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17 CNS Pathology > 17.8 CNS tumors > Flashcards

17.8 CNS tumors Flashcards

1
Q

primary CNS tumors

-location: adult vs children

Most common adult tumor, cell type?

most common child tumor, cell type?

A

adult: supratentorial
children: infratentorial

Adult: GBM–glioblastoma multiforme

Child: PCA–pilocytic astrocytoma

(both astrocytes)

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1
Q

Brain imaging: you see a round mass attached to the dura

  • think what?
  • what would you expect on biopsy?
A

think Meningioma

-biopsy would reveal whorled pattern of cells, psamomma bodies may be present

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2
Q

meningioma

  • what cell type, malignant?
  • population
  • clinical presentation
A
  • arachnoid cells of meninges, benign.
  • adults, esp adult females
  • Presents with seizures– tumor compresses, but does not invade cortex. Tumor expresses estrogen receptor, which is why it is more common in adult females.
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3
Q

Brain imaging–you see a lesion in the cerebral cortex that crosses the corpus callosum

-think what?

A

Butterfly lesion–think GBA–glioblastoma multiforme

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4
Q

primary CNS tumors, children:

  • most common tumor
  • other common ones (2)
A
  1. PCA–pilocytic astrocytoma
  2. medulloblastoma–neuroectoderm cells
  3. ependyoma–ependymal cells
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5
Q

Biopsy: you see small, round blue cells

-think what?

A

medulloblastoma

-Homer-wright rosettes may be present (blue cells wrap around neuritic processes)

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6
Q

Oligodendroglioma (ODG)

  • what cell type, malignant?
  • clinical presentation?
A
  • oligodendrocytes, malignant.
  • may present with seizures, b/c it involes frontal lobe.
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6
Q

Rosenthal fibers

  • what are they
  • where do you see these?
A

-thick eosinophilic processes of astrocytes.

Seen in biopsy of piloytic astrocytoma (PCA)

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6
Q

Biopsy: you see thick red processes and red granular bodies

-think what

A

PCA–pilocytic astrocytoma

  1. (rosenthal fibers–red thick processes of astrocytes)
  2. eosinophilic granular bodies
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6
Q

medulloblastoma

  • what cell type, malignant?
  • population
  • prognosis
A
  • neurons–granular cells of cerebellum (neuroectoderm), malignant.
  • children
  • poor prognosis–tuomr grows rapidly and spreads via CSF–‘drop metastasis’ to cauda equina
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7
Q

meningioma

  • imaging shows what
  • histology shows what?
A
  1. round mass attached to dura
  2. whorled pattern, psmammoma bodies may be present
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8
Q

Pilocytic astrocytoma

  • appearance on imaging
  • appearance, histology (2)
  • positive for what stain
A
  • cystic lesion with mural nodule (nodule growing on wall)
  • think “PiloCYSTIC astrocytoma”
    1. Rosenthal fibers (thick eosinophilic processes of astrocytes)
    2. eosinophilic granular bodies

GFAP+

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10
Q

Pseudopalisading

-histology of what?

A

(Butterfly with star shaped design on palisade fence)

Glioblastoma multiforme, astrocytes

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11
Q

Ependymoma

-histology appearance

A

-perivascular pseudorosettes

(tumor cells surround blood vessel)

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12
Q

Brain imaging:

  • you see cystic lesion with a nodule growing on its wall
  • think what?
A

Think PCA–pilocytic astrocytoma

(think piloCYSTic astrocytoma)

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13
Q

medulloblastoma

-clinical presentation

A
  • malignant tumor, grows rapidly and spreads via CSF
  • “drop metastasis”– mets to the cauda equina via CSF
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14
Q

primary CNS tumors, adults

  • most common?
  • other common ones (2)
A
  1. GBM–glioblastoma multiforme
  2. meningioma–(adult women)
  3. schwanomma
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14
Q

Ependymoma

  • what cell type, malignant?
  • population
A
  • ependymal cells (line ventricles), malignant
  • children
16
Q

Ependymoma

-clinical presentation, location

A

(ependymal cells line ventricles)

-usu arises in 4th ventricle (remember child tumors usu infratentorial). Can obstruct ventricles, cause hydrocephalus

18
Q

CNS tumors

  • what % primary, what % mets
  • metastatic: what are most common sources (3)
A

50% each

  1. lung
  2. breast
  3. kidney
19
Q

What are the cells types for CNS tumors, and what tumors do they make?

(5 cell types, 6 tumors)

A

(see chart)

  1. Astrocytes: PCA (children), GBM (adults)
  2. Oligodendrocytes ODG (adults)
  3. Ependymal cells Ependyoma (children)
  4. Neurons Med (medulloblastoma–children)
  5. Meningothelial cells (Meningioma–adult females)
20
Q

Craniopharyngioma

  • clinical presentation
  • appearance on imaging
A
  • supratentorial mass in child/young adult, may compress optic chiasm, leading to bitemporal hemianopsia
  • calcifications commonly seen (think–epithelial cells are derived from ‘tooth-like’ tissue)
21
Q

Glioblastoma Multiforme (GBM)

  • what cell type
  • malignant?
  • gross presentation
  • histological presentation
  • what stain is positive?
A
  • malignant high grade tumor of astrocytes
  • “Butterfly glioma”– usu arises in cerebral hemisphere and cross corpus callosum
  • ‘pseudopalisading’ – regions of necrosis surrounded by tumor cells and endothelial cell proliferation
  • GFAP+ (glial cells)
    think: butterfly with star design sitting on palisade fence.
22
Q

Craniopharyngioma

  • what cells, how does this arise?
  • malignant?
A
  • epithelial cells, remnants of Rathke’s pouch.
  • benign
23
Q

neurofibramatosis type 2

-assoc with what CNS tumor?

A

-presents with bilateral schwannomas

24
Q

What tumors do these make:

  1. astrocytomas
  2. oligodendrocytes
  3. ependymal cells
  4. neurons
  5. meninges
A
  1. PCA, GBA
  2. oligodendroglioma (adults)
  3. ependymoma (children)
  4. medulloblastoma (children)–neuroectoderm in cerebellum
  5. meningioma
25
Q

medulloblastoma

-histology appearance

A
  • small, round blue cells
  • Homer-Wright rosettes may be present (when the blue cells wrap around neuritic processes)
26
Q

CNS tumor of the neuroectoderm

-which one?

A

Medulloblastoma, in children

-derived from granular cells of cerebellum

28
Q

Primary CNS tumors:

-do they metastasize frequently?

A

No, rarely metastasize, but locally destructive

29
Q

What tumor expresses estrogen receptors?

A

Meningioma–this is why it’s more common in females

30
Q

oligodendroglioma

  • what do you see on imaging?
  • histology appearance?
A

calcified tumor in the white matter, usu in frontal lobe (may present with seizures)

-‘Fried egg” appearance on histology

31
Q

Schwannoma

  • how does it often present if inside cranium?
  • clnical symptoms?
A
  • benign tumor of Schwann cells
  • can involve cranial or spinal nerves. If inside cranium, most frequently invoves CN8 at the cerebellopontine angle
  • Hearing loss and tinnitus
32
Q

Homer-Wright rosettes

A

when small, round blue tumor cells wrap around neuritic processes

-eg medulloblastoma

33
Q

Pilocytic astrocytoma

  • what cell type, malignant?
  • population
  • location
A
  • astrocytes, benign
  • most common of children
  • infratentorial, usu in cerebellum

Think ‘piloCYSTIC astrocytoma’ for cysts

34
Q

Schwannoma

  • cells are positive for what?
  • assoc with what disorder?
A
  • S-100+
  • bilateral tumors seen in neurofibromatosis type 2
36
Q

Drop metastasis

-seen with what?

A
  • tumor metastasizes through CSF to cauda equina
  • seen with medulloblastoma of children.
37
Q

Brain imaging: you see calcified tumor in white matter in the frontal love

-think what

A

Oligodendroglioma

-usu in frontal lobe, calcified. may present with seizures

38
Q

Biopsy: you see tumor cells surround blood vessels

-think what?

A

These are perivascular pseudorosettes

-Ependymoma

39
Q

Glioblastoma multiforme

-prognosis?

A

poor prognosis

40
Q

Imaging: you see calcified lesion

  • in frontal lobe, think what?
  • near optic chiasm, think what?
A
  1. oligodendroglioma
  2. craniopharyngioma
41
Q

Butterfly lesion

-think what

A

‘butterfly glioma’

-GBM–glioblastoma multiforme, adult tumor of astroycytes

42
Q

Biopsy: you see whorled pattern and psamomma bodies

-think what?

A

CNS tumor: Meningioma

43
Q

Fried egg appearance on histology

-think what?

A

Oligodendroglioma

44
Q

Pt presents with hearing loss and tinnitus.

think what CNS tumor?

A

CN8 schwannoma.

-most frequency involves CN8 when inside cranium

17 CNS Pathology (8 decks)

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