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Anatomic Pathology > CNS Tumors > Flashcards

CNS Tumors Flashcards

1
Q

The most common intracranial tumor worldwide is the?

A

Glioma
- Astrocytoma
- oligodendrogliomas
- ependymoma

Followed by
- meningioma
- pituitary adenoma

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2
Q

Classification of CNS tumors

A
  • Gliomas
  • Embryonal neoplasms; medulloblastoma
  • Neuronal tumors; central neurocytoma, ganglioglioma
  • Meningioma
  • Metastatic tumors
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3
Q

Types of Astrocytoma

A

Derived form astrocytes
- Diffuse Astrocytoma (80% of primary brain tumor)
- Pilocytic Astrocytoma

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4
Q

Most common site and age for diffuse Astrocytoma?

A

Site
- cerebral hemispheres
- cerebellum
- brainstem
- Spinal cord
Age
- 4th -6th decade of life

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5
Q

Classification of diffuse astrocytoma ?

A
  • Well differentiated astrocytoma (grade 2)
  • Anaplastic astrocytoma (grade 3)
  • Glioblastoma (grade 4)
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6
Q

Gross and microscopy features of well differentiated diffuse astrocytoma?

A

Gross
- Poorly demarcated infiltrating tumor
- grey, firm/soft, gelatinous
- may show cystic degeneration
Microscopy
- increase in astrocytic glial tumor cells (mild to moderate cellularity)
- Fibrillary background (due to cytoplasmic processes of astrocytes)
- variable degrees of nuclear pleomorphism
Immunohistochemistry
- Glial finrillary acid protein (GFAP) positive

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7
Q

Anaplastic astrocytoma features

A
  • Increased cellularity
  • Cellular and nuclear pleomorphism
  • Anaplasia
  • Presence of mitotic figures
  • Rapid growth of the tumor
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8
Q

Glioblastoma gross features (grade 4)

A
  • Variegated appearance (white and firm areas with soft and yellow necrosed areas)
  • cystic degeneration
  • colors represent multiple areas of recent (red) and old (yellow) hemorrhage
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9
Q

Microscopic features of Glioblastoma

A
  • Increased cellularity
  • Marked cellular and nuclear pleomorphism
  • Frequent mitosis
  • Anaplasia
  • Necrosis
  • Endothelial cell proliferation (forming tufts of piled up cells)
  • May be glomeruloid body (marked endothelial cell proliferation
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10
Q

Types of necrotic patterns in Glioblastoma?

A
  • Serpentine pattern of necrosis
  • Pseudo-palisading (garlanding)
    • edges of the necrotic area is surrounded by the palisading tumor cells
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11
Q

What are the two forms of Glioblastoma ?

A

Primary;
- Arises de novo (no preexisting low grade astrocytoma)
- occur in older patients
Secondary;
previously had low grade astrocytoma
Occur in younger patients

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12
Q

Acquired mutations in Glioblastoma ?

A
  • P53, RB
  • Clinical features: seizures and headaches
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13
Q

Radiological features of Glioblastoma?

A
  • Shows mass effect and Edema of brain adjacent to the tumor
  • Abnormal vessels that are leaky demonstrate contrast enhancement on imaging
  • Grave 4 ; poor prognosis
  • grade 2; remain static or progress slowly over a number of years
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14
Q

Pilocytic astrocytoma features ?

A

In children and young adults
Good prognosis
Site
- site located in the cerebellum, floor and walls of the third ventricles
- well circumscribed

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15
Q

Microscopic features of Pilocytic astrocytoma ?

A
  • Biphasic pattern
  • loose microcystic areas
  • rosenthal fibers and eosinophilic granular bodies
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16
Q

Oligodendroglioma (grade 2)

A
  • Site; common in white mater of cerebral hemisphere
  • Well circumscribed
  • better prognosis than astrocytoma
  • Deletion of chromosomes 1p 19Q
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17
Q

Microscopic features of oligodendrocytoma ?

A

Sheets of round, small l, regular cells
- Nuclei: spherical, with fine granular chromatin
- Cytoplasm: clear halo of cytoplasm surrounding the nuclei (fried egg appearance )
- Stroma: anastomosing capillaries (chicken wire appearance)
- Calcification (calcospherites) common
- mitotic figures is usually not seen

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18
Q

What are the three cs of oligodendrocytoma?

A
  • Clear holo of cytoplasm surrounding the nuclei (fried egg appearance)
  • Chicken wire appearance (anastomosing capillaries)
  • Calcification
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19
Q

Ependymoma features

A

Site
- first 2 decades; 4th ventricle
- adults: Spinal cord associated with NF2

20
Q

Gross and microscopic features of ependymoma

A
  • well demarcated from adjacent brain parenchyma
  • resemble normal ependymal cells
  • cells have well defined cell membrane
  • EPENDYMAL ROSETTES
  • PERIVASCULAR PSEUDO-ROSETTES; tumor cells are arranged around vessels.
21
Q

Special stain and immunochemistry for ependymoma

A

Stain
- PTAH stain
- PTAH positive blepharoplasts (basal bodies of cilia of Ependymal cells)
Immunohistochemistry
- GFAP positive

22
Q

Embryonal tumors are of what origin?

A

Neuroectodermal origin (consisting of primitive, undifferentiated cells)
Most common - medulloblastoma

23
Q

Medulloblastoma

A
  • Neuronal and glial markers may be expressed
  • children mostly (20% brain tumors in children)
  • exclusively in cerebellum
    Children: midline cerebellum
    adults: lateral cerebellar hemispheres
    Gross
  • well circumscribed, gray and friable
24
Q

Microscopic features of medulloblastoma?

A
  • Ana-plastic small blue cells
  • numerous mitotic figures
  • HOMER-WRIGHT rosette: central neutrophil (pink material) surrounded by primitive tumor cells
    gFAB positive
25
Q

Drop metastases of medulloblastoma is seen in?

A
  • Metastasis from the cerebellum to the cauda equina
  • Spread through CsF
  • spread may present as modular masses anywhere in the CnS
26
Q

Clinical features and prognosis of medulloblastoma

A

Poor prognosis in untreated patients
MYC application - Poor prognosis
Clinical features;
- cerebellar dysfunction
- hydrocephalus (occlusion of csf flow )

27
Q

Meningiomas features?

A
  • Benign tumor arising from meningothelial cell of the arachnoid matter
  • 20% of all primary intracranial neoplasms
  • 5th and 6th decade
  • 3:2 (female:male)
28
Q

Molecular genetics of meningioma?

A
  • Sporadic: NF2 mutation
  • Iatrogenic; prior radiation to the cranium
  • Associated with genetic disorder: Gorlin syndrome, NF2
29
Q

Most common sites of meningiomas include?

A
  • Parasagittal regions of the Cerebral hemispheres
  • Dura over the lateral con exits
  • Olfactory groove etc

Can occur anywhere in the intracranium even within the ventricular system.

30
Q

CmGross description of meningioma ?

A
  • Usually well circumscribed
    Encapsulated, smooth, rounded, bosselated, or polyploid mass.
  • usually attached to the dura, compressing underlying brain structures
31
Q

Microscopic features of meningiomas

A
  • Whorled pattern of arrangement of meningoepithelial cells
  • presence of psammoma bodies (laminated, spherical calcospherites)
32
Q

Histological variants of meningioma ?

A

Syncytial (meningothelial); whorled clusters of polygonal cells without visible cell membranes (syncytial) . With centrally placed nuclei

Fibroblastic; spindle shaped elongated cells which are arranged in interlacing or parallel bundles with abundant collagen deposition in between the cells

Transitional/mixed; features of both . Whorls pattern around a central capillary blood vessel

Center of some whorls may show psammoma bodies

33
Q

Meningioma types (part 2)

A
  • Psammomatous: Numerous psammoma bodies
  • Secretory; contains gland like PAS positive eosinophilia secretions (pseudopsammoma bodies)
  • Microcystic; microcystic soaces with a loose spongy appearance
  • Angiomatous; numerous blood vessels
34
Q

Immunohistochemistry for meningioma

A

GFAP negative
Keratin negative
Epithelial membrane antigen (EMA) positive

  • WHO grade I/IV.
35
Q

WHO grading of meningioma (1-3)

A

Majority of meningiomas are WHO grade 1

Grade 1
- meningothelial
- fibroblastic
- microcystic
- transitional
- psammomatous
- Angiomatous (hemangioblastic, angioblastic)
- secretory subtypes
- mataplastic
- lymphoplasmacyte rich

36
Q

Grade 2 classification of meningioma

A
  • Clear cell
  • chordoid subtypes
  • Atypical by criteria
    — 4 -19 mitotic figures
    — Brain invasion
    — Three of the following histological features
    —— increased cellularity
    —— small cells with high N/C ration
    —— large and prominent nucleoli
    —— patternless or sheet like growth
    —— foci of spontaneous or geographic necrosis
37
Q

Grade 3 classification of meningioma ?

A
  • Rhabdoid
  • Papillary subtypes
  • Anaplastic by criteria
    —- 20 or more mitotic figures
    —- display Frank sarcomatous or carcinomatous histology
38
Q

Things that do not affect the grading of meningioma regardless?

A
  • Invasion of dura, bone or soft tissue
  • pleomorphic or atypical nuclei
  • Ki67 is not a true diagnostic criteria (can be greater than 4% and uo 20%)
39
Q

Immunochemistry of secretory meningioma?

A
  • Psudoosammoma bodies are
  • CEA positive
  • Surrounding tumor cells - CEA, cytokeratin positive
  • KLF4 K409Q and TRAF7 mutations
40
Q

Clinical features do meningioma?

A
  • Slow growing
  • Produce symptoms by compressing underlying brain tissue and depend on site
41
Q

Which brain tumors are commonly associated with the following. Histologic findings??

A

1) Rosenthal fibers and eosinophilic granular bodies - Pilocytic astrocytoma
2) Perivascular pseudorosettes - ependymoma
3) pseudopalisading necrosis - Glioblastoma
4) Homer wright rosettes- Medularryblastoma
5) Fried egg appearance and chicken wire vasculature - oligodendrocytoma
6) numerous psammoma bodies - **psammomatous meningioma

42
Q

The most common primary site of tumors that metastasize to the brain are ?

A
  1. Lung
  2. Breast
  3. Skin (melanoma)
  4. Kidneys
  5. Gastrointestinal tract

Mostly carcinomas
Spread through the bloodstream

43
Q

The most common intracranial neoplasms are?

A

Metastatic tumors

44
Q

Choriocarcinoma has a high likelihood of mestasatsizing to ? And Protestant carcinoma ?

A
  • The brain
  • Prostate carcinoma almost never grow in the brain
45
Q

Gross features of primary CNS tumors ?

A
  • Sharply demarcated masses, surrounded by a prominent edmatous zone (boundary is sharp and well defined)
  • usually seen at the junction of GM and WM
  • microscopy - similar to that of the primary tumor
46
Q

Central neurocytoma affects which part of the brain?

A

The intraventricular location

47
Q

Tumors of pediatric age groups ?

A

Medulloblastoma
Pilocytic astrocytoma

Glioblastoma and lymphoma in older patients

Anatomic Pathology (12 decks)

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