Brain tumors book

Question 1

Which are most common overall?

Answer 1

In a general community hospital setting, metastatic brain tumors are more common.

Question 2

A child with craniospinal irradiation for ALL has a higher risk for developing an astrocytoma compared to other children T/F

Answer 2

TRUE Craniospinal irradiation is a risk factor for the subsequent development of astrocytoma and other tumors.

Question 3

Radiation to the head and neck is a risk factor for subsequent development of meningioma T/F

Answer 3

TRUE Radiation to the head and neck, even in small amounts, is a risk factor for the subsequent development of meningioma.

Question 4

Homer-Wright rosettes are relatively uncommon in medulloblastoma T/F

Answer 4

TRUE Homer-Wright rosettes have a high diagnostic value but are seen in a minority of tumors. Most medulloblastomas show diffuse sheets of small blue cells without rosettes

Question 5

*Most primary cerebral lymphomas are:

Answer 5

B cells

Question 6

Low grade tumors have as many but different chromosomal abnormalities as high grade tumors do
T/F

Answer 6

FALSE

The more malignant the tumor, the more numerous and complex the chromosomal and molecular changes.

Question 7

*A 5 year old boy had multifocal brain lesions. The histoloy revealed a dense collection of large atypical mononuclear cells around a blood vessel, consistent with a CNS lymphoma. The most likely underlying factor is:

Answer 7

Genetic immunodeficiency
Cerebral lymphomas in children are rare. The presence of a cerebral lymphoma in a child strongly suggests a genetic immunodeficiency.

Question 8

Which of the following are the most ubiquitous neurocarcinogens?

Answer 8

Nitroso compounds

Question 9

Which of the following is not a feature of pilocytic astrocytoma?

Answer 9

Brisk mitotic activity -
Brisk mitotic activity is not a feature of pilocytic astrocytomas. Drop metastasis have been reported with some hypothalamic pilocytic astrocytomas. PAs may be located in the spinal cord. In their most common location, the posterior fossa, they may obstruct CSF flow causing hydrocephalus. GEDs are a cellular marker of PAs.

Question 10

What finding distinguishes glioblastoma multiforme from lower grade astrocytomas?

Answer 10

Necrosis

Question 11

Which lesions extend across the corpus callosum?

Answer 11

Glioblastoma
Cerebral lymphoma
Schilder’s disease

Question 12

Which present as a ring enhancing lesion?

Answer 12

Acute multiple sclerosis plaques
Metastatic tumors
Glioblastoma

Question 13

A 3 year old boy with a history of headaches and morning vomiting for 10 days presents to the ER after a bad episode of vomiting. He is afebrile. The diagnostic studies might include all of the following except:

A. Fundoscopic examination
B. CSF for viral PCR
C. GI endoscopy
D. MRI

Answer 13

B. CSF for viral PCR - The symptoms suggest increased intracranial pressure. A spinal tap is contraindicated

Question 14

The most common intracranial site of germ cell tumors is:

Answer 14

The pineal gland -The most common site is the pineal gland followed by the suprasellar region.

Question 15

A previously healthy 53 year old man had an insidious onset of headaches, obtundation, and facial paralysis. CSF shows 33 lymphocytes, glucose 36, and protein 72. The most likely diagnosis is:

Answer 15

Meningeal carcinomatosis- The clinical presentation and CSF profile are consistent either with meningeal carcinomatosis or with tuberculous meningitis. Tuberculous meningitis would be expected to have fever and symptoms of infection. Insidious presentation in a 50 year old healthy person is more consistent with carcinomatosis from an occult primary.

Question 16

The most common tumors of the pineal gland are

Answer 16

Germ cell tumors

Question 17

You are called to the OR to do a frozen section of a suprasellar mass in a 5 year old boy. Which of the following would be most likely?

Answer 17

Pilocytic astrocytoma- Pilocytic astrocytoma, followed by a craniopharyngioma, is the most common supracellar tumor in children.

Question 18

Neurofibromatosis 1 (VRNF)

Answer 18

Optic nerve astrocytoma

Question 19

Neurofibromatosis 2 (BANF)

Answer 19

Meningioma

Question 20

von Hippel-Lindau disease

Answer 20

Pheochromocytoma

Question 21

Tuberous sclerosis

Answer 21

Subependymal giant cell astrocytoma

Question 22

Meningioma

Answer 22

Extra-axial

Question 23

Ependymoma of the 4th ventricle

Answer 23

Intra-axial

Question 24

Medulloblastoma

Answer 24

Intra-axial

Question 25

Pituitary adenoma

Answer 25

Extra-axial

Question 26

A three year old boy had a cerebellopontine angle tumor with the ultrastructural features illustrated below.

Answer 26

Ependymoma- The two images show ultrastructural aspects of an ependymoma. The image on the left shows a space which contains multiple cilia. The image on the right shows desmosomes and microvilli.