Neoplasms

Question 1

Pilocytic Astrocytoma

Ages and Grade

Answer 1

CHILDHOOD (and sometimes young adults)

Grade 1

Question 2

Pilocytic Astrocytoma

Locations

Answer 2

Cerebellum, optic pathway, hypothalamus & thalamus, spinal cord, temporal lobe

Question 3

Pilocytic Astrocytoma

Genetics/Histol/etc.

Answer 3

BRAF:KIAA fusion

Bipolar cells with hairlike processes, Rosenthal fibers

Question 4

Diffuse Astrocytoma

Ages and Grade

Answer 4

Mean: 30s-40s

Grade 2

Question 5

Diffuse Astrocytoma

Locations

Answer 5

Cerebral hemispheres (also poss. brainstem) but NOT areas of pilocytic

Question 6

Diffuse Astrocytoma

Genetics/Histol/etc.

Answer 6

irregular distribution of tumor cells, no mitoses

Gross: diffuse expansion of pons in brainstem

Question 7

Anaplastic Astrocytoma

Ages and Grade

Answer 7

Mean: 45 yrs

Grade 3

Question 8

Anaplastic Astrocytoma

Location

Answer 8

Cerebral hemispheres but MORE MITOSES

Question 9

Anaplastic Astrocytoma

Genetics/Histol/etc.

Answer 9

deep/blue purple (more chromatin), aneuploidy
IDH1 mutation + LOH 1p/19q + p53/ATRX
1p/19q responds well to chemo

Question 10

Oligodendroglioma

Ages and Grade

Answer 10

Mean: 42 yrs (onset)

Grade 2

Question 11

Oligodendroglioma

Location

Answer 11

Cerebral WHITE matter but can invade grey (if so - seizures)

Question 12

Oligodendroglioma

Genetics/Histol/etc.

Answer 12

Defined as: 1p/19q deletion to make combined protein (with IDH1 grandparent mutation)
Fried egg w/ v little cytplasm

Question 13

Anaplastic Oligodendroglioma

Ages and Grade

Answer 13

Mean: 46 yrs onset

Grade 3

Question 14

Anaplastic Oligodendroglioma

Location

Answer 14

As Oligodendroglioma

Question 15

Anaplastic Oligodendroglioma

Genetics/Histol/etc.

Answer 15

1p/19q codeletion with 9p loss and 10q loss (found by FISH)

Histol: increased cellularity, nuclear atypia, MITOSES

Question 16

Glioblastoma (GBM)

Ages and Grade

Answer 16

Primary mean: 62 yrs (de novo 90%)
Secondary mean: 45 years (progression from lesser glioma)
GRADE 4

Question 17

Glioblastoma (GBM)

Location

Answer 17

Usually Cerebral hemispheres

Question 18

Glioblastoma (GBM)

Genetics/Histol/etc.

Answer 18

Proliferative blood vessels
Can be multifocal
Very adverse prognosis
If MGMT (methylation) positive then will respond well to alkylating agent
Poss EGFR amp (bad ) on 7p12

Question 19

Ependymoma

Answer 19

USUALLY pediatric (first 2 decades)
Grade 2 (3 if anaplastic)
Ependymal cells that line ventricles (usually 4th) - so presents with obstructive hydroencephalus
If in ADULTS - SPINAL CORD

Question 20

Choroid plexus papilloma

Answer 20

NOT an ependymoma but DOES occur in ventricles

Grade 1

Question 21

Medulloblastoma

Answer 21

Most common malignant brain tumor in CHILDREN
ALL grade 4
Slight M>f, ~50% survival
Origin: GCPs (cerebellar granular) from EGL
Histol: Homer Wright rosettes
Chromosome 17 deletions

Question 22

Meningioma

Answer 22

Women in 50s
“Push/shove” rather than invade, usually solitary
Grade 1 (atypical grade 2 prone to recurrence, anaplastic grade 3)
Hemangioperictyoma: much worse
NF2 mutation on 22q

Question 23

Schwannoma

Answer 23

Slow growing, on nerves, malignancy rare

CRANIAL NERVE 8 most common (so “acoustic neuroma”)

Question 24

Familial Tumor Syndromes

Answer 24

NF-1, NF-2
Tuberous Sclerosis
VHL
Cowden
Turcot's

Question 25

Metastases

Answer 25

Breast, lung, kidney, melanoma, GI (most tumors in the brain are metastases rather than primary brain tumors)