CNS Tumors Flashcards
1
Q
Are most brain tumors primary or metastatic?
A
Metastatic
2
Q
Are most brain tumors in children or adults?
A
Adults
3
Q
What are the two main brain tumors in children?
A
Medulloblastoma
Pilocytic astrocytoma
4
Q
Are adult CNS tumors mostly supra- or infratentorial?
A
Supratentorial
5
Q
Are child CNS tumors mostly supra- or infratentorial?
A
Infratentorial
6
Q
Are adult or pediatric CNS tumors mostly supratentorial?
A
Adult
7
Q
Are adult or pediatric CNS tumors mostly infratentorial?
A
Pediatric
8
Q
Do primary CNS tumors typically show slow or fast growth?
A
Slow
(slowly developing symptoms)
(contrast to Mets - which tend to be acute onset)
9
Q
Do high grade/malignant CNS tumor tend to metastasize?
A
Almost never
10
Q
Glial neoplasm that is predominantly in pediatrics
A
Pilocytic astrocytoma
11
Q
Do slow or progressive growing CNS tumors produce general symptoms (seizures, headache, memory issues)?
A
Slow growing
12
Q
Do slow or progressive growing CNS tumors produce focal signs?
A
Progressive growth or high grade tumors
13
Q
Do low grade/benign or high grade/malignant CNS tumors widely infiltrate and possibly cause significant morbidity or mortality?
A
Low grade/benign
14
Q
Glial neoplasm of astrocytes
A
Astrocytoma
15
Q
This is the most common adult primary brain tumor
A
Astrocytoma
16
Q
What are the two types of Astrocytoma?
A
Localized and Diffuse
17
Q
Which type of Astrocytoma is mostly pediatric?
A
Localized
18
Q
Which type of Astrocytoma is mostly in adults?
A
Diffuse
19
Q
This is the most common form of localized glioma
A
Pilocytic Astrocytoma
20
Q
Most Pilocytic Astrocytomas are in this location
A
Posterior fossa / cerebellum
Often midline
21
Q
Is Pilocytic astrocytoma often in the midline or periphery?
A
Midline (i.e. vermis) = cystic mass with mural nodule
22
Q
Type of astrocytoma that commonly involves optic pathways
A
Pilocytic astrocytoma
23
Q
Pilocytic astrocytoma commonly forms these, which are hallmark of Neurofibromatosis type 1
A
Optic gliomas
24
Q
Type of CNS tumor that commonly forms optic gliomas
A
Pilocytic astrocytoma
25
Is Pilocytic astrocytoma well-circumscribed?
Yes
26
Is a Pilocytic astrocytoma typically curable?
Yes - often surgically resectable
27
Pilocytic Astrocytoma is a tumor of this age group
Pediatric and young adults
28
A tumor that is cystic with an enhancing mural nodule located in the cerebellum is mostly like this
Pilocytic Astrocytoma
29
This CNS tumor has characteristic Rosenthal fibers, which are eosinophilic with a ropey/corkscrew appearnce
Pilocytic Astrocytoma
30
This CNS tumor shows low grade-bland bipolar astrocytes with long, filamentous cytoplasmic processes
Rosenthal fibers, eosinophilic granular bodies, and is GFAP +
Pilocytic Astrocytoma
31
Pilocytic astrocytoma of optic nerve
Optic glioma
32
Optic glioma is this type of tumor of the optic nerve
Pilocytic Astrocytoma
33
Do optic gliomas require resection?
Usually no
(are indolent)
34
Optic gliomas are associated with this disorder
Neurofibromatosis type 1
35
Are optic gliomas associated with Neurofibromatosis type 1 or 2?
Type 1
36
This is the skin lesion seen in Neurofibromatosis type 1
Cafe au lait spots
37
This is the eye lesion seen in Neurofibromatosis type 1
Lisch nodules
38
Localized astrocytoma with seizure association
Pleomorphic Xanthoastrocytoma
39
Pleomorphic Xanthoastrocytoma is seen in this age group
Pediatrics and young adults
40
Pleomorphic Xanthoastrocytoma favors this lobe
Temporal lobe
41
Are Pleomorphic Xanthoastrocytoma slow or fast growing?
Slow
42
Type of CNS tumor where seizures may occur for years before diagnosis
Often produce cyst with enhancing mural nodule
Pleomorphic Xanthoastrocytoma
43
Type of CNS tumor that is pleomorphic, GFAP +, no mitoses or necrosis, and eosinophilic granular bodies frequent
Abundant, sometime foamy cytoplasm
Pleomorphic Xanthoastrocytoma
44
Are mitoses or necrosis seen in Pleomorphic Xanthoastrocytoma?
No
45
A cyst with enhancing mural nodule in the temporal lobe may be this CNS tumor
Pleomorphic Xanthoastrocytoma
46
This is a localized astrocytoma of ventricle
Subependymal giant cell astrocytoma
47
Subependymal giant cell astrocytoma typically grow in the wall of this ventricle
May produce obstructive hydrocephalus
Lateral ventricle
48
Subependymal giant cell astrocytoma is associated with this condition
Tuberous sclerosis
(SEGA, cardiac rhabdomyomas, renal angiomyolipomas, skin lesions)
49
This is an infiltrating tumor of astrocytes
Diffuse astrocytoma
50
Are Diffuse astrocytomas easy to resect?
No - very difficult
51
Grade of Diffuse astrocytoma with increased cellularity, +/- atypia
Non-enhancing
Grade 2
52
Grade of Diffuse astrocytoma that is more cellular, mitoses are present, no necrosis or vascular endothelial proliferation
Grade 3
53
Grade of Diffuse astrocytoma with mitoses, necrosis and/or endothelial proliferation, enhancing
Grade 4
54
Grade 3 Diffuse astrocytomas are characterized by the presence of these
Mitotic figures
55
Grade 4 Diffuse astrocytomas are characterized by the present of these
Necrosis and/or vascular proliferation
56
Fibrillary astrocytoma is this grade
Grade 2
57
Anaplastic astrocytoma is this grade
Grade 3
58
Glioblastoma multiforme is this grade
Grade 4
59
Diffuse astrocytomas occur anywhere in the CNS, but mostly here
Cerebral hemispheres
60
Diffuse astrocytomas occur with this age group
Adults (30-60 years)
61
Is IDH wild type a good or poor prognostic feature of diffuse astrocytomas?
Poor
62
Is IDH mutation a good or poor prognostic feature of diffuse astrocytomas?
Good
63
Mutation of this gene is a good prognostic feature of diffuse astrocytomas
IDH
64
Are diffuse astrocytomas well-defined?
No - poorly defined infiltrative tumor
65
Malignant astrocytic tumor with necrosis and vascular endothelial proliferation
Glioblastoma Multiforme
66
Glioblastoma Multiforme affects this age group
Adults (55-85 years)
67
Are most cases of Glioblastoma Multiforme involving wild type or mutated IDH?
Wild type
68
What is the mean survival of Glioblastoma Multiforme?
18 months
69
MGMT promoter methylation predicts response of this tumor to chemotherapy
Glioblastoma Multiforme
70
This gene predicts response of Glioblastoma Multiforme to chemotherapy
MGMT promoter methylation
71
Are focal signs more or less common with Glioblastoma Multiforme than other brain tumors?
More common
72
This CNS tumor may cross the midline / corpus callosum and form a "butterfly lesion"
Glioblastoma Multiforme
73
This CNS tumor sometimes appears multifocal
Radiology shows a ring enhancing lesion
Glioblastoma Multiforme
74
Morphology of this CNS tumor involves confluent necrosis, and often forms nuclear palisades
Also vascular endothelial proliferation
Glioblastoma Multiforme
75
Neoplasm of oligodendrocytes
Oligodendroglioma
76
Oligodendrogliomas affect this age group
Adults (30-40 years)
77
This CNS tumor often presents with seizures and has a good prognosis
Oligodendroglioma
78
Oligodendrogliomas most commonly occur in this part of the brain
Frontal lobe
79
This symptom is the most common presentation of Oligodendroglioma
Seizures
80
Radiology of this CNS tumor shows calcifications
Oligodendroglioma
81
Morphology of this CNS tumor shows white matter mass with blurring of grey-white junction
Fried egg nuclei and Chicken wire vasculature
Microcalcifications
Oligodendroglioma
82
Fried egg nuclei are characteristic of this CNS tumor
Oligodendroglioma
83
Oligodendrogliomas are associated with these mutations
IDH mutation and loss of 1p and 19q
84
IDH mutation and loss of 1p and 19q are associated with this CNS tumor
Oligodendroglioma
85
Tumor of ependymal lining cells
Ependymoma
86
Ependymomas affect this age group
Pediatrics / young adults
87
Ependymomas often arise here
Near/in ventricular system
(most commonly in 4th ventricle)
88
Ependymomas in adults most commonly occur here
In hemispheres or spinal cord
89
Ependymomas in children mostly commonly occur here
Mostly infratentorial, near fourth ventricle
Produce obstructive hydrocephalus
90
What is the prognosis for Ependymomas?
Excellent if resectable; poor if not
91
Morphology of this CNS tumor will show ependymal rosettes and perivascular pseudorosettes
Ependymoma
92
This variant of Ependymoma occurs at filum terminale
Myxopapillary variant
93
The myxopapillary variant of Ependymomas occurs here
Filum terminale
94
Rapidly growing primitive neuroectodermal tumor of CNS
Medulloblastoma
95
Medulloblastomas affect this age group
Children (3-15 years)
96
Medulloblastoma always occurs in this location
Posterior fossa / cerebellum
97
This CNS tumor is a small round blue cell tumor, with Homer-Wright rosettes and frequent mitoses
Medulloblastoma
98
This CNS tumor is synaptophysin positive
Medulloblastoma
99
Medulloblastomas are positive for this protein
Synaptophysin
100
This CNS tumor is very aggressive, but very radiosensitive
Medulloblastoma
101
Patients with Medulloblastoma with this mutation have 100% survival
WNT mutations
102
This gene amplification is a poor prognosis of Medulloblastoma
Myc amplification
103
This CNS tumor may metastasize through CSF
"drop metastasis"
Medulloblastoma
104
Can Medulloblastomas metastasize?
Yes = drop metastasis (through CSF, "drop" to spinal cord)
105
This CNS tumor requires radiation of entire neuraxis after resection
Medulloblastoma
(due to possibility of drop metastasis)
106
Medulloblastoma is a rapidly growing tumor of this component of the CNS
Neuroectoderm
107
Does the anaplastic variant of Medulloblastoma have a good or poor prognosis?
Poor
108
This is a tumor of arachnoid meningothelial cells
Meningioma
109
Meningioma is a benign tumor of these
Arachnoid cells
110
Meningiomas affect this age group
Adults
111
Histology of this CNS tumor shows whorled configuration and psammoma bodies
Meningioma
112
Morphology of this CNS tumor frequently has a "whorled" configuration
Meningioma
113
This CNS tumor may show Psammoma bodies (concentrically laminated calficiations; layers on layers)
Meningioma
114
Are Meningiomas more common in men or women?
Women
115
Meningiomas are positive for this receptor
Progesterone receptor +
116
CNS tumor that is positive for progesterone receptor, and is more common in women
Meningioma
117
This is a slow growing, rounded, dural based tumor
Meningioma
118
Radiology of this CNS tumor is uniformly enhancing, with a dural tail
Meningioma
119
Meningiomas are mostly cured by this
Surgery
(but not typically necessary unless symptomatic)
120
Meningiomas are associated with this condition
Neurofibromatosis type 2
121
Meningiomas are associated with deletions in this chromosome
22 (especially 22q)
Associated with NF2 syndrome
122
This is the pathognomonic tumor of Neurofibromatosis type 2
Acoustic neuroma
123
Intraventricular proliferation of choroid plexus
Choroid plexus papilloma
124
Choroid plexus papilloma occurs in this age group
Children
125
Choroid plexus papillomas most commonly occur in this stucture
Lateral ventricles
126
Are colloid cysts slow or fast growing?
Slow
(become symptomatic in adulthood)
127
Positional headaches are a symptom of this rare, slowly enlarging mass that may occur near/in lateral ventricle
Colloid cyst
128
Sudden death may occur with this CNS tumor from positional change causing acute obstruction of CSF drainage
Colloid cyst
129
This is a Rathke's pouch remnant epithelial tumor
Craniopharyngioma
130
Craniopharyngioma is a tumor of this
Epithelial remnants of Rathke's pouch
131
Craniopharyngiomas affect this age group
Pediatrics
132
Is Craniopharyngioma commonly supratentorial or infratentorial?
Suprasellar
133
Morphology of this CNS tumor will show calcifications, adamantinomatous epithelium, and cholesterol crystals
Craniopharyngioma
134
Tumor of malignant germ cells
Germinoma
135
Germinoma is positive for this protein
PLAP (placental alkaline phosphatase)
136
CNS tumor that is PLAP (placental alkaline phosphatase) positive, clear cytoplasm, with lots of reactive lymphocytes
Germinoma
137
Stromal neoplasm with hypervascularity
Hemangioblastoma
138
Hemangioblastoma most often occurs in this location
Cerebellum
(also retina, brainstem, cord)
139
Hemangioblastoma is associated with this inherited syndrome
von Hippel-Lindau Syndrome
140
von Hippel-Lindaue syndrome is associated with this CNS tumor
Hemangioblastoma
141
Syndrome that may present with multiple tumors at younger ages
Renal cell carcinoma is common, as well as Hemangioblastomas
von Hippel-Lindau syndrome
142
A patient with a tumor on the cerebellum and history of renal cancer most likely has this CNS tumor
Hemangioblastoma
(associated with von Hippel-Lindau syndrome)
143
Morphology of this CNS tumor is clear, foamy stromal cells
Very vascular
Secretes EPO, which stimulates RBC formation
Hemangioblastoma
144
Hemangioblastoma secretes this, which stimulates RBC formation
EPO (erythropoietin)
145
Hemangioblastomas are positive for this protein
Inhibin
146
CNS tumor that is inhibin positive
Hemangioblastoma
147
Most common CNS neoplasm in immunocompromised patients (AIDS, transplant, elderly)
Primary CNS lymphoma
148
Majority of Primary CNS lymphomas are this type
High grade B cell lymphomas
149
This type of Primary CNS lymphoma will be CD20 positive on IHC
B cell lymphomas
150
Multiplicity, patient history, and occurrence at grey-white matter junction are clinical keys to this majority of CNS tumors
Metastatic disease
151
A mass in the brain that is cytokeratin positive is likely this type
Metastatic
(since cytokeratin is expressed by epithelial cells)
