Usera: CNS Neoplasms

Question 1

Ciliated cells that line the ventricular system and the spinal cord

Answer 1

ependymal cells

Question 2

Schwann cells of the CNS

Answer 2

oligodendrocytes

Question 3

stellate cells that are very important in supporting neurons

Answer 3

astrocytes

Question 4

macrophages of CNS

Answer 4

microglia

Question 5

Most common CNS tumors (70-80% of all CNS tumors)

Answer 5

astrocytomas

Question 6

What area of the brain do astrocytomas usually occur in?

Answer 6

cerebral hemispheres

**can occur anywhere

Question 7

Astrocytomas range in grade from (blank) to (blank)

Answer 7

1; 4

Question 8

List the astrocytomas from Grade 1 through Grade 4

Answer 8

Pilocytic astrocytoma
Diffusely infiltrating astrocytoma
Anaplastic astrocytoma
Glioblastoma multiforme

Question 9

Who grade I (i/iv)
Often cystic and Well circumscribed
Unique histologic appearance, benign behavior
Typically in children and young adults
Usually in the cerebellum, but can occur elsewhere
No p53 mutation

Answer 9

Pilocytic astrocytoma

Question 10

Who typically gets pilocytic astrocytomas?

Answer 10

children and young adults

Question 11

Where do pilocytic astrocytomas occur?

Answer 11

in the cerebellum

**can occur elsewhere

Question 12

What are 2 histological features you would notice if looking at a pilocytic astrocytoma?

Answer 12

dense, “hair-like” fibrillary meshworks
Rosenthal fibers (large red fibers)
little to no nuclear atypia

Question 13

Who grade II (ii/iv)
Poorly defined, infiltrating tumor. Expands and distorts normal brain architecture
Surgical implications?
Increased cellularity with Mild to moderate nuclear atypia
No mitotic figures
Variable prognosis, but usually indolent lesion
p53 mutation common

Answer 13

Diffusely infiltrating astrocytoma

Question 14

Histological features of diffusely infiltrating astrocytoma?

Answer 14

increased cellularity with mild/moderate nuclear atypia;

no mitotic figures

Question 15

Who grade iii (iii/iv)
Similar to grade ii, but with increased, cellularity nuclear atypia and mitotic figures
Median survival 3 years
p53 mutation common

Answer 15

Anaplastic astrocytoma

Question 16

How is a diffusely infiltrating astrocytoma (grade II) different from an anaplastic astrocytoma (grade III)?

Answer 16

anaplastic astrocytomas have

1. increased cellularity
2. increased nuclear atypia
3. mitotic figures

Question 17

Who grade iv (iv/iv)
Most common CNS neoplasm
Highly aggressive, ~6-15 month survival
Marked nuclear pleomorphism and atypia
p53 mutation common

Answer 17

Glioblastoma multiforme

Question 18

What four histological features are indicative of glioblastoma multiforme?

Answer 18

Atypia
Mitotic figures
Endothelial proliferation
Necrosis

Question 19

Glioblastoma multiforme will often cross the (blank) of the brain and may be called a (blank) lesion

Answer 19

midline; butterfly

Question 20

*Who grade ii (ii/iv)
5-15% of gliomas
More common 4th-5th decades
Cerebral hemispheres:
Infiltrating, Cystic, hemorrhagic, frequent calcifications
*Low proliferative rate
Genetics: loss of 1p, 19q associated with good response to chemo/radiation

Answer 20

Oligodendroglioma

Question 21

What Who grade do oligodendrogliomas get?

Answer 21

Who grade II

Question 22

What is one feature you might see in the cerebral hemispheres with a patient with an oligodendroglioma?

Answer 22

calcifications

Question 23

What do oligodendrogliomas look like histologically?

Answer 23

fried-egg nuclei and chicken-wire vasculature

Question 24

What chromosome deletion is a positive predictor of response to chemo/radiation in patients with oligodendroglioma?

Answer 24

1p, 19q

Question 25

Benign tumor of adults (female predominance 3:2) Frequently PR+ Arise from meningothelial cells of the arachnoid Associated with loss of chromosome 22 Many histologic subtypes that vary in biologic behavior

Answer 25

meningiomas

Question 26

Meningiomas are frequently positive for what receptor?

Answer 26

progesterone receptor

Question 27

What chromosome deletion is often associated with meningiomas?

Answer 27

chromosome 22

Question 28

Are meningiomas benign or malignant?

Answer 28

benign, but can become malignant

Question 29

2 distinct histological features of a meningioma?

Answer 29

``` whorled pattern of growth psammoma bodies (starry night calcifications) ```

Question 30

Arise from ependymal cells lining ventricular system Children and adults Associated with nf2 0-20 yrs: paraventricular (4th ventricle most common) Spinal cord most common site in adults

Answer 30

Ependymoma

Question 31

Ependymomas arise from (blank) cells which line the ventricular system

Answer 31

ependymal

Question 32

Ependymomas are associated with (blank)

Answer 32

neurofibromatosis type II

Question 33

Where do people ages 0-20 most frequently get ependymomas?

Answer 33

4th ventricle

Question 34

Where do adults most commonly get ependymomas?

Answer 34

spinal cord

Question 35

Histologic features of ependymomas?

Answer 35

rosettes (empty lumen surrounded by ciliated cells) and pseudorosettes (tumor cells extend toward a blood vessel in the center of the lumen)

Question 36

Cerebellar tumor in children Derived from external granular cell layer Associated with 17p- and myc amplification aggressive, poor prognosis radiosensitive “small round blue cell tumor” with both neuronal and glial phenotypes Homer-wright rosettes (neuronal) Gfap+ (glial)

Answer 36

medulloblastoma

Question 37

Where do medulloblastomas occur? Who gets them?

Answer 37

cerebellum; children

Question 38

Medulloblastomas are associated with amplification of (blank) and (blank)

Answer 38

17p and MYC

Question 39

Medulloblastomas have both neuronal and glial features. What is one neuronal feature? What is one glial feature?

Answer 39

homer-wright rosettes | GFAP+

Question 40

Children most often get brain tumors (blank)

Answer 40

infratentorially (under the tentorium)

Question 41

Ebv-related high-grade b-cell lymphoma (NHL) associated with immunosuppression AIDS, post-transplant 2% extranodal lymphomas, 1% intracranial tumors Frequently multifocal Bcl-6+

Answer 41

Primary CNS lymphoma

Question 42

Primary CNS lymphomas are associated with (blank) and are (blank) positive

Answer 42

EBV; BCL-6

Question 43

Most common CNS malignancy; 25-50% of all intracranial malignancy

Answer 43

metastases

Question 44

Which carcinomas are most likely to metastasize to the CNS?

Answer 44

lung breast melanoma