C.N.S. TUMORS Flashcards by Iseoluwa Ojo

General characteristics of CNS tunors

• In childhood, tumors are likely to arise from the _______, while in adults are mostly ————-.

posterior fossa

supratentorial

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The anatomic site of CNS tumors can have lethal consequences irrespective of the histological classification

T/F

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CNS tumors do not have detectable premalignant stages

T/F

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CNS tumors often metastasize

T/F

They rarely metastasize

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Clinical features of CNS tumors

•_________,_________ , etc

•______,_____________ deficits

Seizures, headaches

Focal neurologic

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Classification of CNS Tumors

• Coverings of the brain (_______)
• Cells intrinsic to the brain (______, ______ tumors,_______ tumors)
• Other cell populations (_______,_______ tumors)
• Metastases
• Sellar region tumors e.g. _______,______________ tumour (PitNET)

Meningioma

gliomas ; neuronal ; choroid plexus

lymphomas; germ cell tumors

craniopharyngioma, pituitary neuroendocrine tumour (PitNET)

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Gliomas

3 types

List!!!!

• Astrocytoma
• Oligidendroglioma
• Ependymoma

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Astrocytomas
Can either be _______ or _________

• Fibrillary

• Pilocytic

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Astrocytomas: Fibrillary

•_____ to ____ decade
• Commonly found in ________
• Grades are ________ (II), _____________ (III), ________ (IV)

4th to 6th

cerebral hemisphere

Diffuse (II), Anaplastic (III), Glioblastoma (IV)

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Astrocytomas: Pilocytic

• (Children or Adults?)
•location : __________
• Relatively (benign or malignant ?)

Children

Cerebellum

benign

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Oligodendroglioma
• _____ and _______ decades
•location : ______ with predilection for _____ matter

Fourth and fifth

Cerebral hemispheres; white

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Oligodendroglioma

• Common genetic finding is loss of ___________ for chromosomes _____ and ——-

heterozygosity

1p & 19q

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Who has a better prognosis

Oligodendroglioma or Astrocytomas

Oligodendroglioma has a Better prognosis than astrocytomas

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Ependymoma
•_______ decades of life
• Most often arise next to the _______________________________ including the _______ of the spinal cord.

• In adults, most common in the _____

First two

ependyma-lined ventricular system

central canal

spinal cord

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Meningioma

• (Benign or Malignant?)
• Originate from _______ cells of the ______
• Usually (poorly or well?) demarcated
• Attached to the ___ with ______ of the underlying brain

Benign

meningothelial; arachnoid

Well

dura; compression

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Meningioma

__________ pattern of cell growth and _______________ bodies.

Whorled

psammomatous

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Meningioma

Subtypes:
•_________
• _________
• ___________

Syncytial

Fibroblastic

Transitional

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Medulloblastoma
• (Children or Adults?)
• _________ location
• Largely (differentiated or undifferentiated?) tumor
•highly (benign or malignant?) .
• Exquisitely radio(sensitive or resistant?)

Children

Cerebellar

undifferentiated

malignant

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Medulloblastoma

• _______ + _______ = high survival rate

Excision + Radiation

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Nervous system tumors
• \___________
• _____________
• ________ tumors

• Schwannoma
• Neurofibroma
• Metastatic tumors

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Schwannoma
• Benign or Malignant?

• Located often at the __________, attached to the ______ branch of the ________ nerve

Benign

cerebellopontine angle

vestibular; eigth cranial

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Schwannoma

• Present with ______ loss/ ______

• Maybe associated with _____ gene mutation.

hearing; tinnitus

NF2

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Schwannoma

Hypo/hypercelllular areas known as _______ and ___________

• In between are areas of nuclear _______ known as ______ bodies

Antoni A and Antoni B.

palisading

Verocay

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Metastatic tumors to the CNS
• Lung, breast, skin (melanoma), kidney, GIT are least common.
• Sharply demarcated.

T/F

F( Most )

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Sellar Region Tumors Tumors of the pituitary gland • _____________ • ___________________ tumor (pituitary ____________)

Craniopharyngioma Pituitary neuroendocrine adenoma

Craniopharyngioma WHO grade ___ (Benign or Malignant?) Usually _______ location but frequently extends into the ______ and neighbouring structures.

1 Benign suprasellar

Craniopharyngioma Two types: _______ craniopharyngioma & _________ craniopharyngioma

Papillary Adamantinimatous

Craniopharyngioma Clinical features: ______ disturbances, endocrine deficiencies e.g. _________ hormone (_____ failure) Diabetes insipidus, headachee etc

visual Growth hormone (growth failure)

Craniopharyngioma ________ hormone is the most commonly affected hormone.

Growth

Most common intraocular malignancy in children is ??

Retinoblastoma

Retinoblastoma Due to loss/inactivation of _____ gene (2-hit hypothesis) m

RB1

Retinoblastoma Classification _______ (unilateral) __________ (bilateral) When associated with ————— (trilateral)

Sporadic Inherited Pineoblastoma

Retinoblastoma Classification Sporadic (_____lateral) Inherited (____lateral) When associated with pineoblastoma (____lateral)

uni Bi Tri

Retinoblastoma Loss/inactivation of ______________ gene A ____________ gene. ________ locus

both alleles of RB1 Tumor supressor 13q14.2

Retinoblastoma 2 hit hypothesis First mutation is ____________ 2nd mutation is ________

somatic/germline. somatic

retinoblastoma Earlier age of onset Usually ___lateral involvement May have other malignancies e.g. _____________

bi osteosarcoma

Germline mutations in RB1 lead to _________________ retinoblastoma

inherited/familial

Retinoblastoma Clinical features: _________ (white reflex), _____,_______, ___ pain, detachment. On histology, ______ and ———— are seen.

Leukocaria glaucoma, strabismus eye rosettes and fleurettes

Retinoblastoma Two types of rosettes: _______________ rosettes _____________ rosettes

Flexner-Wintersteiner Homer Wright

Retinoblastoma Treatment: ———— ___________

Chemotherapy Enucleation

CNS tumors: By the cell type Pineal tumors Tumors of the ______ and ______ nerves(e.g., schwannoma, neuroma, neurofibroma) Mesenchymal nonmeningeothelial tumors(e.g., _____,______,_______,________) Germ cell tumors (e.g., _______)

Pineal hemangiomas, hemangioblastoma, lipoma, hamartoma teratoma

Primary CNS tumors do not metastasize to organs outside the CNS. T/F

Drop metastases (intra____, extra______ ,____ metastases ) and ________ metastases may occur. Typically manifest as _____ along the _______ and ________ that can cause back pain with neurologic symptoms (e.g., limb weakness) Can be detected by ________

dural; medullary; spinal leptomeningeal nodules spine and cauda equina lumbar puncture

Most common primary brain tumor in adults is ??

Glioblastoma

Glioblastoma Often crosses ________, forming a ______ glioma

corpus callosum Butterfly

Glioblastoma Express a protein called _____ (__________________Protein)

GFAP Glial Fibrillary Acidic

2nd most common brain tumor in adults is ??

Meningioma

Meningioma Arise from _______ cells

arachnoid

Meningioma “_______” - external to brain Can have ______ attachment ("tail")

Extra-axial dural

Meningioma Classically affects (male or female?) more than (males or females?) Expresses ______ receptor

Female Male estrogen

3rd most common adult primary brain tumor is ??

Schwannoma

Cerebellopontine angle is where ______ never and ________ nerve emerge from

Facial nerve and vestibulocochlear nerve

Schwannoma Stain positive for protein ———

S-100

Neurofibromatosis Associated with ___________ Autosomal __________ disease

schwannomas dominant

Neurofibromatosis Mutation _____/_____ genes Neurofibromas _____ nodules ___________ spots

NF1 /NF2 Lisch Café-au-lait

Neurofibromatosis Type 1: (Most of Least?) common ————- spots, _________

Most Café-au-lait Neurofibromas

Neurofibromatosis Type 2: _______________ (almost all patients) Meningiomas ______ tumors MISME: —————————

Bilateral schwannomas Multiple Multiple inherited schwannomas, meningiomas, and ependymomas

Oligodendroglioma Usually in _______ lobe

frontal

Pituitary adenoma Most commonly secrete _______, leading to ______,_______,________ etc

prolactin Amenorrhea, galactorrhea, impotence

Pituitary Adenoma Bitemporal ________ <___mm = microadenoma >____mm = macroadenoma

hemianopsia 10 10

Hemangioblastoma Two key facts to know #1: Can produce ____ , leading to _____________ #2: Occur in __________ syndrome

EPO; polycythemia von Hippel-Lindau

Most common brain tumor children is ??

Pilocytic astrocytoma

Pilocytic astrocytoma (Low or High?) -grade astrocytoma Contain _______ fibers

Low Rosenthal

Medulloblastoma Highly (benign or malignant?) primary brain tumor Usually occurs in (children or adults?) Usually occurs in ________ Often in the midline ( ________)

malignant Children cerebellum truncal ataxia

Medulloblastoma Is a Type of ___________________________________________ tumor (PNET)

primitive neuroectodermal

Medulloblastoma ___% children survive to adulthood. Many with ___________________ Can compress _________ , leading yo hydrocephalus

75; complications of treatment 4th ventricle

Nodules in dura of spinal cord: ___________

Drop metastasis”

Craniopharyngioma: location •____________: Anywhere pituitary gland → _______________

Suprasellar base of 3rd ventricle

Craniopharyngioma Derived from ______________ Often ———- and _____ Contain _______ cells

remnants of Rathke's pouch calcified and cystic epithelial

Craniopharyngioma Can compress the ________, causing ______________

optic chiasm Bitemporal hemianopsia

Craniopharyngioma Enucleation: __________________ and __________________ between the globe and the orbit.

removing the eye from the orbit separating all tissue connections