6/16- Neuro-oncology III Flashcards

1
Q

Meningiomas are typically what grade?

A

Grade 1

  • Well-circumscribed
  • Surgically resectable (although over convexity is much easier than in cavernous sinus…)

They can progress to a higher grade (there is such a thing as a malignant meningioma), but they’re rare

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2
Q

What is this?

A

Meningioma

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3
Q

What is this?

A

Meningioma

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4
Q

What kind of cells form meningiomas? Where are they located?

A

Meningoethelial cells

  • Located in dura and arachnoid caps?
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5
Q

What is this?

A

Meningioma???

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6
Q

Where can a Schwannoma occur? Common?

A

Anywhere there are Schwann cells

  • Peripheral nerves
  • Any cranial nerves
  • Very common = CN 8 (cerebro-pontine angle/ponto-medullary junction)
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7
Q

What is this?

A

Meningoethelial cells

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8
Q

What is this?

A

Meningioma of the lateral convexity

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9
Q

What is this?

A

Meningioma

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10
Q

What is this? Origin?

A

Meningioma of the optic nerve

  • Arises from dural sheath of the nerve
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11
Q

Symptoms of CP angle Schwannoma

(auditory neuroma - bad terminology)?

A
  • Unilateral hearing loss
  • Tinnitus possible
  • Nystagmus and vertigo if vestibular n. involved
  • Can compress adjacent nerves (e.g. 5 and 7) if it enlarges
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12
Q

Compare these two tumors of the optic nerve. What are they?

A

L = Meningioma

R = Pilocytic __?

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13
Q

What is this?

A

Meningioma histopathology

(Little Orphan Annie cells??)

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14
Q

What is this?

A

Meningioma histopathology

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15
Q

What is this?

A

Meningioma histopathology

  • Hurricane/tropical storm cells
  • Psammoma bodies
  • Little Orphan Annie cells??
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16
Q

What can be used to confirm that something is a meningioma?

A
  • Epithelial membrane antigen
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17
Q

What can be seen ultrastructurally in meningioma?

A

Desmosomes

18
Q

What is a useful feature that can be used to characterize a Schwannoma (1)?

A

Two different types of architecture

  • Antoni A (dense)
  • Antoni B (less dense)
19
Q

What is another useful feature that can be used to characterize a Schwannoma (2)?

A

Verocay body

  • nuclei adjacent to area without nuclei
20
Q

What is this? Treatment options?

A

CP Angle Schwannoma

  • Can see “ice cream sign” as it spreads into internal auditory canal

Treatment:

  • Surgical resection
  • Stereotactic radiosurgery
21
Q

Genetic predisposition to CP Angle Schwannoma?

A

NF2

  • Bilateral tumors
  • Chromosome 22
  • Merlin gene (schwannoma, meningioma, glioma)
22
Q

Genetic predisposition to Neurofibroma?

A

NF1

  • Neurofibramin -> neurofibroma spindle cell
  • Chromosome 17
23
Q

What is this?

A

Neurofibroma

24
Q

What are two common settings in which you will see primary CNS lymphomas (PCNSL)?

A
  • Immunocompromised patients (most)
  • Elderly patients
25
Q
  • Can Schwannomas be fatal?
  • Can Neurofibromas be fatal?
A

??

  • Schwannomas typically not bad
  • Neurofibromas may become malignant
26
Q

What is this?

A

Primary CNS lymphoma (PCNSL)

  • Angiocentric accumulation of cells
  • Prominent nucleolus (look like immature lymphocytes)
  • Most PCNSLs are large cell lymphomas (like this)
  • Infiltrates tissue (like gliomas); no distinct tumor/mass
27
Q

What immunohistochemistry marker can be used for Primary CNS Lymphomas (PCNSL)?

A

CD20- usually B cell lymphomas

28
Q

What is this? Effects?

A

Metastatic tumors

  • Tend to loosen up vascular junctions, leading to edema
  • Multiple lesions (pretty typical); results in multiple focal neurological deficits
29
Q

What is this?

A

Metastases (3)

  • Multiple discrete lesions with surrounding edema
  • Often occur at grey matter- white matter junction, but may occur anywhere
  • Some pushing over of the cingulate (swollen hemisphere)
30
Q

T/F: PCNSL tumors are surgically resectable?

A

False

  • Typically not, because infiltrate tissue (like gliomas)
  • Not a clear mass
31
Q

T/F: People with PCNSL tumors typically don’t have lymphomas anywhere else

A

True

  • Only about 3% will have systemic lymphoma (although eye sometimes involved)
32
Q

What is this?

A

Metastasis to midbrain

33
Q

What is this? Symptoms?

A

Meningeal carcinomatosis

  • Spread to CSF
  • Can see little lumps all along the cauda equina: tumor implants on the spinal roots
  • May result in multiple radiculopathies (spinal nerve root symptoms)
  • Disturbances of higher cortical function or other problems
34
Q

What virus may cause PCNSLs?

Especially in what population?

A
  • Ebstein-Barr virus (EBV) driven
  • Especially in AIDS patients
35
Q

What is this? Symptoms?

A

Top (under 10mm)- microadenoma

  • Little microadenoma can only present with endocrine symptoms

Bottom (>10mm)

  • Endocrine effects + chiasm compression
  • May result in bitemporal visual field defect
36
Q

What are some autosomal dominant disorders causing hereditary brain tumor syndromes?

A
  • Neurofibromatosis (NF1 and NF2)
  • Tuberous sclerosis
  • von Hippel Lindau disease
37
Q

What tumors does neurofibromatosis cause? Which type?

A

NF1 (chromosome 17)

  • Neurofibromas
  • Neurofibrosarcomas

NF2 (chromosome 22)

  • Schwannomas
  • Meningiomas
  • Gliomas
38
Q

What tumors does tuberous sclerosis cause?

A
  • Subependymal giant cell astrocytoma

(with rare malignant degeneration to:)

  • Glioblastoma multiforme
  • “Tubers”- heterotopias
39
Q

What tumors does von Hippel Lindau cause?

Genetic mechanism?

A

(oncogene knocked out on chromosome 3)

  • Hemangioblastoma
  • Metastatic renal cell carcinoma
40
Q

What is this?

A

Hemangioblastoma

41
Q

What is this? Cellular origin?

A

Hemangioblastoma

  • Very bloody tumor (many vascular channels)
  • Cells making up tumor have foamy cytoplasm with clear areas
  • Hemangioblast origin (circular cell from bone marrow that is repairing endothelial cells of BVs)
  • Once seen, then have to worry about them develping a renal carcinoma
42
Q

What are the most common cancers causing metastases in the brain?

A

Most (80%):

- Lung

- Breast

Then:

  • Melanomas
  • Renal
  • GI