6 CNS Tumors

Question 1

If an adult has a CNS tumor is it most likely supra or infratentorial?

Answer 1

• supratentorial more common in adults

- infratentorial more common in children

Question 2

Name 2 intracranial tumors associated with adults

Answer 2

fibrillary astrocytoma

glioblastoma

Question 3

Name 2 intracranial tumors associated with children

Answer 3

juvenile pilocytic astrocytoma

medulloblastoma

Question 4

Name 2 spinal cord tumors associated with adults

Answer 4

meningiomas and shcwannomas

Question 5

Name 2 spinal cord tumors associated with children

Answer 5

astrocytomas and ependymomas

Question 6

What symptoms would you expect if a tumor is located supratentorial?

Answer 6

• headache
• localizing signs
• seizures
• raised intracranial pressure

Question 7

What symptoms would you expect if a tumor is located infratentorial?

Answer 7

• Cranial nerve defects
• Cerebellar signs
• Raised intracranial pressure

Question 8

Name 3 tumors of glial origin

Answer 8

Astrocytic (WHO I-IV)
Oligodendroglial (WHO II-III)
Ependymal (WHO II-III)

Question 9

What is the most common CNS low grade tumor in children? Where does it occur?

Answer 9

• Juvenile Pilocytic Astrocytoma

- Most commonly in cerebellum

Question 10

Is a juvenile pilocytic astrocytoma cured with excision?

Answer 10

yes

Question 11

What would you see on imaging of a pilocytic astrocytoma?

Answer 11

cystic with enhancing mural nodule

Question 12

Histological examination of a juvenile pilocytic astrocytoma would show ________ fibers

Answer 12

rosenthal

Question 13

A fibrillary astrocytoma (WHO II) would show what on imaging?

Answer 13

non-enhancing mass

Question 14

________ astrocytoma is a WHO III tumor

Answer 14

Anaplastic

Question 15

Name two key histological findings of a glioblastoma (WHO IV)

Answer 15

glomeruloid vessels

palisading necrosis

Question 16

T/F- primary glioblastoma usually arises de novo in older patients where as secondary GBM arises through a progression from fibrillary to anapestic astrocytoma to GBM in younger patients

Answer 16

true

Question 17

What mutations is glioblastoma associated with?

Answer 17

EGFR
TP53
PTEN

Question 18

Oligodendroglioma is usually _____tentorial

Answer 18

supra

Question 19

T/F- oligodendrogliomas do not usually bleed

Answer 19

false, they do

Question 20

What mutations would you look for in an oligodendroglioma to assess for prognosis and treatment response to PVU therapy (procarbazine, vincristine, CCNU)

Answer 20

1p and 19q deletions

Question 21

oligodendroglioma has a histological appearance resembling what?

Answer 21

fried egg

Question 22

ependymomas are almost always (intra/extra) ventricular

Answer 22

intraventricular

Question 23

T/F- -Ependymomas are usually supratentorial in adults, infratentorial (4th ventricle) in children, and more commonly affect the spinal cord in adults

Answer 23

true

Question 24

What would you see histologically in an ependymoma?

Answer 24

perivascular pseudo rosettes, nuclear free zone

Question 25

Meningiomas are more common in adults or children? Males or females?

Answer 25

adults

females

Question 26

Although meningiomas are usually benign, they can be deadly because of what factor?

Answer 26

if they grow in a bad location such as the medulla

Question 27

Histological features of a meningioma?

Answer 27

meningiothelial whorl
intranuclear inclusions
psammoma body

Question 28

Name the criteria for an atypical meningioma (WHO II)

Answer 28

A: Chordoid meningioma or Clear cell meningioma
OR
B: Mitoses 4 to

Question 29

Name the criteria for Malignant (anaplastic) meningioma (WHO III)

Answer 29

1. papillary meningioma
OR
2. rhabdoid meningioma
OR
3. >20 mitoses per 10 HPF
OR
4. meningothelial origin difficult to identify (i.e. tumor has sarcomatous appearance)

Question 30

Name 2 important embryonal tumors (WHO IV) for this lecture

Answer 30

medulloblastoma
cerebral neuroblastoma (PNET)

Question 31

Medulloblastoma is a tumor of children derived from cells of the ________ layer of the fetal cerebellar cortex

Answer 31

external granular layer

Question 32

T/F- medulloblastoma is not aggressive

Answer 32

False, it is very aggressive

Question 33

T/F- p53 mutation is rare in cerebral neuroblastoma

Answer 33

true

Question 34

What is the most common choroid plexus tumor

Answer 34

papilloma

Question 35

Where do choroid plexus tumors occur in adults? children?

Answer 35

adults: 4th ventricle
children: lateral ventricle

Question 36

Craniopharyngiomas are located in the _____ region

Answer 36

suprasellar

Question 37

Craniopharygiomas arise from what origin?

Answer 37

rathke’s pouch

Question 38

Name symptoms of a craniopharyngioma

Answer 38

visual problems, endocrine abnormalities, hypothalamic syndrome, diabetes insipidus

Question 39

What are the most common primary tumor sites in brain metastasis?

Answer 39

lung, breast, colon