What genetic variation is associated with poor prognosis ih medulloblatoma?
i(17q) - the short arm of chromosome 7 gets deleted and replaced with another long arm
42
What are the histologic geatures of medulloblastoma?
small, dark, elongated, anaplastic cells with homer-wright rosettes
43
What are the usual presenting symptoms with medulloblastoma?
headache, morning vomiting which gets worse with time, back pain and motion difficulties
44
What gender developes medulloblastoma more often?
boys
45
What is a meningioma a tumor of?
arachnoid cells - attached to dura
46
What is the prognosis of meningiomas?
very god - they're slow growing and benign, cured by resection
47
What are the morphological characteristics of a meningioma?
attached to dura
forms in syncytial pattern
psammoma bodies (calcium deposits)
48
Who typically gets primary brain lymphomas?
immunosuppressed patients
49
How canyou diagnose a primary brain lymphoma?
easily detectable in the CSF
50
Where is a common place for a schwannoma to be located? What symptoms?
around CN7 at the cerebellopontine angle
hearing loss, tinnitus
51