Brain Tumors

Question 1

What is a key characteristic about Astrocytomas after they are removed?

Answer 1

– They have a high recurrance rate and when they recur they often have a higher grade.

Question 2

What is the distribution of age of patients diagnosed with astrocytomas?

Answer 2

– 30-50
Younger = Lower Grade
Older = Higher Grade

Question 3

An 8 year old presents with progressive ataxia and frequent falls and is diagnosed with a posterior fossa tumor. How would you describe the histology?

Answer 3

A low-moderate cellularity tumor composed of cells with elongated hair-like processes forming dense networks, alternating with microcystic areas.
—Pilocystic Astrocytoma—

Question 4

How are Pilocystic Astrocytomas different than other astrocytomas?

Answer 4

–They do NOT progress to a higher stage over time–

Found in the Cerebellum

Question 5

If a 32 year old male has an MRI that shows effaced gyri of the cerebrum, what might be the tumor and histology?

Answer 5

Astrocytoma - Low Grade (Due to Age)

– Low-Moderate cellularity and nuclear atypia with fibrillary cytoplasm with RARE Mitoses.

Question 6

If a 42 year old male who previously had a low grade astrocytoma removed, presents with focal neurologic findings, what might be the newest etiology?

Answer 6

– High Grade Astrocytoma

Question 7

What are the differences in histology between Grade II and III Astrocytomas?

Answer 7

• • Grade II = Low to moderate cellularity/atypia, few mitoses
• • Grade III = moderate cellularity, MARKED mitotic activity

Question 8

What is the highest grade astrocytoma and its histology?

Answer 8

Glioblastoma Muliforme

• • prominent microvascular proliferation and NECROSIS
• • PSEUDOPALISADING – (pillars w/ necrosis between)
• • Glomerus appearance

Question 9

What genetic test can be performed to assess survival if a patient is diagnosed with High grade Oligodendroglioma?

Answer 9

Look for 1p and 19q Allelic Deletions

– Increases survival and increased susceptibility to chemotherapy

Question 10

What is the unique histologic findings of Oligodendrogliomas?

Answer 10

• • Moderate cellularity with “halos” around the nuclei –

* *Fried Egg Appearance**

Question 11

If a patient is diagnosed with Ependymoma, where might a tumor be localized?

Answer 11

Tumor protruding from ventricle lining, posterior fossa

Question 12

Who most commonly are diagnosed with Ependymomas and what can be a distinctive histologic finding?

Answer 12

Children and a Young Adults
True Rosettes – cells arranged around a central lumen
Pseudorosettes – cells arranged around vessel
– True are lost at higher grades –

Question 13

What is an independent risk factor for developing a neuro gliomas?

Answer 13

– Prior Exposure to Radiation –

Question 14

If you are assessing a 12 year old patient for possible central process, and find his CSF pressure is elevated, might might you be suspicious of? (Hydrocephalus)

Answer 14

Choroid Plexus Papilloma – produces too much or blocks

Colloid Cyst - blocks Foramen of Monroe

Question 15

If a patient has a long standing seizure history and is found to have a well circumscribed mass in the temporal lobe, what might is most likely?

Answer 15

– Ganglioglioma –

Question 16

A 56 year old patient with AIDS has had progressive neurologic deficits, what is most likely?

Answer 16

Primary CNS B-cell Lymphoma - Periventricular

• Immunocompromised
• EBV Associated

Question 17

If you are looking at a histology slide and see blue cells in circular formations around a pink/necrotic area, what might be most likely?

Answer 17

Medulloblastoma

– Homer-Wright Rosettes

Question 18

Who and where does a Medulloblastoma most affect?

Answer 18

• Children

- Cerebellum – ataxia and gait instabilities

Question 19

What must be done to ensure complete treatment of Medulloblastoma?

Answer 19

– Complete radiation of the head and spinal cord, since Medulloblastoma frequently spreads throughout SubArchanoid Space

Question 20

What are primitive neuroectodermal neoplasms responsible for?

Answer 20

Medulloblastoma in Children

Question 21

What type of intracranial mass usually contains Progesterone receptors?

Answer 21

Meningioma

Question 22

What are the characteristics of Meningioma?

Answer 22

• Women
• Benign
• Dural based - well defined, Meninges origin
• Progesterone receptors
• Whorls of round oval nuclei

Question 23

What are the key histologic findings of a Meningioma?

Answer 23

• • Whorls

- - Psammomma Bodies

Question 24

What is consistent with brain metastasis over primary lesions?

Answer 24

– Metastasis there are usually more than one lesions and at the grey-white junctions

Question 25

When you find a patient with numerous intracranial lesions what should you do?

Answer 25

• • Body Scan to look for primary process
• • Can Biopsy, if still unsure.
• • Radiation Therapy of the whole head to even destroy the microscopic abnormalities

Question 26

When would a gamma knife be most appropriate to use for treatment?

Answer 26

– Focal Area of Radiation Therapy –

Question 27

A patient has bilateral tinnitus progressively develop over time, what is most commonly associated?

Answer 27

Neurofibroma Type 2

• • Schwannomas – CN8 Tumors
• • Do not commonly progress to maligant

Question 28

What histology is consistant with elongated spindle cells with wavey nuclei?

Answer 28

• • Peripheral sheath tumors

- - Neurofibromas

Question 29

When a plexiform nerve lesion is discovered, what is it most likely associated with and where?

Answer 29

Neurofibroma Type 1

– Trigeminal Nerve is commonly affected

Question 30

What are associations found with Neurofibroma Type 1?

Answer 30

• • Cutaneous Neurofibromas
• • Plexiform Lesions – metastatic potential
• • Cafe au lait / Axillary freckles
• • Lich Nodules
• • Optic Nerve Glioma

Question 31

What might you expect to find on imaging, if a patient is found to have a VHL gene mutation with frequent falls?

Answer 31

Cerebellar Hemangioblastoma
– VHL – controls angiogenesis
Von Hippel Lindau Disease

Question 32

If a patient presents with worsening progressive neurologic symptoms of ataxia, vertigo, and nystagmus and is found to have an antibody to Purkinje Cells, what might you be suspicious of?

Answer 32

Subacute Cerebellar Ataxia
– This is when the immune cells are attacking cancer cells, but there seems to be a similar antigen in the CNS that they also attack causing damage.

Question 33

If a patient is found to have hydrocephalus and on MRI there seems to be increased densities in the cortex nonspecifically. PMHx reveals autism and seizure histories. What could be causing these symptoms?

Answer 33

Tuberous Sclerosis

• • Cortical Hamertomas
• • Subependymal Giant Cell Nodules – obstructing CNS