CNS Tumors Flashcards by Brandon edlund

What is the typical clinical setting of diffuse and anaplastic astrocytoma?

Diffuse:
Anaplastic:

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What are the general differences between metastasis to the brain and from other primary rumors and primary brain tumors?

Primary - poorly circumscribed, single, location varies

Secondary - well circumscribed, often multiple, location usually located in the junction between gray and white matter

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What is the morphological appearance of diffuse and anaplastic astrocytoma?

Diffuse: diffuse, large area
Astrocytoma:

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What is the Histologically appearance of diffuse and anaplastic astrocytoma?

Diffuse: more cellular, some holes, infiltrative, fibriles, start seeing pleomorphic, gemistocytic (only some)
Anaplastic: more cellular, more pleomorphism, GFAP more, mitotic figure (specific stain) split,

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What are the genetic changes of diffuse and anaplastic astrocytoma?

Diffuse: don’t do well in survival,
Astrocytoma:

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What is the prognosis of of diffuse and anaplastic astrocytoma?

Diffuse: greater than 5 years
Anaplastic: 2-3 years

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How do glioblastoma and pilocytic astrocytoma differe clinically?

Pilocytic: not a whole lot
Glioblastoma: slowly progressive neuro deficit, usually motor weakness, increased ICP, nausea, vommiting, seizures, butterfly, bilateral quadriplegia

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How do glioblastoma and pilocytic astrocytoma differe Histologically?

Pilocytic:
Glioblastoma: pseudopalisading necrosis, cross midline, serpentine necrosis, tumor cells escapes necrosis

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What is the WHO grading for I-IV grade CNS tumors?

Determined by histology

Grade I: low poliferative potential (meningiomas), can resect
Grade II: infiltrative, low proliferation, cannot resect
Grade III: generally Histologically evidence of malignancy (nuclear atypia, pliomorphic, mitotic)
Grade IV: cytologically malignant, mitotically active, necrosis prone (in center). Vessels and actively growing.

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What are the clinical and morphological features of oligodendroglioma?

Clinical: les common, seizures
Morphologically: calcifications (dark irregular shapes, fall out), fired egg look, perinuclear halo
-squash prep showing vascular it
Genetic: 1p and 19q arm deletion

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What are the clinical and morphological features of ependyoma?

Clinical: children in brain, adult in spinal cord, slow growing but 4 yr prognosis, if spread hey go to spinal cord, CSF dissemination
Morphologically: massive, no necrosis or blood supply, very disorganized

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What are the clinical, genetic, and morphological features of medulloblastoma?

Clinical: children, cerebellum, radiosensitive, headache, worsening vommiting, back pain and motion sickness
Morphological: well circumscribed
Genetic: i(17q10) = poor
Histologically: small, dark cells, elongated, anaplastic, homer- wright rosettes

More predominant in males

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What are the clinical and morphological features of meningioma?

Clinical: slow-growing, benign, of arachnoid cells
Morphological:mat thatched to dura, compressed brain, syncytial pattern, psammoma bodies

Second most common primary brain tumor

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What are the four types of rosettes commonly found in brain tumors?

Also called canal

Vascular pseudo rosette (blood vessel)
Homer- wright - protein in the center
Flexner - Wintersreiner (Rb) -
4.

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What are the three gliomas?

astrocytoma
oligodendroglioma
ependdyoma

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What percent of CNS tumors are metastic from another site?

70%

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What are the two most common tumors?

GMF

Meningioma

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What percent of tumors spread to the brain?

25-50%

Lung, melanoma, breast

What are sometimes the first sign of the primary tumor?

Meningeal carcinomatosi- tumor studding the surface of the brain

Little studs

What do metastatic tumors look like Histologically?

Infiltration

Pliomorphic

Follow path of least resistance

What are the most common brain cancers in children?

Medulloblastoma
Astrocytoma

CNS tumors are 27% of CNS tumors in children
(Second leading cause of tumors)

What is adjuvant treatment?

If the treatment follows the primary treatment (chemo, radiation, tumor)

Tries to get rid of residual cancer cells

Where are most tumors located in children and adults?

Children: 70% in PF
Adults: 70% in ST (hemispheric)

What is part of the prognosis other than grade?

Age
Location
Performance (therapy can cause brain damage)
Radiological features 
Extent of resection
Proliferation index
Genetic alterations

What are you worried about with brain radiation?

Of too much DNA breaks brain cells die Brain tumor stem cells can be resistant to radiation

What are survival rates for grades of CNS tumors?

II: greater than 5 years III: generally 2-3 IV: depends on treatment, maybe greater than 5 in 60/80%, in elderly will not usually live more than a year

What is a glioblastoma?

Highest grade astrocytoma

What are the gradings for astrocytoma?

I: pilocytic astrocytoma II: diffuse astrocytoma III: anaplastic astrocytoma - more cellular, pleomor IV: glioblastoma - variation on location, necrosis, micro vascular proliferation

What are Rosenthal fibers?

Fibers in grade I astrocytoma pilocytic astrocytoma Big red gashes, corkscrew, eosinophilic, GFAP (an IM filament)

What is a biphasic pattern?

Pilocytic astrocytoma Looks like patches of dense cells and empty spaces (cystic is open)

What are the genetic pathways of pilocytic astrocytoma?

BRAF pathway is important (also for melanoma) | Also fusion protein with BRAF leading to strange transcription

What do you look for BRAF/KIAAA1549?

FISH Blue things are nuclei, BRAF duplication -Three-color phase FISH is they are too close together green and red make yellow, if you see yellow you probably have duplication

When do you see GFAP?

Se in mature astrocytes, secreted in injury, see more in tumor

What genetics do you look for glioblastoma?

EGFR, but targeting it doesn't work | LDH translocation

Where do you see a butterfly tumor?

Glioblastoma

What do you try to do to stop glioblastomas?

Anti VEGF, or so,e growth factor

Where so you see homer-wright rosettes?

Medulloblastoma (grade IV)

Where do you see small, blue,dark round cells with pseudorosettes?

Medulloblastoma

What are psammoma bodies?

Calcium deposits Meningiomas Darker and denser that oligodendroglioma

What is a syncytial pattern?

Meningiomas Little balls rounding off Onions maybe

What are primary brain lymphomas?

``` Clinical: rare except in immunocompromized, easily detectable in CSF, aggressive, poorly responsive Morphological: EBV+, large B cells Multiple nodules with necrotic foci Often peri ventricular Ring enhancing lesion (toxoplasmosis) ```

What is a schwannoma?

3rd most common VII CN cerebellopontine angle Hearing Los, tinnitus Good prognosis after surgery

Where do you see Flexner-Wintersreiner rosettes?

Retinoblastoma