CNS TUMOR PART 2 Flashcards
بسم الله الرحمن الرحيم
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Pilocytic astrocytoma
Is grade …
ageL .,…. and ……
It is the most common CNS neoplasm in childern
causing ,,,.,and,,,, symtopms
site in ,,,,,,,,,
Behavior is ……..and…..and……prognosis
Grade1
Children and young adults
Headache and ataxia
Cerebellum
3rd ventricle - spinal cord - cerebral hemispheres or Optic Nerve .
Bening slowly growing with good prognosis
Most common CNS neoplasm in children ?
Piocytic astrocytoma
Genetic profile of piloastrocytoma
BNM
1-Alteartions of BRAF
2- inactivation of Neurofibramatiosis type 1
3-Mitogen activated protein kinase pathway MAPK Path activated
_++++++++++++++=
No IDH Mutation
describe pilocytic astrocytoma grossly
May be
1-Cystic with mural nodule in the wall of the cyst
or
2-Well cirumscribe solid mass
Rosenthal fibers appear in ?
Pilocytic astrocytoma
Pilocytic astrocytoma in microso ?
,,,,,,,,phasic pattern
,,,,,,BODIES
More often in loose regions
Necrosis and mistosi are raer
Low to moderate cellulari
Biphasic pattern
with Rosenthal fibers apperance
with Rosenthal fibers apperance stian + with
Glial fibrillary acid protien
Immature higly celleular
Higly mitotic active
- higly malignant
poorly differentiated neoplasms dissemiating along CSF “resembling Developing nervous system” and belongs to
“small round blue cell tumor “
Embryonal neoplams grade 4
grade 4
mention examples of embryonal neoplams
Medullablastoma
AT RT atypical teratoid Rhabdoid tumor
Embryonal tumor with multilayer rosettes
CNS primitive neuroectodermal tumor PNETs
Menignioma
Behavior ?
20% of all 1ry intracranial tumors
Usually SS?
Age ? sex?
grade?
benign
___________
Solitary - slowly growing
in female more in adults more
grade 1
Origin of Meniginoma ?
Arise from arachanoid meningothelial cells
Attached to dura
may extend to overlying bone
Ionizing radiation
Hormones
Menignoma sporadic and solitary common
Describe genetic profile
MCN
Merlin inactivation
+
Loss of one copy of Chormosome 22
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NF2 INCREASES THE Probability of Meningioma
prognosis depends on ?
Sixe - location - surgical accessibility and histological grade
describe gross picture of the menigioma
Greyish white
Well cirumscribed
Dura based
Hyperostosis
cut surface whorlly shaped
brain compression
Gritty sensation in cutting menigoma why?
Psammoma bodies
Mention micrpscopic types of Menigomas
sftp
Synctial
Fibroblastic
transitonal
psammomtous
Synctial mengiona is ?
menngioma with cells in whorls and no cell membrane visible
Fibroblastic menigiona
Menigoma with elongated cells surrouned bundles of collagen
Transitional Meningioma
Between synctial and Fibroblastic so ! ?
Whotls + bundle of fibroblastic tissue of collagen
Psammaotus ?! meenigoma
Psammoma bodies
Atypical meningoma is interdeiate between beiningan and malignant states with increased mitotic activiy and brain invasion how do you know it?
What is its features ?
-Increased Cellularity
-Small cells with Increasd Nucelar cytoplasmic ratio
-Prominet Nuclei
-Cellular growth as sheet
Foci of spon atnerous necrosis
Anaplatsic maligant meniegona
Grade….
maligant cytology resmbing ?
Marked increasi in ?
Grade 3
Carcinoma melanoma sarcoma of high grade
Mitotic activity
Tumors of the cranial and paraspinal nerve - schwanomas
8%=
85%
30%
______________
90% are ,ss?
4% arise in the setting of ?
The peak incidne in ,,,, to ,,, decades
Intracrainal tumors
Cerebellopontine angle tumors
Spinal nerve root tumors
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Soliraty sporadic
NF2
4 To 6th
Schwannoma Neurilemmoma
…..Nerve sheath tumor of ……. origin
derived from ,,,,,cellls which nomrally produce ,,,,,,,,
Gross ……….,………………,………….attached to nerve from outside and can be easily separated from it
Maligant change very rare
Beining of NEURAL CREST ORIGIN
Swhanc cells = myelin
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Solitary well circumscribed encapsulated tumprs
peiroheral schannomas are ,,,,,,,
paraspinal tumors :-
Spinal nerve tumors = …..+signs of ………..
8th cranial nerve tumors leads to ? …..,….,….
Motor symptoms are ,,,, becauses ?
Asymptomatic
radiuclar pain + signs of nerve root compression
Hearing loss ,tinnutis +vertigo
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uncommon becasue? Schwannmoas favor sensort nerve roots
Hallmark of NF2 IS ?
Bilateral Vestibular tumors
THe most common presentation of schwannomas ?
Pain !
paiiiiiin !
Primary central Nervous system lymphoma
High grade diffuse …..lymphoma
accounting for 2% of ,,,,,,,,,,, and 1% ,,,,,,,,,,
in ummunosuppresed most common CNS neoplasm
In non immunosupprede incidence increased after,,,,,,years
Aggrssive with poor ?
Lymphoma orginating outside CNS reasrly spreads to brain parenchyma
B cell
Extranodal lymphoma + intracranial tumors
___________________
60 years
____________
poor response to chemotherapy
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Gross of primary cns lymphoma
Homgoenous firm
Brownish gray in color
with Hge and Necrosis
Micro of primary cns lymphoma
Sheets of anaplastic B Cells with prominetn nuceli
Necrosis
Reactive inflammatory infiltrate
The most common primary CNS germ cell tumor is
Germinoma
Germ cell tumors
Primary brain germ cell tuomrs along the ……. in …..and ……
1% of ……..
age……..
Midline
pineal &suprasellar
brain tumors
first and second decades
Metatic carncimoc tumots mention
Lung breast Kideny GIT
tumor in skin gives to brain ?
Maligantn melanoma
acute leukimia gives?
menigeal deposits
Metastaitc tumors route ?
or directly
site
80% in
15%
may in ?
HEMATOGENOUS
___________
Cerebral hemispherea at junction of white and grey matter
cerebellm
dura and leptomeingies
Metatstic spinal cord compression
MSCC
Local back pain or refered pain in limb is the intial presenting symptom
Familiat tumor syndrome
due to inacticvation of tumor supressor genes as ?
Tuberous sclerosis
Von hipple lindu disease
Von hipple lindaue mode of tansmossion is ?
casued by …… mutation of VHL tmours spupreesor gene located on chromosome ,,,,
VHL Protien plays a role in ,,,,,,,,
Autosomal dominant
Germline
3p
Cellular oxygen sensing
Hemangioblastoma of VHl disease in ?
Retina CEREBELLUM SPINAL CORD KIDENY PANCREAS
Hemangioma of VHL ?
Lungs
Liver
Pancreas cyst
kideny pheochromcytoma renal cysts renal cell carcinoma
Symptoms of VHL ?
Hemagnioblastoma
Hemangioma
الحمدلله رب العالمين
Verocay bodies found in ?
Schwannomma
