CNS Tumors

Question 1

In gliomas, we see amplification of

Answer 1

EGFR

Question 2

In an astrocytoma, we see loss of tumor suppressor genes

Answer 2

TP53 and ATRX

Question 3

In a glioma, we see the loss of the tumor suppressor gene

-better prognosis

Answer 3

IDH

Question 4

An example of epigenetic gene silence is seen in a glioblastoma with

Answer 4

MGMT hypermethylation

Question 5

An example of a tumor caused by persistent activation of gene mutation product is seen in gliomas with

Answer 5

EGFRvIII

Question 6

An example of a tumor caused by chromosomal abnormality is seen in an oligodendroglioma with the co-deletion of

Answer 6

1p19q

Question 7

Radiation causes an increase in the incidence of

Answer 7

Meningiomas

Question 8

May induce mesenchymal and glial tumors

Answer 8

Nitroso compounds

Question 9

Mostly arise in the cerebellum and hypothalamus

-seen most commonly in children and young adults

Answer 9

Pilocytic Astrocytoma

Question 10

Has a bihasic histological pattern and rosenthal fibers on histological staining

Answer 10

Pilocytic Astrocytoma

Question 11

Pilocytic astrocytomas are characterized as being

Answer 11

GFAP positive

Question 12

Tumor most frequently seen in cerebral hemispheres

• usually a poorly demarcated lesion
• commonly in children and young adults

Answer 12

Diffure Astrocytoma

Question 13

Histologically, shows atypical cells infiltrating in a diffuse fashion and large cells with eosinophilic cytoplasm (gemistocytic astrocytoma)

Answer 13

Diffuse astrocytoma

Question 14

The most mlignant glioma

-most frequently in middle aged adults

Answer 14

Glioblastoma

Question 15

Glioblastomas are most commonly in the

Answer 15

Frontal and temporal lobes

Question 16

A poorly defined mass with heterogenous appearance

Answer 16

Glioblastoma

Question 17

Characterised by increased cellularity, nuclear atypia, mitosis, vascular endothelial hyperplasia, and necrosis

Answer 17

Glioblastoma

Question 18

Cause of glioblastoma with better chemosensitivity

Answer 18

MGMT gene promoter hypermethylation

Question 19

Insidious and slow growing tumors mostly in cerebral hemispheres

-Usually in middle aged adults

Answer 19

Oligodendroglioma

Question 20

The types of oligodenrogliomas that are chemosensitive solid tumors are due to a co-deletion of

Answer 20

1p and 19q

Question 21

More circumscribed than astrocytoma

Answer 21

Oligodendroglioma

Question 22

Tumor cells are uniform with “fried egg” appearance

Answer 22

Oligodendroglioma

Question 23

An oligodendroglioma is classified as grade II or III (Anaplastic) if there is marked

Answer 23

Mitosis, vascular endothelial proliferation, and necrosis

Question 24

Some oligodendrogliomas have an astrocytic component. These are called

Answer 24

Oligoastrocytomas

Question 25

Oligodendrogliomas are positive for

Answer 25

Oligo-2

Question 26

Tumor frequently in ventricles causing hydrocephalus -predominantly in children and adolescents

Answer 26

Ependymoma

Question 27

An ependymoma in the spinal cord and filum terminale

Answer 27

Myxopapillary Ependymoma

Question 28

Characterized as being exophytic and well demarcated

Answer 28

Ependymoma

Question 29

Grade III ependymoma characterized by more mitoses, vascular endothelial hyperplasia and necrosis

Answer 29

Anaplastic Ependymoma

Question 30

Ependymomas are positive for

Answer 30

GFAP, MAP2, and EMA

Question 31

Greyish, friable mass, commonly in the ventricles -Mostly in adults

Answer 31

Central neurocytoma

Question 32

Composed of round uniform cells with scanty cytoplasm -WHO grade II tumor

Answer 32

Central Neurocytoma

Question 33

A central neurocytoma is positive for

Answer 33

Synaptophysin and chromogranin

Question 34

Associated with cortical malformation -Presents with a history of chronic epilepsy

Answer 34

Ganglioglioma

Question 35

Cystic tumor with calcified mural node -Common in children

Answer 35

Ganglioglioma

Question 36

Typically a Grade I tumor and is rarely a higher grade

Answer 36

Ganglioma

Question 37

Most frequent malignant tumor in children - Tumor of cerebellum - solid and ill-defined

Answer 37

Medulloblastoma

Question 38

Highly cellular, small oval or round cells with neuronal, glial and other differentiations and neuronal rosette formation

Answer 38

Medulloblastoma

Question 39

Medulloblastoma is characterized as a grade

Answer 39

IV tumor

Question 40

A curcumscribed mass attached to the dura -most common in adult women

Answer 40

Meningioma

Question 41

Basic histology: pseudointranuclear inclusion, whorl, psammomatous calcification

Answer 41

Meningioma

Question 42

Meningiomas are positive with

Answer 42

EMA and PR

Question 43

Tumor of the cerebellum associated with von Hippel Lindau disease -occur in young to middle aged adults

Answer 43

Hemangioblastoma

Question 44

Histological characteristics: Numerous delicate capillaries set in a background of clear foamy cells

Answer 44

Hemangioblastoma

Question 45

A hemangioblastoma is positive with

Answer 45

Inhibin, CD31, and CD34

Question 46

Suprasella solid and cystic mass -most frequently seen in children and adolescents

Answer 46

Craniopharyngioma

Question 47

Histological characteristics: Squamoid cells and keratin with loose connective tissue stroma - CKs positive - Grade I tumor

Answer 47

Craniopharyngioma

Question 48

Most common secretory tumor - Suprasella - Most common in adults - More common in females

Answer 48

Pituitary adenoma

Question 49

What percentage of pituitary adenomas are non-secretory?

Answer 49

20%

Question 50

Histological characteristics: Sheets of uniform cells with round nuclei with delicate chromatin -Positive in synaptophysin, chromogranin, NSE, and hormone (if secretory)

Answer 50

Pituitary adenoma

Question 51

Extracranial malignancy often demarcated from brain tissue -morphologically similar to primary extracranial tumor

Answer 51

Metastatic neoplasm

Question 52

Associated with a gene mutation -neoplasm and non-neoplasm

Answer 52

Tumor predisposition syndromes (Phakomatoses)

Question 53

Characteried by neurofibromin negatively regulating the Ras onco-protein

Answer 53

Neurofibromatosis Type I (NF1) (von Recklinghausen's disease)

Question 54

The mechanism is via Merlin which involves cellular proliferation

Answer 54

Neurofibromatosis Type II (NF2)

Question 55

Mechanism is via VHL protein which activates Hypoxia Inducible Factor (HIF)

Answer 55

Von Hippel Lindau Syndrome

Question 56

Mechanism is through Hamartin or Tuberin which negatively regulates mTOR protein in a kinase signaling pathway involved in regulation of energy, metabolism and mRNA translation as a tumor suppressor

Answer 56

Tuberous Sclerosis Complex (TSC)