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OMS - 2 Neuro Final > Brain Tumor DSA > Flashcards

Brain Tumor DSA Flashcards

1
Q

______ account for 80% of
primary brain tumors

A

Astrocytomas

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2
Q

2 types of astrocytomas

A
  1. diffusely infiltrating
  2. localized
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3
Q

Astrocytomas are MC found in the _______ location

A

cerebral hemispheres

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4
Q

Astrocytomas are typically _______ grade tumors.

A

low

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5
Q

Astrocytomas are strongly positive for _______

A

glial fibrillary acidic protein (GFAP)

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6
Q

Anaplastic astrocytoma (grade III/IV) show ________ (3 histologic findings)

A
  1. nuclear enlargements
  2. mitotic figures
  3. gametocytes (yellow arrow)

(NO necrosis)

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7
Q

Diffuse astrocytomas are frequently due to _______ mutation, but are the majority are ______ mutation.

A
  • TP53
  • IDH1
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8
Q
A

Diffuse astrocytoma (grade II) high power

(note the fibrillar background)

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9
Q

What is this? Why?

A
  • gemistocytic astrocytoma
  • eosinophilic cytoplasm w/eccentric nuclei
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10
Q

Dx? Why?

A
  • Anaplastic astrocytoma (grade III)
  • mitotic activity (black arrow)
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11
Q

Necrosis is NOT a feature of astrocytoma; that would make it ______.

A

glioblastoma

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12
Q

Dx? Why?

A
  • Anaplastic astrocytoma
  • mitotic figures (black and yellow arrows)

(yellow arrow: circular mitotic figure)

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13
Q
A

Glioblastoma

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14
Q

Glioblastomas are rapidly growing tumors that cause _______.

A

herniation

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15
Q

Glioblastomas are grade IV and are derived from ______ cells

A

astrocytic progenitor

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16
Q

Survival rate for IDH-mutant glioblastoma

A

3 years

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17
Q

Survival rate for IDH-wild type glioblastomas

A

15 months

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18
Q

Dx? Why

A

Glioblastoma

large tumor cells w/pleomorphic hyperchromatic nuclei

(yellow arrows: multinucleated)

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19
Q

Dx? Why?

A
  • Glioblastoma
  • Palisading: serpiginous or serpentine foci of necrosis & hypercellularity
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20
Q

Dx? Why?

A
  • Glioblastoma
  • Glomeruloid body (yellow arrow): tufts of microvascular hyperplasia w/multiple lumen
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21
Q

Dx? Why?

A
  • Pilocytic astrocytoma
  • cystic w/gelatinous material (arrow)
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22
Q

WHO grade for pilocytic astrocytoma? Why?

A
  • Grade I
  • slow growing
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23
Q

_________ (2) set Pilocytic astrocytomas apart from other astrocytomas.

A
  1. rarely caused by TP53 mutation
  2. genetic alterations of MAP kinase pathway
24
Q

Dx? Why?

A
  • Pilocytic astrocytoma
  • nuclei have little atypia & microcysts
25
Q

Dx? Why?

A
  • Pilocytic astrocytoma
  • Rosenthal fibers (arrow)
26
Q

Define Rosenthal fibers (arrow)

A

elongated eosinophilic bodies containing GFAP and heat-shock proteins

(found in pilocytic astrocytoma)

27
Q

Dx? Why?

A
  • Pilocytotic astrocytoma
  • hair-like fibrillary processes of tumor cells

(“pilo” meaning hair)

28
Q

Dx?

A

Oligodendroglioma (yellow arrow)

29
Q

What is the cause of this?

A

IDH1 or IDH2 mutation & deletion of 1p & 19q

(oligodendroglioma)

30
Q

Dx? Why?

A
  • oligodendroglioma
  • sheets of round to oval nuclei, “fried egg appearance”: clear halo around nucleus

(“oligodendro” because tumor cells resemble oligodendrocytes; see picture)

31
Q

Dx? Why?

A
  • oligodendroglioma
  • fried egg appearance: nuclei are small & uniform w/vacuolated cytoplasm
32
Q

Dx? Yellow arrow?

A
  • oligodendroglioma
  • calcified foci
33
Q

Most oligodendrogliomas are WHO grade ______.

A

II

(anaplastic oligodendrogliomas are grade III)

34
Q

How are anaplastic oligodendrogliomas characterized?

A
  1. high cell density
  2. nuclear anaplasia
  3. high mitotic activity
35
Q

Survival rate for oligodendroglioma

A

w/surgery, chemo, radiation:

  • Grade II: 20 years
  • Grade III: 15 years
36
Q

MC location for Oligodendrogliomas

A

white matter of cerebral hemispheres

37
Q

Dx?

A

Ependymoma

38
Q

MC location for ependymoma

A

spinal cord (central canal)

39
Q

Ependymomas often lead to ______.

A

secondary hydrocephalus (rarely disseminate to CSF)

40
Q

Ependymomas typically arise from _______.

A

Ependymal cells lining the ventricles of the brain and central canal of the spinal cord

41
Q

In adults with ependymoma, there is typically a ______ mutation.

A

Neurofibromatosis Type 2 (NF2)

42
Q

Dx?

Yellow arrow?

Black arrow?

A
  • Ependymoma
  • perivascular pseudorosettes
  • canal: gland-like structure
43
Q

Define perivascular pseudorosettes (yellow arrow)

A

anuclear cells create a zone around blood vessels (but NOT around the lumen)

(characteristic of ependymomas)

44
Q

Dx?

A

Ependymoma

(note the rosettes at the arrow & GFAP stain)

45
Q

WHO grade?

A

II

(ependymoma)

46
Q

Location of ependymoma with the most favorable outcomes?

A

spinal cord

(85% have 5 year survival)

47
Q

Dx? Why?

A
  • Myxopapillary Ependymoma
  • papillary structures lined by bland-appearing cuboidal cells w/myxoid stroma

(containing mucopolysaccarides)

48
Q

MC location for myxopapillary ependymoma?

A

cauda equina of spinal cord

49
Q

Myxopapillary ependymomas can disseminate to the _______ if not completely excised.

A

subarachnoid space

50
Q

Dx? Why?

A
  • Choroid plexus papilloma
  • papilla lined by cuboidal epithelium line the tumor

(closely resembles the normal structure of the choroid)

51
Q

MC location of choroid plexus papilloma in adults? children?

A
  • 4th ventricle
  • lateral ventricles
52
Q

MC neuronal tumor

A

ganglioglioma (WHO grade I)

(this is a mix or ganglion & glial cells; glial cells usually resemble pilocytic astrocytoma)

53
Q

blue arrows

A

ganglion cells (ganglioglioma)

54
Q

MC location for gangliogliomas?

A

temporal lobe

55
Q

Dx? Black arrows?

A

ganglioglioma

56
Q

Gangliogliomas are typically WHO grade I, when is surgery necessary?

A

medically refractory epilepsy

OMS - 2 Neuro Final (36 decks)

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