6 CNS Tumors Flashcards
If an adult has a CNS tumor is it most likely supra or infratentorial?
- supratentorial more common in adults
- infratentorial more common in children
Name 2 intracranial tumors associated with adults
fibrillary astrocytoma
glioblastoma
Name 2 intracranial tumors associated with children
juvenile pilocytic astrocytoma
medulloblastoma
Name 2 spinal cord tumors associated with adults
meningiomas and shcwannomas
Name 2 spinal cord tumors associated with children
astrocytomas and ependymomas
What symptoms would you expect if a tumor is located supratentorial?
- headache
- localizing signs
- seizures
- raised intracranial pressure
What symptoms would you expect if a tumor is located infratentorial?
- Cranial nerve defects
- Cerebellar signs
- Raised intracranial pressure
Name 3 tumors of glial origin
Astrocytic (WHO I-IV)
Oligodendroglial (WHO II-III)
Ependymal (WHO II-III)
What is the most common CNS low grade tumor in children? Where does it occur?
- Juvenile Pilocytic Astrocytoma
- Most commonly in cerebellum
Is a juvenile pilocytic astrocytoma cured with excision?
yes
What would you see on imaging of a pilocytic astrocytoma?
cystic with enhancing mural nodule
Histological examination of a juvenile pilocytic astrocytoma would show ________ fibers
rosenthal
A fibrillary astrocytoma (WHO II) would show what on imaging?
non-enhancing mass
________ astrocytoma is a WHO III tumor
Anaplastic
Name two key histological findings of a glioblastoma (WHO IV)
glomeruloid vessels
palisading necrosis
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
true
What mutations is glioblastoma associated with?
EGFR
TP53
PTEN
Oligodendroglioma is usually _____tentorial
supra
T/F- oligodendrogliomas do not usually bleed
false, they do
What mutations would you look for in an oligodendroglioma to assess for prognosis and treatment response to PVU therapy (procarbazine, vincristine, CCNU)
1p and 19q deletions
oligodendroglioma has a histological appearance resembling what?
fried egg
ependymomas are almost always (intra/extra) ventricular
intraventricular
T/F- -Ependymomas are usually supratentorial in adults, infratentorial (4th ventricle) in children, and more commonly affect the spinal cord in adults
true
What would you see histologically in an ependymoma?
perivascular pseudo rosettes, nuclear free zone
Meningiomas are more common in adults or children? Males or females?
adults
females
Although meningiomas are usually benign, they can be deadly because of what factor?
if they grow in a bad location such as the medulla
Histological features of a meningioma?
meningiothelial whorl
intranuclear inclusions
psammoma body
Name the criteria for an atypical meningioma (WHO II)
A: Chordoid meningioma or Clear cell meningioma
OR
B: Mitoses 4 to
Name the criteria for Malignant (anaplastic) meningioma (WHO III)
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)
Name 2 important embryonal tumors (WHO IV) for this lecture
medulloblastoma cerebral neuroblastoma (PNET)
Medulloblastoma is a tumor of children derived from cells of the ________ layer of the fetal cerebellar cortex
external granular layer
T/F- medulloblastoma is not aggressive
False, it is very aggressive
T/F- p53 mutation is rare in cerebral neuroblastoma
true
What is the most common choroid plexus tumor
papilloma
Where do choroid plexus tumors occur in adults? children?
adults: 4th ventricle
children: lateral ventricle
Craniopharyngiomas are located in the _____ region
suprasellar
Craniopharygiomas arise from what origin?
rathke’s pouch
Name symptoms of a craniopharyngioma
visual problems, endocrine abnormalities, hypothalamic syndrome, diabetes insipidus
What are the most common primary tumor sites in brain metastasis?
lung, breast, colon
