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MNI (neuro path) > L12- CNS Tumors > Flashcards

L12- CNS Tumors Flashcards

1
Q

list the common places CNS tumors arise

A
  • Meninges (*menigiomas)
  • Brain (*gliomas, neuronal tumors, choroid plexus tumor)
  • Others: CNS lymphoma, germ cell tumors
  • Metastasis
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2
Q

Brain Tumors:

  • (1) local effects, generally
  • (2) diffuse effects, generally
A

1- seizure, compression of nerve or vessel (=> necrosis)

2- inc ICP => confusion, ataxia, n/v, incontinence, HA

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3
Q

categorize the CNS tumor types

A

Primary

  • Intrinsic: *Gliomas (astrocytoma, oligodendroglioma, ependymomas), Neuronal tumors, *Embryonal neoplasm / medulloblastoma
  • Extrinsic: *Meningiomas, *Schwannomas, Pituitary adenoma

Secondary

  • metastasis
  • lymphoma (especially in immunocompromised Pts)
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4
Q

Primary CNS tumors:

  • Children: (1) relative location, (2) most common types
  • Adults: (3) relative location, (4) most common types
A

Children- 20% of all tumors are brain tumors
1- infratentorial (posterior fossa, includes cerebellum)
2- astrocytoma, medulloblastomas, glioblastomas, ependymomas

3- supratentorial
4- astrocytoma, glioblastomas, oligodendroglomas, mestastatic tumors, meningiomas

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5
Q

list the types of gliomas

A

astrocytoma, oligodendroglioma, ependymoma

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6
Q

diffuse astrocytoma:

  • (1)% of all gliomas
  • (2) age of onset
  • (3) location of tumor
  • (4) tumor marker
A 
(glioma)
1- 80%
2- 30s-50s
3- both cerebral hemispheres (diffuse locations -- not one solid mass)
4- GFAP- glial fibrillary acidic protein
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7
Q

GFAP is the tumor marker for….

A 
(glial fibrillary acidic protein)
diffuse astrocytoma (glioma)
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8
Q

briefly describe the grades for diffuse astrocytomas

A 
(glioma // based on Histology)
I- manageble Tx
II (diffuse astrocytoma)- can remain stable for years
III (anaplastic astrocytoma)
IV (glioblastoma)- rapid deterioration
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9
Q

describe the main gross pathological features for diffuse astrocytoma

A

(glioma // grade II, III)

  • poorly defined gray infiltrating tumor distorting brain contours
  • doesn’t form a discrete mass
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10
Q

describe features of diffuse astrocytoma on MRI

A

(glioma)

ring enhancing mass in many locations

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11
Q

Glioblastoma, gross pathological features

A

(highly variable)

  • firm + white — soft + yellow due to necrosis (rapid growth exceeds angiogenesis speed)
  • cystic degeneration, hemorrhage- via rapid growth > angiogenesis

-butterfly shaped appearance- since it crosses midline

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12
Q

Glioblastoma, microscopic pathological features

A

eosinophilic necrotic foci:

  • pseudo-palisading (enclosure) of malignant nuclei
  • endothelial cell proliferation
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13
Q

pilocytic astrocytoma:

  • (benign/malignant)
  • (2) affected age group
  • (3) common tumor location
A

(glioma)
1- benign
2- children, young adults
3- cerebellum – may also involve 3rd ventricle, optic paths, spinal cord, hemispheres

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14
Q

pilocytic astrocytoma:

  • related to (1) genetic changes
  • (2) is an associated development with the tumor
A

(glioma)
1- BRAF translocations

2- cysts –> they can enlarge to cause many other symptoms

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15
Q

Oligodendroglioma:

  • (1) affected age group
  • (2) describe progression
  • (3) common tumor location
A

1- 30s-40s
2- insidious growth –> several yrs for Sxs to develop
3- cerebral hemispheres- mostly frontal* and temporal (*highly myelinated areas)

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16
Q

Ependymoma:

  • (1) predominant locations
  • (2) most common location for <20y/o
  • (3) most common location for adults, which is associated with (4) genetically
A 
(glioma)
1- ependyma lined ventricular cavity + central canal of spinal cord
2- 4th ventricle
3- spinal cord
4- NF-2
17
Q

Ependymoma, microscopy:

  • (1) cell features
  • (2) surrounding features
  • (3) cell-to-cell features
  • (4) surrounding cell-to-cell features
A

(glioma)
1- cells appear normal, round/oval nuclei, abundant granular chromatin
2- variable, fibrillary
3- rosette formation –> long delicate processes extending into lumen
4- pseudo-rosettes are perivascular

18
Q

Embroyonal tumors:

  • (1) origin
  • (2) main cellular feature
  • (3) most common tumor
A

1- neuroectodermal origin
2- small round cells
3- medulloblastoma

19
Q

Medulloblastoma:

  • affects (adults/children)
  • (2) common location
  • (3) related genetic defects
A

(embryonal tumor)
1- children
2- cerebellum
3- Wnt-β catenin pathway, MYC overexpression

20
Q

Medulloblastoma:

  • (1) malignancy and prognosis
  • (2) are common and useful clinically in most tumors
  • (3) is an important feature related to treatment
A

(embryonal tumor)
1- highly malignant, poor prognosis
2- neuronal and glial tumor markers
3- very radiosensitive

21
Q

Medulloblastoma, gross appearance

A

(embryonal tumor)

  • well-circumscribed
  • gray
  • friable
  • may involve leptomeninges (arachnoid + pia, CSF inbetween)
22
Q

Medulloblastoma, microscopic features

A

(embryonal tumor)

  • sheets of small, round, blue anaplastic cells
  • hyperchromatic nuclei + abundant mitosis — scant cytoplasm
  • rosettes
23
Q

Meningioma:

  • (1) cell origin
  • (benign/malignant)
  • affects (adults/children)
  • (4) tumor location
A

1- arachnoid meningothelial cells (attached to dura mater)
2- benign
3- adults
4- external surface of ventricular system (attache to dura mater)

24
Q

Meningioma:

  • (1) basis of prognosis
  • (2) clinical features
  • (3) clinical associations (+ genetic)
A

1- depends on size, location, surgical accessibility, histological grade

2- vague non-localizing Sxs + focal Sxs with compression of adjacent brain

3:
-multiple meningiomas + 8th nerve schwannoma OR glial tumor (NF-2)

25
Q

Menigioma:

  • (1) gross features
  • (2) microscopic features
A

1- well defined mass –> compression w/o invasion

2:

  • whorled, tight clusters of cells w/o visible cell membrane
  • some with psammoma bodies (calcified necrotic tissue)
26
Q

Schwannoma:

  • (benign/malignant) tumor arising from (2)
  • (3) is alternate name (hint- its a misnomer)
  • (4) symptoms
A

1- benign
2- peripheral nerves
3- acoustic neuroma
4- local compression of CN-8 => tinnitus, hearing loss

27
Q

Schwannomas are commonly associated with a (loss/gain)-of function mutation of (2) gene for (3) protein on chromosome (4).

A

1- loss-of-function
2- NF-2
3- merlin
4- chr.22

28
Q

Schwannomas:

  • (1) gross features
  • (2) and (3) are the separate microscopic areas (include features for both)
  • (4) features between main structures in (2)
A

1- firm, gray masses

2- Antoni A: dense, eosinophilic, spindle cells with cellular intersecting fascicles, palisading (enclosed) nuclei

3- Antoni B: loose

4- nuclear free zones- Verocay bodies

29
Q

tumor- positive test for IDH-1/2 mutation indicates….

A

better prognosis in glioblastoma

30
Q

tumor- positive test for 1p and or 19q deletions indicates….

A

better prognosis in oligodendroglial tumors

31
Q

tumor- positive test for β-catenin expression indicates….

A

better prognosis for medulloblastoma

32
Q

Metastatic tumors:

  • (1)% of all intracranial tumors
  • most originate from (2) type tumors, commonly from (3) locations
  • (4) is the main location of metastasis
A

1- 25-50%
2- carcinomas
3- lung, breast, melanoma, kidney, GIT
4- gray-white matter junction —> sharply demarcated mass

MNI (neuro path) (9 decks)

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