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jK NEURO > CNS Nervous System Tumors > Flashcards

CNS Nervous System Tumors Flashcards

1
Q

primary vs secondary

A

primary from cells in the brain- can be totally begnign or malignant; secondary is metastatic and prognosis is grim

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2
Q

50% of metastatic tumors in brain originate in:

A

lungs

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3
Q

most prevelant malignant brain tumors in children/ adults

A

meduloblastoma/glioblastoma

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4
Q

most common benign cns tumor in children/adults:

A

pilocytic astrocytoma/meningioma in closed space, benign can still kill from icp (herniation)

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5
Q

cns tumors tend to:

A

spread within cns and never outside of cns

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6
Q

majority of cancer origin;

A

sporadic (no risk factors or known cause)

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7
Q

risk factors for cns tumors:

A

radiation and immunosuppression

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8
Q

theraputic radiation increases risk factors:

A

20 fold most commonly meningioma (possible glioblastoma) usually 10 years later

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9
Q

immunosuppression risk factors:

A

aids patients 3600 fold increase in risk for primary cns lymphoma. mostly diffuse large b-cell lymphoma; ebv is implicated in most cases

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10
Q

signs symptoms:

A

headache, seizure, ams

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11
Q

“mass effect”

A

tumor grows and has no where to go so it herniates (with edema), most often how tumors kill

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12
Q

where cingluate gyrus goes under falx______, where medial temporal lobe pushes under the tentorium _____, where the tonsils of the cerebellum herniate down into foramen_____

A

subfalcine heniration of the cingulate gyrus, transtentorial herniation of medial part of temporal lobe, transforaminal herniation of cerebellar tonsil
most often how brain tumors kill

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13
Q

intra-axial:

A

tumors that arise within parenchyma of ns (brain, sc, etc)

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14
Q

extra-axial:

A

tumors that arise in the coverings (meninges) of brain and sc

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15
Q

supratentorial tumors:

A

occur above the tentorium, include the cortex, etc, and are the most common types of adult tuors (cerebrum)

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16
Q

infratentorial:

A

occur below tentorium and encompass the cerebellum and brainstem (most pediatric tuors)

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17
Q

tumors are classified via:

A

histogenesis- tumors arise from cells intrinsic to an organ system and shows similar morphology and protein expression as the celll of origin

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18
Q

glial cells include:

A

astrocytes oligodendrocytes, give rise to gliomas

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19
Q

neurons and progenitor cells:

A

give rise to primitive neuroectodermal tumors (PNETs)

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20
Q

tumors of nerve sheath:

A

schwannoma

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21
Q

grading is a measure of ____. the grading includes

A

degree of differentiation; low grade (well-differentiated) bc it resembles the cell/tissue of origin. High grade are porrlydifferentiated and no longer resembe the cell of origin- worse prognosis
graded I II III IV (better to worst)

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22
Q

grade I is _____, beyond is_____

A

benign, malignant 2 low grade, 3,4 are high grade malignancy
greater than 5 to less than a year

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23
Q

three characteristics often found in high grade tumors:

A

high mitotic activity
vascular endothelial proliferation
necrosis

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24
Q

most common glioma in children and adults:

A

astrocytomas: either diffuse (highly infiltrative) or circumscribed (minimal brain infiltration)

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25
Q

adults tend to get ______ astrocytomas, while children tend to get more ______

A

diffuse, highly infiltrative, impossible to remove fully via surgery; circumscribed, minimally infiltrative

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26
Q

most common brain tumor/glioma in adults:

A

diffuse astrocytoma, supratentorial in cerebral hemispheres

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27
Q

the enhanced imagine of diffuse astrocytomas:

A

low grade, or grade 2 are “non-enhancing” while grade 3 are somewhat contrast enhancing (patchy enhancement), and 4 are contrast enhancing “ring enhancing”(glioblastoma)

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28
Q

if you see a ct with blood vessels lit up on the outside and a very dull, non lit up circle, it is:

A

grade 2 non contrast enhancing astrocytoma

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29
Q

if you see bright, fine pink thread looking cells. If it histologically still looks like brain tissue but just has a few too many glal cells in it (bright pink)

A

you know it’s glial, it’s grade 2 because it still looks like brain tissue

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30
Q

astrocytoma that crosses the corpus collusum:

A

grade 3 or 4 high-grade diffuse astrocytoma (contrast enhancing)

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31
Q

when looking at a histological sample, it is pleomorphic when you see____

A

the blue cells are all different sizes, althogh they are still all astrocytes

32
Q

another sign on histological stain that shows a high grade (4) tumor is the prevelance of ____

A

mitotic cells (the little blue guys are going through mitosis)

33
Q

pictures of ring enhancing lesion shows_____ you can also see ____

A

necrosis in the middle, crossing the corpus collosum, diffuse astrocytoma grade 4 glioblastoma

34
Q

another characteristic finding of glioblastoma:

A

vasculature endothelial proliferation that resembles the glomerulus of kidneys. Abnormal layering and streaks of vasculature

35
Q

pseudopalisating:

A

classic picture of glioblastoma. Tumor cell nuclei palisate along the outside like a jagged picket-fence “palisating” or “pseudo-palisating necrosis”

36
Q

diffuse astrocytomas originate with a precursor cell that _______ in about _____ of the cases

A

mutates in the IDH and TP53 gene (IDH mutations are associated with a better prognosis). This is how a diffuse astrocytoma goes from precursor cell to grade 2 then so on

37
Q

besides diffuse astrocytoma, there are ________, and the most common type is _______

A

circumscribed astrocytoma; pilocytic astrocytoma; most common primary benign cns tumor in chilren

38
Q

most common primary benign cns tumor in chilren is ____ it accounts for approximately _____, and occur most commonly in the ______

A

pilocytic astrocytoma, 35% of cns tumors in children; most commonly in the cerebellum (not always clinically benign bc they can be in bad locations and cause mortality that way

39
Q

most common site of pilocytic astrocytomas are _______; it is ____ meaning it occurs in the _____. The typical example is ______

A

cerebellum; cystic, contrast enhancing mural nodule, located in the cerebellum

40
Q

histologically, if you see super fine hairlike structures and red structures, it is ______

A

pilocytic astrocytoma, pilocytic refers to being “hair-like” and the red structures are rosenthal fibers one of the definitive factors

41
Q

genetics of pilocytic astrocytomas include:

A

KIAA1549-BRAF fusion is found in 70% of pilocytic astrocytomas (lead from precursor cell to grade 1)

42
Q

the adult tumors that are all diffuse, infiltrating, and are most common in the frontal lobe of adults:

A

oligodendrogliomas

43
Q

grades of oligodendrogliomas:

A

only 2: 2 low and 3 is high grade. 3 is also referred to as anaplastic oligodendrglioma

44
Q

the grade 2 oligodendrogliomas are ______

A

not ring enhancing

45
Q

histologically, oligodendrogliomas are said to have a _____ characterized by ______

A

fried egg, round nuclei, perinuclear clearing (halos) and a delicate network of capillaries (said to look like “chicken-wire”)

46
Q

grade 3 oligodendrogliomas are characterized on autopsy by____

A

hemmorage, necrosis, crossing of the corpus collosum

47
Q

genetics of oligodendrogliomas include:

A

deletions of chromosomal arms 1p and 19q which are found in 60-80% (found in 2/3) of oligodendrogliomas. This is how they progress from precursor cells to grade 2. if only 1 deletion is found the prognosis is drastically bettter than both

48
Q

ependymomas occur in children in the ________, while the adult version is in the _____

A

cerebellum, spinal cord

49
Q

ependymomas (in children) occur in the ______, and most all are grade____

A

posterior fossa (4th ventricle/cerebellum), grade 2

50
Q

classic example of ependymoma are tumors centered in _____ that have ______ are ______ and have the potential to _______

A

4th ventricle, nodular enhancing pattern, drop into the spinal column

51
Q

on histology, the ependymomas show:

A

an anuclear zone that is is called a perivascular pseudorosette. the true rosette is one in which the tumor cells create a lumen, and the pseudo rosette is one in which the anuclear section is actually in a blood vessel

52
Q

genetics of ependymomas:

A

loss of chromosome 22q and mutation in the nf2

53
Q

primitive neuroectodermal tumors are composed of ____ and the most common example are ______

A

primitive or embryonal cells, fit into the category small blue cell tumor, usually occur in children, medulloblastoma

54
Q

______ are the most common primary malignant cns tumor in children, arise in ____ and are classified as ______

A

medulloblastoma, posterior fossa (cerebellum), who grade 4,

55
Q

medulloblastomas grow in the ______ and have a _______

A

center of the 4th ventricle with a solid area of contrast enhancement (nodular)

56
Q

the ______ growth of medulloblastomas are in contrast to the ______ of pilocytic

A

nodular, cystic quality

57
Q

on histology, the distinguishing qualities of medulloblastoma are:

A

BLUE, very closely packed together and there is almost no cytoplasm (highly cellular)

58
Q

the most common extra axial tumors:

A

meningiomas, grow along the inner surface of the dura, occuring in adults, usually benign

59
Q

meningiomas are typically:

A

dural-based mass (extra-axial), contrast enhancing, 90% grade 1

60
Q

on ct, meningiomas have ________

A

dural tail (comma shaped)

61
Q

on histology, meningiomas are characterised by _____, and over time they calcify and form psammoma bodies

A

whorl formation (circular tumors), psammoma bodies

62
Q

Schwannomas are _____

A

nerve sheath tumors, they are all benign, arise from schwann cells of cranial nerves, and occur in adults (typically cerebellopontine angle of cranial nerve 8) (acoustic neuroma or vestibular neuroma) “CP angle tumor”

63
Q

on ct all schwannomas are ______ and on histo they are ______

A

enhancing, antoni A (super dense area) and antoni B (diffuse, empty area)

64
Q

most common primary malignant cns tumor in children?

A

medulloblastoma

65
Q

most common primary malignant cns tumor in adults?

A

glioblastoma: ring enhancing, crossing the corpus collosum, pseudopallisating necrosis on histo

66
Q

most common primary site for cns metastases?

A

adenocarcinoma (the smoking cancer cells that metastasize to the brain are small cell carcinoma)

67
Q

most common begnign cns tumor in children??

A

pilocytic astrocytoma

68
Q

which of the following greatly increase the risk of developing a cns neoplasm?

A

theraputic radiation

69
Q

what is the most common radiation-induced intracranial tumor?

A

meningioma takes 10 years

70
Q

a WHO grade 1 tumor has a survival rate of ____ while grade 4 has ______

A

> 5 years or curable, <1 less than or equal to 1

71
Q

diffuse astrocytomas on ct can be identified bc:

A

low grade non enhancing, grade 3 is “patchy enhancement” grade 4 is “ring lesion”

72
Q

TEST: oligodenroglioma: identify from histo (fried egg), and tell what important genetic mutation caused the tumor:

A

deletions of 1p/19q

73
Q

3 most common pediatric tumors are:

A

pilocytic, meduloblastoma, ependymoma, all in posterior fossa, one is blue (meduloblastoma), between ependymoma and pilocytic, if you see pseudorosettes, you know it’s ependymoma

74
Q

TEST:

A

tumor in posterior fossa (pediatric) and histo is going to have red rosenthal

75
Q

Dural tail CR scan,

A

extra axial, dural based, whorl bodies, meningioma

76
Q

cp angle tumor:

A

schwannoma, antoni A and Antoni B

jK NEURO (35 decks)

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