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Brain and Behavior Part 2 - My Cards > CNS Tumors > Flashcards

CNS Tumors Flashcards

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1
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A

Diffuse Astrocytoma

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2
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Rosenthal Fiber

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3
Q

What tumor type are Rosenthal Fibers associated with?

A

Pilocytic Astrocytoma

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4
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Glomeruloid Tufts (in Glioblastoma)

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5
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Eosinophilic Granular Body, found in cystic areas of pilocytic, astrocytoma

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6
Q
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Cystic cerebellar lesion with a contrast-enhancing mural nodule (Pilocytic Astrocytoma)

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7
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A

Necrotic Glioblastoma

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8
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Rosenthal fiber

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9
Q
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Pilocytic Astrocytoma - compact and spongy parts

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10
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Gemistocytic Variant of Diffuse Astrocytoma

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11
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A

Anaplastic Astrocytoma

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12
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Oligodendroglioma
Distinctive features of these glial-derived tumors include round, regularly appearing neoplastic cells without obvious cytoplasmic processing. Note the presence of small, branching, delicate capillary processes in the background. These are so-called “chicken wire capillaries.” Interspersed between tumor cells are small, reactive astrocytes, which are recognizable due to their fine, eosinophilic, cytoplasmic processes.

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13
Q
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Oligodendroglioma, Chicken-wire capillaries

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14
Q
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Oligodendroglioma with chicken wire capillaries

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15
Q
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Green: neuron – prominent nucleolus, large nuclei
Blue: oligodendrocyte – round nuclei, compact chromatin, barely any cytoplasm
Light blue: astrocyte – oval to elongated nuclei, open chromatin, scant prominent eosinophilic cytoplasm

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16
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A

Ependymoma With Rosettes and Canals

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17
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Normal Ependymal Lining

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18
Q
A

Ependymoma

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19
Q
A

Pilocytic Astrocytoma (from wikipedia)

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20
Q
A

Perivascular pseudorosette

This rosette consists of tumor cells collected around a blood vessel. It’s called a pseudorosette because the central structure isn’t part of the tumor. In the past, the term pseudorosette meant any rosette that didn’t have a truly empty lumen…but it seems that designation is kind of outdated. These rosettes are common in ependymomas, but you also see them in medulloblastoma, PNET, central neurocytomas, and glioblastomas.

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21
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True Rosette

This rosette (seen in ependymoma) consists of tumor cells surrounding an empty lumen. It is thought that these structures represent attempts by the tumor cells to recreate little ventricles with ependymal lining. One thing to note: although these guys are characteristic of ependymoma, they’re not seen in every case. In fact, it’s fairly uncommon to find them at all (they’re only present in a small percentage of well-differentiated ependymoma).

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22
Q
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Perivascular pseudorosette, Ependymoma

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23
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Homer Wright Rosette

This rosette, named for James Homer Wright, the first director of the Massachusetts General Hospital, is typically seen in neuroblastomas, medulloblastomas, and primitive neuroectodermal tumors (PNETs). It consists of a halo of tumor cells surrounding a central region containing neuropil (hence its association with tumors of neuronal origin).

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24
Q
A

Medulloblastoma

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25
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Medulloblastoma

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26
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Medulloblastoma

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27
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Medulloblastoma

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28
Q
A

Medulloblastoma

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29
Q
A

Medulloblastoma, with Homer Wright Rosettes

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30
Q
A

Medulloblastoma, Neurofilament protein used to detect differentiation

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31
Q

What tumor type(s) are Homer Wright Rosettes associated with?

A

neuroblastomas, medulloblastomas, and primitive neuroectodermal tumors (PNETs)

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32
Q

What tumor type is “chicken wire” associated with?

A

Oligodendroglioma - goes along with “fried eggs”

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33
Q

Difference between neurofibroma and Schwannoma?

A

The neurofibroma incorporates axons, while the Schwannoma displaces normal elements of the nerve to one side.

34
Q

Bilateral acoustic/vestibular Schwannoma = ?

A

Neurofibromatosis Type II

35
Q

Multiple neurofibromas is probably…

A

Neurofibromatosis type 1

36
Q
A

Multiple Neurofibromas, NF1

37
Q
A

Multiple Neurofibromas, NF1

38
Q
A

Multiple Ring Enhancing Lesions Due to Metastatic Cancer

39
Q
A

Transitional Meningioma, with whorls and cords of neoplastic cells

40
Q
A

GBM, EGFR Stain
Glioblastoma characteristically expresses EGFR (a membrane protein) strongly when there is EGFR genetic amplification. Again, positive staining appears brown. Based on this, as well as other later molecular changes, GBMs can be classified on a molecular basis as primary or secondary.

41
Q
A

GBM, p53 Stain
Glioblastoma usually does not show a strong expression of p53 (a nuclear protein). A positive stain would label the nuclei brown, this is a negative stain with the nuclei stained in blue (hematoxylin is used as a counterstain).

42
Q
A
43
Q
A

Psammomatus Meningioma, contains Psammoma bodies

44
Q
A

Fibrous Meningioma

45
Q

Age distribution of brain tumors?

A

Bimodal - first peak incidence in children < 5, second peak in adults 45-70

46
Q

Most common tumors in children ages 0-4? (#1 and 2)

A
  1. Embryonal/primitive/medulloblastoma
  2. Pilocytic astrocytoma
47
Q

Most common tumors in children age 5-14?

A
48
Q

Most common (2) tumors in adults >45?

A
  1. Meningioma
  2. Glioblastoma
49
Q

What are the two most common (in general) types of cancer in children under 15?

A
  1. Leukemia
  2. Primary CNS neoplasm
50
Q

Do gliomas and embryonal tumors occur more frequently in males or females?

A

Males

51
Q

Do meningiomas occur more frequently in males or females?

A

Females

52
Q

True or false: most primary brain tumors have a known etiology

A

False - most of them are sporadic, etiology unknown

53
Q

Neoplasm associated with Tuberous sclerosis?

A

Subependymal giant cell astrocytoma

54
Q

True or false: primary CNS lymphomas are associated with immunodeficiency?

A

True

55
Q

What is the sole environmental factor clearly associated with increased tumor risk?

A

Irradiation (causes meningioma and astrocytoma/neuroepithelial tumors in ALL kids)

56
Q

Gorlin syndrome = what type of tumor?

A

Medulloblastoma

57
Q

Li-Fraumeni syndrome = what type of tumor?

A

Glioma

58
Q

NF1 = what tumors?

A
  1. Neurofibroma
  2. Malignant nerve sheath tumor
  3. Optic nerve astrocytoma
  4. Meningioma
59
Q

NF2 = what tumors?

A
  1. Schwannoma
  2. Meningioma
  3. Ependymoma
60
Q

Four signs/symptoms related to tumor location?

A
  1. Epilepsy
  2. Focal neurological deficit
  3. Mental changes
  4. Obstructive hydrocephalus = headache
61
Q

4 signs of raised intracranial pressure

A
  1. Headache (particularly postural and nocturnal or early morning)
  2. Vomiting (esp kids)
  3. Papilledema
  4. Clouding of consciousness and coma
62
Q

5 Herniation sites?

A
  1. Tonsillar herniation (cerebellar tonsils thru foramen magnum)
  2. Superior cerebellar herniation (cerebellum up thru the tentorium)
  3. Subfalcine herniation (cingulate gyrus beneath falx cerebri)
  4. Transtentorial herniation of the parahippocampal gyri - also uncal herniation - temporal lobe herniates across the tentorium cerebelli
  5. Bilateral transtentorial or diencephalic - diencephalon herniates thru the tentorium cerebelli
63
Q

This is an example of what kind of herniation

A

External herniation

64
Q

This is an example of what kind of herniation

A

Tonsillar

65
Q

This is an example of what kind of hemorrhage

A

Duret Hemorrhage, secondary to transtentorial hernaition and stretching/tearing of brainstem vasculature

66
Q

A 43-year-old man has a superficial oligodendroglioma on the left frontal lobe with infiltration of the cortex. The most likely presenting symptoms are:

A. Ataxia and dysmetria

B. Mental status changes with symptoms of schizophrenia

C. Epileptiform fits

D. Loss of vision

A

C - the tumor is too superficial to cause B.

67
Q

What type of herniation

A

Parahippocampal

68
Q

Small areas of bleeding in the ventral and paramedian parts of the upper brainstem, (midbrain and pons), secondary to raised intracranial pressure with formation of a transtentorial pressure cone involving the cerebral peduncles (crus cerebri) and other midbrain structures caused by raised pressure above the tentorium.

A

Duret Hemorrhage

69
Q

Cerebral peduncle indentation associated with some forms of transtentorial herniation (uncal herniation). It is a secondary condition caused by a primary injury on the opposite hemisphere of the brain.

A

Kernohan’s notch

70
Q
A

Glioblastoma

71
Q
A

Glioblastoma, Proliferative Blood Vessels
Glioblastoma on medium power. Note on the right an area of fresh hemorrhage. On the center and left, tufts of small vessels represent glomeruloid endothelial proliferation, which are due to the formation of new microvasculature. Note that there are several layers of endothelial cells surrounding each lumen, signifying abnormal endothelial growth.

72
Q
A

Pseudopalisading necrosis, Wikipedia

73
Q
A

Compared to normal white matter, this GBM demonstrates diffuse infiltration of neoplastic cells along white matter fascicles. Note the presence of numerous mitoses.

74
Q

Does GBM stain for Ki-67?

A

Yes, strongly

75
Q

What does GFAP stain?

Is GFAP stain found in GBM?

A

Astrocytes; Yes, positive GFAP will confirm the cells’ origin as astrocytes and the histological diagnosis of GBM.

76
Q

Does primary GBM stain for p53?

Does primary GBM stain for EGFR?

A

No

Yes, if there is EGFR amplification

77
Q

Does secondary GBM stain for p53?

Does secondary GBM stain for EGFR?

A

Yes, and IDH1

not so much

78
Q

Is primary or secondary GBM associated with patients over 45?

A

Primary

79
Q
A

Metastatic lung adenocarcinoma

80
Q
A 
Metastatic Adenocarcinoma (High Power)
 Papillary epithelial differentiation is well demonstrated in this example: epithelial cells are lining fibrovascular cores. Note also the presence of mucin-filled goblet cells with blue-gray cytoplasm.
81
Q
A

Metastatic Adenocarcinoma, TTF stain
This stain marks a transcription factor seen in lung adenocarcinomas. Note that the nuclei stain darkly brown.

Brain and Behavior Part 2 - My Cards (8 decks)

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