CNS neoplasm-Usera Flashcards
What are the categories of CNS neoplasms (6)?
- Glial neoplasms
- Meningiomas
- Ependymoma
- Medulloblastoma
- CNS lymphoma
- Metastasis
What are the 4 types of neuroglia in the CNS?
What do each do?
- ependymal cells (line ventricles and central panel of spinal cord)
- oligodendrocytes (myelinate)
- astrocytes (support, metabolic function, glutamate neurotransmision, calcium homeostasis)
- microglia (macrophages of CNS)
What are the 2 types of neuroglia in the PNS? What do each do?
Satellite cells
Schwann cells
How can you tell an astrocyte from an oligodendrocyte?
Astrocytes-> loose chromatin (cause they are actively transcribing genes)
Oligodendrocytes-> dense chromatin
(blank) are the most common CNS tumors.
astrocytomas (70-80%)
Astrocytomas usually involve the (Blank) hemispheres, but can occur elsewhere
cerebral
How do you grade astrocytomas?
Grade 1-4
What grade is a glioblastsoma multiforme?
Grade 4
What grade is diffusely infiltrating astrocytoma?
Grade 2
What grade is anaplastic astrocytoma?
Grade 3
What grade is pilocytic astrocytoma?
Grade 1
What grade is a pilocytic astrocytoma? What does it look like? Is it malignant or benign? Who typically gets them? Where do you usually find them? Is there a p53 mutation?
1 well circumscribed and cystic benign children and young adults cerebellum (but can occur elsewhere) -no
What is the histological appearance of a pilocytic astrocytoma?
- Dense, “hair-like” fibrillary meshworks.
- rosenthal fibers
What does a pilocytic astrocytoma look like on a sagittal CT?
cystic space with mural nodule
What grade is a diffusely infiltrating astrocytoma? What does it look like? Does it have a p53 mutation? What is its prognosis? Does it have mitotic figures?
- II
- poorly defined, infiltrating tumor with increased cellularity with mild to moderate nuclear atypia
- YES
- variable, but usually indolent lesion
- no
What grade is anaplastic astrocytoma? What does it look like? Does it have mitotic figures? What is the median survival? Does it have a p53 mutation?
- III
- similiar to grade II, but with increased, cellularity and nuclear atypia
- YES
- 3 years
- yes
What grade is glioblastoma mutiforme? Is it common? Is it aggressive? What does it look like? Is p53 mutation common? What is the prognosis?
IV yes -highly aggressive -marked nuclear pleomorphism and atypia -yes -6-15 month survival
If you see pseudopalisating necrosis, what kind of glial neoplasm is this?
glioblatoma multiforme
What is the mneumonic for glial neoplasms and what does it tell us?
Atypia
Mitotic figures
Endothelial proliferation
Necrosis
Most glial neoplasms dont cross the midline but (blank) do.
glioblastoma multiformis
What grade is an oligodendroglioma?
What percent of gliomas are oligodendroglioma?
What age do you get oligodendrogliomas?
II
5-15%
4th-5th decades
Where do you see oligodendrogliomas and what would you describe them as?
-cerebral hemispheres (FRONTAL LOBE)
Infiltrating, cystic, hemorrhagic, frequent CALCIFICATIONS
What genes are associated with a good response to chemo/radiation with oligodendrogliomas?
1p, 19q
Oligodendrogliomas can be what grades?
II, III, IV
no such thing as a grade I
What can oligodendrogliomas often present with?
seizures
What is the histological appearance of oligodendrogliomas?
fried egg appearance with chicken wire vasculature
Are meningiomas present in adults or children?
What kind of receptors do they commonly have?
Are the benign or malignant?
adults
estrogen/progesterone
benign
What chromosome loss is associated with meningiomas?
loss of chromosome 22
What can meningiomas form in the dura and why is this dangerus?
Can form mass in dura that presses on cortex and induces seizures
What is the histological appearance of meningiomas?
looks like starry night and has Psammoma bodies (whirled pattern of growth)
Where can you get meningiomas?
- parasagital
- olfactory groove
- supraseller
- clivus
- foramen magnum
- cerebellar
Where do ependymomas derive from?
Who gets them?
What disease is associated with it?
ependymal cells lining ventricular system
- children and adults
- NF2
Where do you most commonly see ependymomas in people ages 0-20?
4th ventricle
Where do you most commonly see ependymomas in adults?
spinal cord
What do ependymomas present as histologically?
pseudorosets and rosets
Who does medulloblastomas present in, children or adults?
What are medulloblastomas derived from?
What genes are associated with medulloblastoma and what do they indicate?
Is it suscpetible to radiation?
- children
- neuroectoderm and granular cells of cerebellum
- 17p and MYC amplification… aggressive and poor prognosis
- yes
How do medulloblastomas present histologically?
as small round blue cell tumors w/ homer-writght rosettes (look like suns)
What protein is present in medulloblastomas?
GFAP (glial fibrillary acidic protein)
If you see a child with a tumor in the cerebellum, what should you be thinking?
either its malignant and its medulloblastoma or its benign and its a pilocytic astrocytoma
(blank) typically have supratentorial tumors.
(blank) typically have infratentorial tumors.
adults
children
What virus is asociated with High grade B cell lymphoma?
EBV
(blank) percent of extranodal lymphomas are primary CNS lymphomas
(blank) percent of intracranial tumors are primary CNS lymphomas.
2%
1%
Are primary CNS lymphomas typically multifocal or unifocal?
multifocal
What is a good marker for primary CNS lymphoma? What does this tell us?
BCL-6+
says tumor cells are B cells that are derived from the germinal center of a lymphoid follicle
Where do primary CNS lymphomas typically occur first?
perivascularly
How can you look for EBV in your primary CNS lymphoma?
with EBER and ISH
What do lymphomas look like histologically?
dishesive and around vasculature
What is the MOST common CNS malignancy?
metastases
What are the most common carcinomas associated with CNS malignancy?
- lung
- breast
- melanoma
- RCC
- GI
Metastases make up (blank) percent of all intracranial malignancy
50%
T or F
brain tumors are relatively rare compared to other cancers that metastasize to the brain
T
