Brain Tumors Flashcards
1
Q
What is the incidence of brain tumors?
A
1-2 / 10,000
2
Q
What percent of brain tumors are primary? Secondary?
A
1’ =50%
2’ = 50%
3
Q
What are the origins of brain tumors? (4)
A
- Meningeal
- Cells intrinsic to the brain (Gliomas/neuronal/others)
- CNS lymphoma
- Metastases
4
Q
What is the order of incidence of mets in the brain?
A
- Lung
- Breast
- GU
- Osteosarcoma
- Melanoma
6 GI
(LUBGOM)
5
Q
Where are mets in the brain usually located? What are their characteristics?
A
Multiple, well circumscribed; usually present at the gray white junctions
6
Q
What cells give rise to glioblastoma multiforme?
A
Astrocytes
7
Q
What cells give rise to astrocytomas?
A
Astrocytes
8
Q
What cells give rise to meningioma?
A
Meningothelial cells
9
Q
What cells give rise to medulloblastomas?
A
Neural cell precursors
10
Q
What cells give rise to schwannomas?
A
Schwann cells
11
Q
Which usually has multiple lesions: primary brain tumors, or secondary?
A
Secondary
12
Q
True or false: mets to the brain are usually well circumscribed masses
A
True
13
Q
How often do primary tumors of the brain metastasize?
A
Rarely
14
Q
True or false: even benign tumors of the brain are problematic
A
True–limited space in the skull
15
Q
What are the s/sx of increased ICP? (6)
A
- *-HA
- Vomiting
- Papilledema**
- Ocular palsies
- AMS
- Back pain
16
Q
What is the drug of choice for emergent increased ICP?
A
Mannitol
17
Q
What percent of childhood cancers are brain cancers?
A
20%
18
Q
The majority of adult brain tumors are found where? Children?
A
Adults = supratentorial Child = infratentorial (posterior fossa)
19
Q
What are the 4 major childhood primary brain tumors?
A
- Pilocytic
- Medulloblastoma
- Ependymoma
- Craniopharyngioma
20
Q
What are the top four adult brain cancers?
A
- Glioblastoma
- Meningioma
- Hemangioblastoma
- Schwannoma
21
Q
Are astrocytomas benign or malignant tumors?
A
Malignant
22
Q
What are the gross characteristics of astrocytomas?
A
Large, multicolored (red) mass with a central area of necrosis and hemorrhage
23
Q
What are the histological characteristics of Glioblastoma multiforme? (4)
A
- Hypercellular
- Hyperchromatism
- Pleomorphism
- Palisading around necrosis
24
Q
Histological slide of the brain with hypercellularity, hyperchromatism, pleomorphic cells, and palisading cells around a central area of necrosis = ?
A
Glioblastoma multiforme
25
What is the prognosis for Glioblastoma multiforme?
Poor
26
Is Glioblastoma multiforme benign or malignant?
Malignant
27
Where in the brain are Glioblastoma multiforme usually found?
Cerebral hemispheres, and can cross corpus callosum
28
What are butterfly gliomas?
Glioblastoma multiforme that crosses the corpus callosum
29
What is the stain that can be used to highlight Glioblastoma multiforme?
GFAP
30
What is GFAP? Where is it found?
Glial fibrillary acidic protein
| intermediate filament that is expressed by numerous cell types in the CNS, including astrocytes, and ependymal cells
31
How can you identify meningiomas grossly?
White capsule that surrounds it
32
What are the histological characteristics of meningiomas?
Spindle cells in a Tight whorling tumors cells
33
Spindle cells in a Tight whorling tumors cells = what?
Meningiomas
34
Are meningiomas benign or malignant?
Benign
35
Where are meningiomas usually found?
Convexities of the hemispheres
36
What cells give rise to meningiomas?
Arachnoid cells external to brain parenchyma, that may have a dural attachment
37
True or false: meningiomas are often asymptomatic
True
38
What is the treatment for meningiomas ?
Resection
39
What are the 4 tumors that has psammoma bodies?
1. Papillary thyroid carcinoma
2. Papillary serous cystadenomas
3. Meningiomas
4. Papillary renal cell CA
40
What are the gross characteristics of hemangioblastomas?
large, exophytic red mass
41
What, generally, are hemangioblastomas composed of?
Vascular structures
42
What are the histological characteristics of hemangioblastomas?
Closely arranged, thin-walled capillaries with minimal interleaving parenchyma + foamy cells
43
Are hemangioblastomas malignant or benign?
Benign
44
Where are hemangioblastomas usually found in the brain?
Cerebellum
45
What diseases are associated with hemangioblastomas?
VHL syndrome if found with retinal angiomas
46
What is the hematological disorder that can be brought about 2/2 hemangioblastomas? Why?
Polycythemia 2/2 EPO production
47
Closely arranged, thin-walled capillaries with minimal interleaving parenchyma + foamy cells = ?
hemangioblastomas
48
Polycythemia 2/2 to a brain tumor point to what type of brain tumor?
hemangioblastomas
49
What is the genetic cause of VHL syndrome?
VHL suppressor gene on chromosome 3
50
What is the genetic cause of tuberous sclerosis?
TSC1, TSC2 genes which code for hamartin, tuberin respectively
51
What are the gross characteristics of Schwannomas?
"Fish flesh"--soft tan appearance
52
What is the antoni A pattern of Schwannoma?
Palisading nuclei surrounding pink areas
53
What is the antoni B pattern of Schwannoma?
Looser stroma, fewer cells, and myxoid changes
54
Where are Schwannoma usually found in the brain?
Cerebellopontine angle
55
What is the stain that can be used for Schwannoma?
S100
56
S100 is used to stain for what brain tumors? (3)
Schwannoma, neurofibromas, melanoma
57
Which CN is usually affected with Schwannomas?
CN VIII
58
Bilateral Schwannomas = what inherited disease?
NF2
59
Are Schwannomas benign or malignant?
Benign
60
What are the CT findings with oligodendroglioma?
Calcifications with a central mass
61
What are the gross characteristics of oligodendrogliomas?
Thickened corpus callosum and diffuse involvement
62
How fast do oligodendrogliomas grow?
Slowly
63
What are the histological characteristics of oligodendrogliomas?
Small, round nuclei with a *perinuclear halo*
*Chicken wire vasculature*
64
Small, round nuclei with a perinuclear halo + Chicken wire vasculature= ?
oligodendrogliomas
65
What age group do oligodendrogliomas usually present?
Middle aged
66
"Fried egg" cells with round nuclei and clear cytoplasm = ?
oligodendrogliomas
67
True or false: oligodendrogliomas usually have calcifications on a noncontrast CT
True
68
What is the most common pituitary adenoma?
Prolactinoma
69
What is the classic visual field deficit associated with pituitary adenomas?
Bitemporal hemianopia
70
What is the effect of a secreting prolactinoma on GnRH?
Decreases
71
What stimulate prolactin release, and which inhibits?
```
Stimulate = TSH
Inhibits = dopamine
```
72
What is the typical appearance of a pilocytic astrocytoma?
Cystic structure
73
What is the prognosis for pilocytic astrocytomas?
Good
74
What are the histological characteristics of pilocytic astrocytomas?
Small
75
What are the rosenthal fibers that can be found in pilocytic astrocytomas?
Thick, elongated, worm-like or corkscrew eosinophilic bundles
76
Where in the brain are pilocytic astrocytomas usually found?
Cerebellum
77
What is the stain that is useful for highlighting pilocytic astrocytomas?
GFAP
78
Are pilocytic astrocytomas usually malignant or benign?
Benign
79
What are the histological characteristics of pilocytic astrocytoma?
Rosenthal fibers
80
Homer wright Rosettes are found in what brain tumor?
Medulloblastoma
81
What are Homer wright Rosettes?
Small, blue cells cells
82
Are Medulloblastoma malignant or benign?
Malignant
83
What are the cells that give rise to Medulloblastomas?
Neuroectodermal cells
84
What are the mass effect problems associated with Medulloblastomas? (2)
Compression of 4th ventricle
Spinal drop mets to the spinal cord
85
What are the histological characteristics of medulloblastomas?
Homer-Wright rosettes
86
What are the histological characteristics of Ependymomas?
- *Perivascular pseudorosette*
| - Rod shaped blepharoplasts found near nucleus
87
Where are Ependymomas usually found in the brain?
4th ventricle
88
What is the major sequelae of Ependymoma? Why?
Hydrocephalus--usually invades the 4th ventricle
89
What is the prognosis for Ependymomas?
Poor
90
What are the blepharoplasts found in Ependymomas?
Modified centriole
91
Are craniopharyngiomas malignant or benign?
Benign
92
What are the mass effect problems associated with craniopharyngiomas?
Bitemporal hemianopsia
93
What is the most common childhood supratentorial tumor?
craniopharyngiomas
94
What cells give rise to craniopharyngiomas?
Cells from Rathke's pouch
95
True or false: calcification is common with craniopharyngiomas?
True
96
Closely arranged, thin-walled capillaries with minimal interleaving parenchyma + foamy cells = what brain tumor?
Hemangioblastoma
97
Rosenthal fibers are found in what brain tumor?
Pilocytic tumors
98
-*Perivascular pseudorosette* + Rod shaped blepharoplasts found near nucleus = what brain tumor?
Ependymoma
