Brain Tumors

Question 1

Most CNS tumors originate where?

Answer 1

**metastatic from another site **

bladder, lung, breast, kidney, liver, and melanoma

Question 2

Most common primary brain tumors? (2)

Answer 2

Giloblastoma multiforme (GBM)

menigioma

Question 3

How do you distinguish a primary brain tumor from a metastasis to the brain?

Answer 3

PBT:

• Poorly circumscribed
• Usually single
• Location varies by specific type

Metastasis:

• generally well circumscribed
• often multiple
• Usually located in the junction between gray and white matter

Question 4

Most common CNS tumors in children? (2)

Answer 4

• Medulloblastoma
• Astrocytoma

CNS tumors are 2nd most common neoplasm in children

Question 5

Any treatment that follows the primary treatment is called what?

Answer 5

adjuvant treatment

Question 6

WHO Grade I

Answer 6

generally low proliferative potential– possible to cure following resection alone

Question 7

WHO Grade II

Answer 7

generally infiltrative but low proliferative activity

(cells are starting to move into places that they shouldn’t be)

Question 8

WHO Grade III

Answer 8

general histological evidence of malignancy (nuclear atypia and much mitotic activity)

Question 9

WHO Grade IV

Answer 9

cytologically malignant, mitotically active, necrosis prone. Rapid pre and post operative disease progression

Question 10

pilocytic astrocytoma

Answer 10

Grade I

Low proliferative potential

Question 11

A child patient presents with a primary brain tumor that is in the posterior fossa (common to cerebellum), and you hear from the oncologist that the patient has a good prognosis. What do they likely have? WHO Grade?

Answer 11

pilocyclic astrocytoma

(Grade I)

Morphologic features:–often cystic–bipolar cells with long hair-like processes–rosenthal fibers–biphasic: loose areas and dense areas

Question 12

Rosenthal fibers are associated with what what type of primary brain tumor? What color do they appear on H and E?

Answer 12

pilocytic astrocytoma

rosenthal fibers are eosinophilic (red) and composed of several proteins including GFAP

Question 13

diffuse astrocytoma

Answer 13

Low proliferative potential but infiltrative

Grade II

Question 14

anaplastic astrocytoma

Answer 14

shows more cellular regions–more pleomorphism, more mitoses

Grade III

Question 15

GFAP

Answer 15

glial fibrillary acidic protein

Principle intermediate filament in mature astrocytes

If elevated, indicates damage to astrocytes

Question 16

Difference between primary GBM and secondary GBM

Answer 16

secondary GBM begins as a anaplastic astrocytoma

primary GBM is direct diagnosis

Question 17

pseudopalisading necrosis

Answer 17

a key feature of a primary GBM

Question 18

glioblastoma

Answer 18

Grade IV

• variation in appearance in different areas
• necrosis
• vascular proliferation

Question 19

A patient presents with seizures and an MRI indicates a sharply circumscribed hemispheric masses, and biopsy reveals a highly vascularized tumor, round nuclei with cytoplasmic halos and some calcification. What type of neoplasm?

Answer 19

Oligodendroglioma

Question 20

Medulloblastoma

Answer 20

WHO grade IV

Clinical features: Usually in children, usually in cerebellum–Very radiosensitive!– isochromosome (17)(q10) = poor prognosis

Morphologic features: Well-circumscribed Histologic features: Small, dark, elongated, anaplastic cells–Homer-Wright rosettes

Question 21

A child patient presents with headach, and morning vomitting that gets worse with time. In addition, the patient is having trouble with motion sickness and back pain. What should you be worried about?

Answer 21

Medulloblastoma

(Remember to look for isochromosome 17 i17, which if present is a poor prognosis)

Question 22

Meningioma

Answer 22

Second most common primary brain tumor

Clinical features:–benign tumor of arachnoid cells–slow-growing, benign–cured by resection

Morphologic features:–attached to dura, compresses brain–syncytial pattern–psammoma bodies

Question 23

syncytial pattern

Answer 23

sworreling

Question 24

psammoma bodies

Answer 24

calcium deposits