Brain Tumors Flashcards
What is a key characteristic about Astrocytomas after they are removed?
– They have a high recurrance rate and when they recur they often have a higher grade.
What is the distribution of age of patients diagnosed with astrocytomas?
– 30-50
Younger = Lower Grade
Older = Higher Grade
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?
A low-moderate cellularity tumor composed of cells with elongated hair-like processes forming dense networks, alternating with microcystic areas.
—Pilocystic Astrocytoma—
How are Pilocystic Astrocytomas different than other astrocytomas?
–They do NOT progress to a higher stage over time–
Found in the Cerebellum
If a 32 year old male has an MRI that shows effaced gyri of the cerebrum, what might be the tumor and histology?
Astrocytoma - Low Grade (Due to Age)
– Low-Moderate cellularity and nuclear atypia with fibrillary cytoplasm with RARE Mitoses.
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?
– High Grade Astrocytoma
What are the differences in histology between Grade II and III Astrocytomas?
- Grade II = Low to moderate cellularity/atypia, few mitoses
- Grade III = moderate cellularity, MARKED mitotic activity
What is the highest grade astrocytoma and its histology?
Glioblastoma Muliforme
- prominent microvascular proliferation and NECROSIS
- PSEUDOPALISADING – (pillars w/ necrosis between)
- Glomerus appearance
What genetic test can be performed to assess survival if a patient is diagnosed with High grade Oligodendroglioma?
Look for 1p and 19q Allelic Deletions
– Increases survival and increased susceptibility to chemotherapy
What is the unique histologic findings of Oligodendrogliomas?
- Moderate cellularity with “halos” around the nuclei –
* *Fried Egg Appearance**
If a patient is diagnosed with Ependymoma, where might a tumor be localized?
Tumor protruding from ventricle lining, posterior fossa
Who most commonly are diagnosed with Ependymomas and what can be a distinctive histologic finding?
Children and a Young Adults
True Rosettes – cells arranged around a central lumen
Pseudorosettes – cells arranged around vessel
– True are lost at higher grades –
What is an independent risk factor for developing a neuro gliomas?
– Prior Exposure to Radiation –
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)
Choroid Plexus Papilloma – produces too much or blocks
Colloid Cyst - blocks Foramen of Monroe
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?
– Ganglioglioma –
A 56 year old patient with AIDS has had progressive neurologic deficits, what is most likely?
Primary CNS B-cell Lymphoma - Periventricular
- Immunocompromised
- EBV Associated
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?
Medulloblastoma
– Homer-Wright Rosettes
Who and where does a Medulloblastoma most affect?
- Children
- Cerebellum – ataxia and gait instabilities
What must be done to ensure complete treatment of Medulloblastoma?
– Complete radiation of the head and spinal cord, since Medulloblastoma frequently spreads throughout SubArchanoid Space
What are primitive neuroectodermal neoplasms responsible for?
Medulloblastoma in Children
What type of intracranial mass usually contains Progesterone receptors?
Meningioma
What are the characteristics of Meningioma?
- Women
- Benign
- Dural based - well defined, Meninges origin
- Progesterone receptors
- Whorls of round oval nuclei
What are the key histologic findings of a Meningioma?
- Whorls
- - Psammomma Bodies
What is consistent with brain metastasis over primary lesions?
– Metastasis there are usually more than one lesions and at the grey-white junctions
When you find a patient with numerous intracranial lesions what should you do?
- Body Scan to look for primary process
- Can Biopsy, if still unsure.
- Radiation Therapy of the whole head to even destroy the microscopic abnormalities
When would a gamma knife be most appropriate to use for treatment?
– Focal Area of Radiation Therapy –
A patient has bilateral tinnitus progressively develop over time, what is most commonly associated?
Neurofibroma Type 2
- Schwannomas – CN8 Tumors
- Do not commonly progress to maligant
What histology is consistant with elongated spindle cells with wavey nuclei?
- Peripheral sheath tumors
- - Neurofibromas
When a plexiform nerve lesion is discovered, what is it most likely associated with and where?
Neurofibroma Type 1
– Trigeminal Nerve is commonly affected
What are associations found with Neurofibroma Type 1?
- Cutaneous Neurofibromas
- Plexiform Lesions – metastatic potential
- Cafe au lait / Axillary freckles
- Lich Nodules
- Optic Nerve Glioma
What might you expect to find on imaging, if a patient is found to have a VHL gene mutation with frequent falls?
Cerebellar Hemangioblastoma
– VHL – controls angiogenesis
Von Hippel Lindau Disease
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?
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.
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?
Tuberous Sclerosis
- Cortical Hamertomas
- Subependymal Giant Cell Nodules – obstructing CNS
