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Neuro Block 5 > CNS Tumors > Flashcards

CNS Tumors Flashcards

0
Q

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

A

Diffuse:
Anaplastic:

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1
Q

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

A

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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2
Q

What is the morphological appearance of diffuse and anaplastic astrocytoma?

A

Diffuse: diffuse, large area
Astrocytoma:

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3
Q

What is the Histologically appearance of diffuse and anaplastic astrocytoma?

A

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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4
Q

What are the genetic changes of diffuse and anaplastic astrocytoma?

A

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

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5
Q

What is the prognosis of of diffuse and anaplastic astrocytoma?

A

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

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6
Q

How do glioblastoma and pilocytic astrocytoma differe clinically?

A

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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7
Q

How do glioblastoma and pilocytic astrocytoma differe Histologically?

A

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

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8
Q

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

A

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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9
Q

What are the clinical and morphological features of oligodendroglioma?

A

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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10
Q

What are the clinical and morphological features of ependyoma?

A

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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11
Q

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

A

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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12
Q

What are the clinical and morphological features of meningioma?

A

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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13
Q

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

A

Also called canal

  1. Vascular pseudo rosette (blood vessel)
  2. Homer- wright - protein in the center
  3. Flexner - Wintersreiner (Rb) -
    4.
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14
Q

What are the three gliomas?

A
  • astrocytoma
  • oligodendroglioma
  • ependdyoma
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15
Q

What percent of CNS tumors are metastic from another site?

A

70%

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16
Q

What are the two most common tumors?

A

GMF

Meningioma

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17
Q

What percent of tumors spread to the brain?

A

25-50%

Lung, melanoma, breast

18
Q

What are sometimes the first sign of the primary tumor?

A

Meningeal carcinomatosi- tumor studding the surface of the brain

Little studs

19
Q

What do metastatic tumors look like Histologically?

A

Infiltration

Pliomorphic

Follow path of least resistance

20
Q

What are the most common brain cancers in children?

A

Medulloblastoma
Astrocytoma

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

21
Q

What is adjuvant treatment?

A

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

Tries to get rid of residual cancer cells

22
Q

Where are most tumors located in children and adults?

A

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

23
Q

What is part of the prognosis other than grade?

A 
Age
Location
Performance (therapy can cause brain damage)
Radiological features 
Extent of resection
Proliferation index
Genetic alterations
24
Q

What are you worried about with brain radiation?

A

Of too much DNA breaks brain cells die

Brain tumor stem cells can be resistant to radiation

25
Q

What are survival rates for grades of CNS tumors?

A

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

26
Q

What is a glioblastoma?

A

Highest grade astrocytoma

27
Q

What are the gradings for astrocytoma?

A

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

28
Q

What are Rosenthal fibers?

A

Fibers in grade I astrocytoma pilocytic astrocytoma

Big red gashes, corkscrew, eosinophilic, GFAP (an IM filament)

29
Q

What is a biphasic pattern?

A

Pilocytic astrocytoma

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

30
Q

What are the genetic pathways of pilocytic astrocytoma?

A

BRAF pathway is important (also for melanoma)

Also fusion protein with BRAF leading to strange transcription

31
Q

What do you look for BRAF/KIAAA1549?

A

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

32
Q

When do you see GFAP?

A

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

33
Q

What genetics do you look for glioblastoma?

A

EGFR, but targeting it doesn’t work

LDH translocation

34
Q

Where do you see a butterfly tumor?

A

Glioblastoma

35
Q

What do you try to do to stop glioblastomas?

A

Anti VEGF, or so,e growth factor

36
Q

Where so you see homer-wright rosettes?

A

Medulloblastoma (grade IV)

37
Q

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

A

Medulloblastoma

38
Q

What are psammoma bodies?

A

Calcium deposits
Meningiomas
Darker and denser that oligodendroglioma

39
Q

What is a syncytial pattern?

A

Meningiomas

Little balls rounding off
Onions maybe

40
Q

What are primary brain lymphomas?

A 
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)
41
Q

What is a schwannoma?

A

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

42
Q

Where do you see Flexner-Wintersreiner rosettes?

A

Retinoblastoma

Neuro Block 5 (20 decks)

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