6/16- Neuro-oncology III Flashcards
Meningiomas are typically what grade?
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
What is this?
Meningioma
What is this?
Meningioma
What kind of cells form meningiomas? Where are they located?
Meningoethelial cells
- Located in dura and arachnoid caps?
What is this?
Meningioma???
Where can a Schwannoma occur? Common?
Anywhere there are Schwann cells
- Peripheral nerves
- Any cranial nerves
- Very common = CN 8 (cerebro-pontine angle/ponto-medullary junction)
What is this?
Meningoethelial cells
What is this?
Meningioma of the lateral convexity
What is this?
Meningioma
What is this? Origin?
Meningioma of the optic nerve
- Arises from dural sheath of the nerve
Symptoms of CP angle Schwannoma
(auditory neuroma - bad terminology)?
- Unilateral hearing loss
- Tinnitus possible
- Nystagmus and vertigo if vestibular n. involved
- Can compress adjacent nerves (e.g. 5 and 7) if it enlarges
Compare these two tumors of the optic nerve. What are they?
L = Meningioma
R = Pilocytic __?
What is this?
Meningioma histopathology
(Little Orphan Annie cells??)
What is this?
Meningioma histopathology
What is this?
Meningioma histopathology
- Hurricane/tropical storm cells
- Psammoma bodies
- Little Orphan Annie cells??
What can be used to confirm that something is a meningioma?
- Epithelial membrane antigen
What can be seen ultrastructurally in meningioma?
Desmosomes
What is a useful feature that can be used to characterize a Schwannoma (1)?
Two different types of architecture
- Antoni A (dense)
- Antoni B (less dense)
What is another useful feature that can be used to characterize a Schwannoma (2)?
Verocay body
- nuclei adjacent to area without nuclei
What is this? Treatment options?
CP Angle Schwannoma
- Can see “ice cream sign” as it spreads into internal auditory canal
Treatment:
- Surgical resection
- Stereotactic radiosurgery
Genetic predisposition to CP Angle Schwannoma?
NF2
- Bilateral tumors
- Chromosome 22
- Merlin gene (schwannoma, meningioma, glioma)
Genetic predisposition to Neurofibroma?
NF1
- Neurofibramin -> neurofibroma spindle cell
- Chromosome 17
What is this?
Neurofibroma
What are two common settings in which you will see primary CNS lymphomas (PCNSL)?
- Immunocompromised patients (most)
- Elderly patients
- Can Schwannomas be fatal?
- Can Neurofibromas be fatal?
??
- Schwannomas typically not bad
- Neurofibromas may become malignant
What is this?
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
What immunohistochemistry marker can be used for Primary CNS Lymphomas (PCNSL)?
CD20- usually B cell lymphomas
What is this? Effects?
Metastatic tumors
- Tend to loosen up vascular junctions, leading to edema
- Multiple lesions (pretty typical); results in multiple focal neurological deficits
What is this?
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)
T/F: PCNSL tumors are surgically resectable?
False
- Typically not, because infiltrate tissue (like gliomas)
- Not a clear mass
T/F: People with PCNSL tumors typically don’t have lymphomas anywhere else
True
- Only about 3% will have systemic lymphoma (although eye sometimes involved)
What is this?
Metastasis to midbrain
What is this? Symptoms?
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
What virus may cause PCNSLs?
Especially in what population?
- Ebstein-Barr virus (EBV) driven
- Especially in AIDS patients
What is this? Symptoms?
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
What are some autosomal dominant disorders causing hereditary brain tumor syndromes?
- Neurofibromatosis (NF1 and NF2)
- Tuberous sclerosis
- von Hippel Lindau disease
What tumors does neurofibromatosis cause? Which type?
NF1 (chromosome 17)
- Neurofibromas
- Neurofibrosarcomas
NF2 (chromosome 22)
- Schwannomas
- Meningiomas
- Gliomas
What tumors does tuberous sclerosis cause?
- Subependymal giant cell astrocytoma
(with rare malignant degeneration to:)
- Glioblastoma multiforme
- “Tubers”- heterotopias
What tumors does von Hippel Lindau cause?
Genetic mechanism?
(oncogene knocked out on chromosome 3)
- Hemangioblastoma
- Metastatic renal cell carcinoma
What is this?
Hemangioblastoma
What is this? Cellular origin?
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
What are the most common cancers causing metastases in the brain?
Most (80%):
- Lung
- Breast
Then:
- Melanomas
- Renal
- GI
