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Flashcards in CNS Tumors Deck (43):
1

Where are most CNS tumors found?

Over 85% are seen within the brain

2

Where are most CNS tumors found in adults?

Supratentorial - typically in the cerebrum

3

Where are most CNS tumors found in children?

Infratentorial - typically in the cerebellum

4

What is unique about benign and malignant CNS tumors?

Even benign tumors can have fatal outcomes due to their location and often surgical resection is restricted due to anatomical constraints that could leave to damage and loss of function.

5

Expansile Growth

Sharp border between the tumor and surrounding tissue

6

Infiltrative Growth

Single tumor cells spread in brain parenchyma and surround normal structures

7

How frequent is the metastasis of CNS tumors?

VERY rare.

8

What are some common signs of CNS tumors?

- Headaches
- Nausea and vomiting
- Seizures
- Syncope

9

What is the most common CNS tumor in adults?

Glioblastoma Multiforme

10

What is the most common CNS tumor in children?

Pilocytic Astrocytoma

11

What are the types of gliomas?

- Astrocytoma
- Oligodendroglioma
- Ependymoma

12

What is seen on microscopy of pilocytic astrocytoma?

Piloid Cells with hair-like processes - biphasic architecture with compact and microcystic areas

13

What kind of fibers will be seen in pilocytic astrocytoma?

Rosenthal Fibers

14

Glioblastoma Multiforme

Malignant astrocytoma and is the most common CNS tumor in adults. It can cross the corpus callosum as a butterfly lesion and shows with areas of necrosis

15

What are the cellular features of glioblastoma multiforme?

- Pseudopalisading cells around necrosis
- Endothelial cell hyperplasia
- GFAP positive

16

Oligodendroglioma

Malignant tumor of oligodendrocytes that has a better prognosis that others and may present with seizures.

17

What is a classic finding of oligodendrogliomas on CT?

Intratumoral Calcifications

18

What is the appearance of oligodendroglioma on histology?

Fried egg appearance of cells with chicken-wire capillary pattern and possible perineuronal/vascular satellitosis.

19

What are the rosettes seen in medulloblastoma?

Homer-Wright Rosettes - central core of delicate neutrophil fibrils

20

What are the rosettes seen in retinoblastoma?

Flexner-Wintersteiner Rosettes - cells are arranged around an empty lumen

21

What are the rosettes seen in ependymoma?

Perivascular Pseudorosette - halo of tumor cells surrounds a blood vessel

AND

True Ependymal Rosette - halo of tumor cells surrounds an empty central lumen

22

Ependymoma

Arises in the walls of ventricles and central canal of spinal cord and is more frequent in children with the 4th ventricle as the most common site.

23

Medulloblastoma

Arises from undifferentiated neuroectodermal cells and is malignant and found in children.

24

What is seen on histology of medulloblastoma?

Sheets of undifferentiated cells with scanty cytoplasm and dark staining nuclei

25

Meningioma

Arises from arachnoid cells and is benign and seen in adult females and often asymptomatic but can cause seizures.

26

What are some of the histologic features of meningioma?

- Psammoma bodies
- Whorls
- Fascicles in the fibroblastic variant

27

Craniopharyngioma

Benign tumor in children that is derived from Rathke's pouch and can cause visual symptoms and endocrine dysfunction.

28

What can craniopharyngioma be confused for?

Pituitary Adenoma

29

What is a symptom in children that raises the possibility of craniopharyngioma?

Presentation of bitemporal hemianopsia

30

What are some features of craniopharyngioma that can be seen on CT?

Calcifications of the tumor are common

31

Schwannoma

Benign tumor of Schwann cell origin that is common at the CPA and CN VIII as an acoustic neuroma leading to hearing loss and tinnitus

32

What does bilateral acoustic neuromas raise suspicion for?

Neurofibromatosis Type-2

33

What is a marker for Schwannoma?

S100

34

What are the common sources of metastasis to the CNS?

- Lung
- Breast
- Kidney

35

A 56‐year‐old man has had headaches and difficulty concentrating for the past 2 months. He then begins to exhibit odd behavior, such as hitting golf‐balls at his neighbors doors and windows. He suffers a grand mal seizure, and is admitted to the hospital. MR imaging of the brain reveals a large mass with extensive necrosis in the left cerebral hemisphere extending across corpus callosum into the right
hemisphere. Which of the following neoplasms is he most likely to have?

A. Meningioma
B. Glioblastoma
C. Medulloblastoma
D. Metastatic adenocarcinoma

B. Glioblastoma

36

Neurofibromatosis Type-1

Mutation of neurofibromin-GTPase activating protein on Ch17 that leads to a high chance of malignant transformation

37

What are the symptoms of NFT1?

Neurofibromas, acoustic schwannomas, optic nerve
gliomas, Lisch nodules and café‐au‐lait spots.
– Plexiform neurofibroma is pathognomonic of NF 1

38

Neurofibromatosis Type-2

Mutation of gene on Ch22 that is a tumor suppressor gene, Merlin, leading to bilateral acoustic Schwannomas and multiple meningiomas

39

Tuberous Sclerosis

Hamartomatous lesions from mutations in TSC1 and TSC2 (hamartin and tuberin)

40

What is the triad of tuberous sclerosis?

- Adenoma sebaceum
- Seizures
- Mental retardation

41

Von Hippel-Landau Disease

VHL tumor suppressor gene on Ch3 is mutated which leads to increased HIF and VEGF leading to growth and tumor formation.

42

What is VHL disease associated with?

- Hemangioblastoma
- Renal cell carcinoma

43

Hemangioblastoma

Closely arranged thin‐walled
capillaries with little intervening parenchyma
‐Can produce erythropoietin ‐
secondary polycythemia

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