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ADV PATH > 1F-CNS > Flashcards

1F-CNS Flashcards

1
Q

Most common tumor of the brain

A

Glial tumors

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2
Q

What grade of Astrocytoma?

Circumscribed; bipolar and multipolar cells, microcysts, Rosenthal fibers, granular bodies, vascular proliferation or focal necrosis

A

Grade 1: Pilocytic

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3
Q

What grade of Astrocytoma?

  • Moderate hypercellularity
  • Mild nuclear atypia
  • No or minimal mitotic activity
A

Grade 2: Diffuse

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4
Q

What grade of Astrocytoma?

  • Increased cellularity
  • Diffuse infiltration
  • Increased nuclear atypia
  • Increased mitotic activity
A

Grade 3: Anaplastic

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5
Q

What grade of Astrocytoma?

  • Vascular proliferation
  • Widespread necrosis
  • Crowded anaplastic cells
  • Marked nuclear atypia
  • Brisk mitotic activity
A

Grade 4: Glioblastoma

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6
Q

Largest group of gliomas

A

Grade 2: Diffusely infiltrating astrocytoma

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7
Q

Diffusely infiltrating astrocytoma is most prevalent in what age

A

Adults

*can also be seen in children; affects all ages

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8
Q

Location of Diffusely infiltrating astrocytoma

A

At any level of central neuraxis

  • Predilection:
  • Adults: Supratentorial, cerebral cortex (Cerebral hemisphere)
  • Children: Infratentorial, cerebellum
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9
Q

Symptoms of Diffusely infiltrating astrocytoma

A
  • Headaches
  • Seizures
  • Focal sensorimotor deficits
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10
Q

Three variants of Diffusely infiltrating astrocytoma

A
  • Fibrillary: most frequent; thread-like
  • Gemistocytic: plump cells
  • Protoplasmic
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11
Q

DIffuse astrocytoma occurring in 3rd-4th decade of life; characterized by discohesive patternless array of glial cells

A

Fibrillary astrocytoma

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12
Q

Important gross characteristic of Fibrillary astrocytoma

A

Spatially indistinct

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13
Q

Symptoms presenting in Fibrillary astrocytoma

A
  • Intermittent seizures

- Headache

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14
Q

Microscopic features of Fibrillary astrocytoma

A
  • Calcospherites
  • Hair-like cytoplasmic processes
  • Microcysts
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15
Q

This evolves from a well-differentiated astrocytoma; Demonstrates nuclear angulation, dense hyperchromasia, pleomorphism, and mitotic figures

A

Grade 3: Anaplastic astrocytoma

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16
Q

Neoplastic transformation of committed astroglial progenitors

A

Grade 4: Glioblastoma multiforme

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17
Q

Oncogenic pathways involved in Glioblastoma multiforme

A
  • TP53 mutation/ deletion
  • Loss of heterozygosity in chr 10
  • EGFR amplification
  • PTEN mutation
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18
Q

Glioblastoma multiforme characteristics

A
  • More rapid growth
  • Destructive invasion
  • Very aggressive
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19
Q

Microscopic features of Glioblastoma multiforme

A
  • Highly cellular
  • Mitotically active
  • Bizarre multinucleated giant cells or small anaplastic cells
  • Coagulative necrosis w/ or w/o palisading cells
  • Glomeruloid appearing microvascular proliferation
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20
Q

Well-circumscribed, gelatinous masses often with cysts, hemorrhage, and calcification; occurs in 4th-5th decade of life

A

Oligodendroglioma

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21
Q

Location of Oligodendroglioma

A

White matter of cerebral hemisphere

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22
Q

Impt. microscopic characteristic of Oligodendroglioma

A

Spherical nuclei with halo of cytoplasm (“sunny side up fried egg appearance”)

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23
Q

T or F: Oligodendroglioma has worse prognosis than astrocytoma

A

FALSE

*Better prognosis than astrocytoma

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24
Q

CNS tumor usually found centrally in the brain or spinal cord; often manifested with hydrocephalus and CSF dissemination

A

Ependymoma

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25
Q

Locations of ependymoma

A

● Most often at ependyma-lined ventricular system
● First two decade of life - fourth ventricle
● In adults - spinal cord

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26
Q

Impt. microscopic feature of ependymoma

A

Ependymal rosette

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27
Q

T or F: Ependymoma has a poor prognosis

A

TRUE

*because of its behavior and location

28
Q

Most common mixed gliomas

A

Oligoastrocytoma

29
Q

Location of Mixed glioma

A
  • Supratentorial tumors of adulthood

- Favors frontal and temporal lobes

30
Q

T or F: Mixed gliomas are more common than pure gliomas

A

FALSE, they are rare

31
Q

Very aggressive CNS tumors that are common among children; they are derived from primitive neuroepithelial precursors

A

Embryonal neuroepithelial tumors

32
Q

Microscopic characteristic of Embryonal neuroepithelial tumors

A

Small anaplastic cells uncommitted to any particular cytogenetic pathway

33
Q

Most common primitive neuroepithelial neoplasm in CNS

A

Medulloblastoma

34
Q

Very primitive-looking cells coupled with rosette-like configuration

A

Medulloblastoma

35
Q

Age of occurrence in Medulloblastoma

A

Children: 5-10 y/o
Adult: 3rd-4th decade

36
Q

Location of Medulloblastoma

A

Cerebellar vermis

  • 75% of childhood lesions arise in the cerebellar vermis
    • often expanding to fill the 4th ventricle
    • producing obstructive hydrocephalus
37
Q

T or F: Medulloblastoma are highly malignant and are resistant to radiotherapy

A

FALSE

● Rapid growth (highly malignant)
● Radiosensitive

38
Q

T or F: When you can identify the tumor from normal tissue, most likely it is benign. Malignant tumors have indistinct borders

A

FALSE

  • When you can identify the tumor from normal tissue, most likely it is MALIGNANT
  • BENIGN tumors have indistinct borders
39
Q

Pineal gland tumor that has an aggressive local growth with destructive invasion of neighboring structures. it has predilection for children and adolescents and has proclivity for dissemination via the CSF

A

Pineoblastoma

40
Q

Pineal gland tumor that has a varied histology and unpredictable biologic potential; has rosette structures

A

Pineocytoma

41
Q

T or F: What would differentiate medulloblastoma from pineocytoma is the location

A

TRUE

42
Q

Most common CNS neoplasm in immunosuppressed patients

A

Primary brain lymphoma

43
Q

CNS lesion of B-cell origin, often with multiple tumor masses

A

Primary brain lymphoma

44
Q

A common CNS lesion arising from meningothelial cells of the arachnoid which may compress the underlying brain

A

Meningiomas

45
Q

T or F: Most meningiomas are benign

A

TRUE

46
Q

What grade of Meningioma?

○ Less than four mitotic figures per 10 hpf

A

Grade I: Meningioma

47
Q

What grade of Meningioma?

○ Increased mitotic activity: 4-19 per 10 hpf
○ Or three or more of the following:
■ Increased cellularity
■ Small cells with high nuclear-to-cytoplasmic ratio
■ Prominent nucleoli
■ Sheetlike and/or patternless growth pattern
■ Foci of spontaneous or geographic necrosis

A

Grade II: Atypical meningioma

48
Q

What grade of Meningioma?

○ Increased mitotic activity >19 per 10 hpf
○ Or malignant and or anaplastic cytologic appearance

A

Grade III: Anaplastic meningioma

49
Q

Most frequent nerve sheath tumor; benign

A

Schwannomas

50
Q

Location of schwannomas

A

Adults: Cerebellopontine angle or lumbosacral spinal extramedullary space

51
Q

Schwannoma that originates in the vestibular branch of the CN VIII

A

Acoustic schwannoma or neuroma

52
Q

Microscopic features of Schwannoma

A

Antoni A, Antoni B, Verrucae bodies

53
Q

Antoni A vs Antoni B

A
  • Antoni A: very cellular; palisading of the nuclei (verrucae bodies)
  • Antoni B: loose area
54
Q

Malignant counterpart of Scwannoma

A

Malignant peripheral nerve sheath tumor

55
Q

Origin of Malignant peripheral nerve sheath tumor

A
  • Half arise de novo

- Other half from nerves involved by neurofibromatosis

56
Q

Two conditions where MPNST should be the primary consideration

A

○ When the tumor develops in a patient with a type I Recklinghausen’s disease
○ When the tumor is obviously arising with the anatomic compartment of a major nerve

57
Q

Histologic characteristics of MPNST

A
  • Serpentine shape of tumor cells
  • Arrangements in palisade or whorls
  • Marked contrast between deeply
    hyperchromatic nuclei and pale cytoplasm
  • Perivascular concentration of cells
  • Abundant mitosis.
58
Q

Secondary brain tumors origin

A
  • Direct extension

- Hematogenous metastasis

59
Q

Most common primary sites

A

Lung, breast, skin, kidney, GIT

60
Q

T or F: Sarcomas typically spread to the brain directly

A

FALSE

*Sarcomas typically spread to the lungs first en route to the brain.

61
Q

Most common location of secondary tumors

A

Frontoparietal cerebral tissues

62
Q

Reason behind the common location of secondary tumors

A

Due to middle cerebral artery

63
Q

T or F: Metastatic lesions are usually compact in their growth pattern and thus tend themselves to excision

A

TRUE

64
Q

Histologic characteristic of Secondary tumors in the brain

A

Conform to the histology of the primary site.

65
Q

T or F: A confident diagnosis of metastatic carcinoma can often be made at the time of surgery by examination of the smear or crush preparation showing cellular cohesion of most epithelial neoplasms.

A

TRUE

ADV PATH (10 decks)

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