Neoplasms Flashcards by A B

Grade 1 lesions means

low prolif potential
well circumscribed
cure = resection alone

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Grade 2 lesions

infiltrative
low proliferative but still recurs
can’t cure just by resection

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Grade 3 lesions means

nuclear atypia

incr mitotic activity = malignancy

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Grade 4 tumors

mitotically active
necrosis prone
rapid disease evolution

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Describe pilocytic astrocytoma (WHO grade 1)
age population
typically located where?

in children

located in cerebellar hemispheres, optic nerves/chiasm, then hypothalamus

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Describe pilocytic astrocytoma

cellular features

well circumscribed, non infiltrative
cystic, occasional calcifications

biphasic features = both compact (pilocytic with elongated bipolar cells and rosenthal- eosinophilic bodies)

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Treatment of pilocytic astrocytoma

if in cerebellar = excision alone

if elsewhere, need more therapy

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Diffuse astrocytoma (WHO grade II)
affects where?

occurs in what ages?

caused by what mutation?

affects white matter of cerebral hemisphere, infiltrative pattern

btwn 30-50 years

causd by p53 mutations

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Diffuse astrocytoma

cellular features

ill-defined border

irregular tumor cell distrib/nuclear features but
no mitosis

many astrocytic types (fibrillary, protoplasmic, gemisocytic) in same tumor

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if diffuse astrocytoma shows signs of hyperchromatism, nuclear atypia, or mitosis then menas

can progress to grade III

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treatment of diffuse astrocytoma

surgery + radiation/chemo

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Anaplastic astrocytoma (WHO grade III)
usu due to?

shows more ___ compared to diffuse astrocytoma

age?

location?

usu due to progression of diffuse astrocytoma (grade II)

shows more MITOSIS than diffuse astrocytoma

45 y/o

cerebral hemispheres

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Anaplastic astrocytoma (WHO grade III)
can use what kind of marker to identify?

MIB-1 to identify which cells in M phase to find if high level of mitotic activity

MOST IMPORTANT USE TO DISTINGUISH BTWN DIFFUSE VS ANAPLASTIC

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Anaplastic astrocytoma (WHO grade III)
compared to grade IV, does not have what?

no necrosis/angiogenesis

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Anaplastic astrocytoma (WHO grade III)
treatment

surgery + radiation/chemo

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Glioblastoma multiforme (WHO grade IV)
frequency?

usu found in what ages?

types of mutations?

most are at what stage?

most common of all gliomas

presents in 50-60

EGFR and PTEN mutations

90% primary (de novo)

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Glioblastoma multiforme (WHO grade IV)
cellular features

exhibits what pattern?

highly infiltrative and hemorrhagic
necrosis
angiogenesis
cell migration
nuclear changes
high mitotic rate 
edema

“butterfly pattern b/c cross hemispheres

with VEGF = incr BBB leakiness and microvascularity

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Glioblastoma multiforme (WHO grade IV)
treatment

surgery, radiation, chemo but prognosis

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oligodendroglioma (WHO grade II)
most often where?

what age?

presents as?

prognosis compared to diffuse astrocytoma

in cerebral white matter

usu in adults (42 y/o)

presents as seizures

better prognosis than diffuse astrocytoma

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oligodendroglioma (WHO grade II)

survival based on?

survival based on loss of hetoerozygosity of chromosome 1p and 19q so can respond well to chemo –> creates fusion btwn 1 and 19

share IDH1 with oligo and astrocytic lineage

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oligodendroglioma (WHO grade II)
classically what stage?

cellular appearance

grade II or III

fried egg = monotonous tumor with scant eosinophilic cyto and perinuclear haloes

+ calcifications and hemorrhages

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oligodendroglioma (WHO grade II)

tumor marker?

MIB-1 to find cells in M phase to see if enough mitotic activity for grade III

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oligodendroglioma (WHO grade II)

treatment

surgery + radiation/chemo

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Anaplastic oligodendrogliomas (grade III)
usu due to?

progression of oligodendroglioma with more mitosis

more vascular proliferation and necrosis

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``` Anaplastic oligodendrogliomas (grade III) shows what on preoperative neuroimaging ``` histological appearance what tumor marker

DQ shows enhancement fried egg apppearance like oligodendroglioma MIB-1 for cells in M phase

Anaplastic oligodendrogliomas (grade III) treatment

surgery + radiation/chemo

ependymoma (WHO grade II) arises from what cells? most present what age? most present where?

arises from ependymal cells in ventricles (intraventricular) presents by 20 years old (vs spinal cord = usu in adults only) most in 4th ventricle with obstructive hydrocephalus

ependymoma (WHO grade II) cellular appearnce

perivascular pseudorosettes mimic ependymal canals with vessel in center commonly calcified; protrude from 4th ventricle

ependymoma (WHO grade II) | comparison prognosis btwn 4th ventricle vs lateral ventricles/spinal cord

worse if in 4th ventricle

ependymoma (WHO grade II) | treatment

excision

Anaplastic ependymoma (grade III) progression of ? usu found where in kids vs adults

progression of ependymoma found in 4th ventricle in kids found in spinal cord in adults

``` Anaplastic ependymoma (grade III) cellular appearance ``` tumor marker?

same as ependymoma = perivascular pseudorosettes with calcification MIB-1 for cells in M phase

``` Anaplastic ependymoma (grade III) treatment ```

surgery + radiation/chemo

medulloblastoma (grade IV) most common tumor in what age? metastasizes via what pathways related to what genetic defects? can lead to?

children only 3-8 years old metastasize via CSF pathways (only brain tumor that metastasizes systemically) chromosome 17 deletions/mutations causes obstructive hydrocephalus

medulloblastoma (grade IV) | arises from?

external granule layer of cerebellum

medulloblastoma (grade IV) | cellular features

Homer-wright pseudorosettes (circular nuclei with central anuclear area) small blue cells (small embryonal cells with little cytoplasm)

medulloblastoma (grade IV) | what to avoid

don't do LUMBAR PUNCTURE because creates pressure gradient from incr ICP --> herniation

medulloblastoma (grade IV) | presents with?

gait, nystagmus, dysmetria due to cerebellar location

medulloblastoma (grade IV) treatment what is assoc with worse prognosis

aggressive chemo/radiation worse prognosis if: 1) spread to CSF 2) MYC oncogene amplification

Choroid plexus papilloma (grade I) always located where in kids vs adults can lead to?

located in lateral ventricles in kids located in 4th ventricle in adults lead to non-comm hydrocephalus

Choroid plexus papilloma (grade I) | cellular appearance

mimic normal choroid plexus except papillary formations are more abudant low mitotic rate mild nuclear atypia

Choroid plexus papilloma (grade I) | treatment

excision

mixed tumors ganglioma (grade I) usu located where mix of what?

usu in temporal lobe mix of neurons and glia

mixed tumors ganglioma (grade I) cellular appearance

``` well circumscribed often cystic (like pilocystic astrocytoma) ``` likely with calcifications and perivascular lymphocytes ncr jumbled, abnormal neurons with low grade glial background

mixed tumors ganglioma (grade I) treatment

excision

``` mixed tumors mixed oligoastrocytoma (grade II) ``` mix of?

admixed astrocytes and oligodendrocytes

``` mixed tumors mixed oligoastrocytoma (grade II) ``` cell marker? what stain to distinguish astrocytes from oligodendrocytes

MIB-1 to find cells in M phase GFAP staining to distinguish

``` mixed tumors mixed oligoastrocytoma (grade II) ``` treatment better prognosis if?

surgery + rad/chemo better if loss of heterozygosity of 1p, 19q

``` mixed tumors anaplastic oligoastrocytoma (grade III) ``` mix of?

admixed astrocytes + oligodendrocytes with high mitotic activity

``` mixed tumors mixed oligoastrocytoma (grade II) ``` tumor marker?

MIB-1 to find cells in M phase of cell cycle

``` mixed tumors mixed oligoastrocytoma (grade II) ``` treatment

surgery + rad/chemo

meningeal and mesenchymal tumors meningioma usu grade? if in kids suspect? peak incidence in what gender/age?

usu grade 1 if in kids think familial cancer peak in women in 50's

meningeal and mesenchymal tumors meningioma which form assoc with worse prognosis

hemangiopericytoma worse prognosis

meningeal and mesenchymal tumors meningioma usu attach to? nickname?

usu attach to meninges with dural tail that extends in either direction "pusher and shover" tumors

meningeal and mesenchymal tumors meningioma treatments

excision

meningeal and mesenchymal tumors schwannoma found where?

usu on cranial nerves usu CN 8 | also on spinal nerve roots

meningeal and mesenchymal tumors meningioma histology

little variability, slow growing

meningeal and mesenchymal tumors meningioma treatment

excision

metastatic tumors usu from where? grade?

1) breast 2) lung 3) kidney 4) malignant melanoma 5) GI tract tumors grade IV (well demarcated, noninfiltrate rare hemorrhage)

ratio of cerebral: cerebellar mets route of metastasis to brain

8:1 hematogenous NOT LYMPHATIC