CNS tumor scenario Flashcards
Middle-aged adult with polycythemia
signs of increased ICP
attached imaging
What would you expect the morphology of a biopsy to look like?
What is this?
thin-walled capillaries with erythrocytes
intracytoplasmic lipid inclusions
Hemangioblastoma
Adult with signs of increased ICP
Cerebral mass
Biopsy: hypercellular white matter with microvascular proliferation, areas of necrosis/ hemorrhage and surrounding pseudopalisading arrangements of tumor cells
Glioblastoma multiforme
“Butterfly glioma”
Adult presents with signs of increased ICP and personality changes.
Imaging shows a slow-growing intraparenchymal frontal lobe mass composed of calcifications
What do you expect the brain biopsy to look like
oligodendeoglioma
cells with clear cytoplasm and large round nuclei, resembling fried eggs
chicken wire patterns of capillary anastomoses
Adult presents with a benign brain tumor
h/o NF2
what are the 2 most likely types of tumors this adult has?
- meningioma
- acoustic schwannoma
Adult presents with hearing loss, tinnitus and hydrocephalus.
Immunohistotyping results: S-100+
What do you expect imaging and biopsy to show?
Imaging: enhancing lesion by the internal auditory canal with possible extension into the cerebellopontine angle
Biopsy: Biphasic pattern of Antoni A and Antoni B Bodies
in analyzing a patient’s brain biopsy, you come across this.
what are they and how do you know?
what does this patient likely have?
Antoni A region of cells: the glial cells are arranged in a palisading pattern with interspersed nuclear-free zones
the nuclear-free zones are called Verocay bodies
The patient likely has an acoustic schwannoma
in analyzing a patient’s brain biopsy, you come across this.
what are they and how do you know?
what does this patient likely have?
Antoni B region of cells
the cells form a loose mesh with their appendices and have unstained myxoid stroma
Acoustic schwannoma
what are these?
where do you see them?
What would you expect imaging to show in a patient with these?
psammoma bodies
Meningioma
well defined space-occupying lesion, resembling a snowball.
possible spinal cord involvement
A child presents with signs of increased ICP
If there is a tumor present, where do you expect to find it?
Cerebellum
- Most common malignant= medulloblastoma
- Most common benign= pilocytic astrocytoma
both are seen in the cerebellum
A child presents with a cerebellar brain tumor.
imaging is taken and reveals this.
what type of tumor is it?
is it malignant or benign?
what would you expect to find on morphology?
Pilocytic astrocytoma
benign
bipolar cells composed of central basophilic nuclei with eosinophilic pilocytic processes (Rosenthal fibers)
A child presents with a cerebellar brain tumor.
imaging is taken and reveals this.
what type of tumor is it?
is it malignant or benign?
what would you expect to find on morphology?
What is he also likely to have?
Medulloblastoma (notice it looks more like a mass than a cyst)
Malignant
Homer Wright rosettes
sheets of anaplastic primitive cells with scant cytoplasm and high mitotic figures
Turcot syndrome
describe the highlighted region of this image
Homer Wright rosettes:
light central areas of neutropil, surrounded by concentric clusters of cells
Characteristic of medulloblastoma
A patient presents with a brain tumor.
morphology reveals this.
what type of tumor is it?
is it malignant or benign?
what would you expect to find on imaging?
What else could the patient have?
Ependymoma
benign
intraparenchymal tumor with calcifications and cystic components around the ventricles
NF2
The patient could be a child or an adult!
Describe this image
Ependymoma
perivascular pseudorosettes: rod-shaped blepharopblasts arranged in a radial manner around several vessels
A patient presents with a brain tumor.
morphology reveals this.
what type of tumor is it?
is it malignant or benign?
what would you expect to find on imaging?
Where are the cells derived?
Craniopharyngioma
benign
suprasellar calcified cyst with lobulated contours
Rathke pouch
Describe the following image
Craniopharyngioma
cysts with viscous brown-yellow cholesterol cysts, resembling motor oil
cords/ nests of palisading squamous epithelium in “wet keratin”
