CNS tumours (9)

Question 1

What percentage are CNS tumours of all neoplasms?

Answer 1

2%

Question 2

What’s the most common cancer in children?

Answer 2

Leukaemia, then CNS tumours

Question 3

Which CNS tumours are most common in women?

Answer 3

Meningioma

Question 4

Which CNS tumours are most common in men?

Answer 4

Glioma

Question 5

What CNS tumours are most common in children?

Answer 5

Cerebellum, PNET (medulloblastoma)

Question 6

Which CNS tumours are most common in adults?

Answer 6

Cerebrum, glioma and meningioma

Question 7

Function of arachnoid membrane and pia mater

Answer 7

Protein and support

Question 8

Tumour of arachnoid membrane and pia mater

Answer 8

Meningioma

Question 9

Function of neurons

Answer 9

Sit in cortex, cause epilepsy, not in contact with blood supply need quiet environment, don’t give origin to many tumours, metabolic needs supplied by glia cells

Question 10

Tumour of neuronal

Answer 10

Neurocytoma

Question 11

Tumour of nerve sheath

Answer 11

Schwannoma

Question 12

Glia cells

Answer 12

Astrocytes, Oligodendrocytes, Ependymal cells and choroid plexus cells, microglia

Question 13

Tumour of glia

Answer 13

Glioma

Question 14

Function of astrocytes

Answer 14

Support and protect (connect neurons with blood supply)

Question 15

Tumour of astrocytes

Answer 15

Astrocytoma

Question 16

Function of oligodendrocytes

Answer 16

Myelination

Question 17

Tumours of oligodendrocytes

Answer 17

Oligodendroglioma

Question 18

Function of ependymal cells

Answer 18

Controls, produces and moves CSF

Question 19

Tumour of ependymal cells

Answer 19

Ependyoma

Question 20

Function of choroid plexus cells

Answer 20

Specialised ependymal cell

Question 21

Function of microglia

Answer 21

Defence (activated if ischaemia, allows inflammatory cells cross BBB)

Question 22

Benign behaviour

Answer 22

Slow growing, respect surrounding tissue, no/slow progression, no recurrence, surgery

Question 23

Malignant behaviour

Answer 23

Rapid growing, invade and destroy surrounding tissue, progress, recurrent, surgery and adjuvant therapy

Question 24

Grade 1

Answer 24

Benign, no recurrence, no/very slow progression

Question 25

Grade 2

Answer 25

Low grade, progression (astrocytoma 6-7 y)

Question 26

Grade 3

Answer 26

High grade, rapid progression (astrocytoma 2-3 y)

Question 27

Grade 4

Answer 27

Aggressive (necrosis and vascular proliferation)

Question 28

Histological criteria for malignancy

Answer 28

1. Cellular density and atypia 2. Mitotic activity 3. Necrosis 4. Vascular proflieration

Question 29

Atypia

Answer 29

Structural abnormality in cell

Question 30

Hardest part about treating Gliomas?

Answer 30

Cells migrate through brain, can't see borders/take it out completely, no barriers in communication

Question 31

Space occupying lesion

Answer 31

Only 50ml allowed to accumulated, malignancy, abscess, haematoma

Question 32

Astrocytic tumours

Answer 32

Fine fibrillary and microcytic background, increased cellular density, pleomorphism (size/shape/chromasia)

Question 33

Diffuse astrocytoma II

Answer 33

Infiltrative, microcytic, fibrillary, low cellular density, mild atypia, no mitotic activity

Question 34

Anaplastic astrocytoma III

Answer 34

Moderate cellular density, moderate pleomorphism, mitoses

Question 35

Glioblastoma IV

Answer 35

High cellular density and mitoses, necrosis, vascular proliferation

Question 36

Pilocytic astrocytoma I

Answer 36

Benign, non-infiltrative, children, cerebellum, well-defined, cystic, pilocytes (thin hair-like), Rosenthal fibres (think elongated worm-like), vascular proliferation

Question 37

Oligodendroglioma II/III

Answer 37

Round uniform nuclei with clear cytoplasm (fried-egg appearance), arborising capillaries (chicken wire), calcifications

Question 38

Ependymoma II/III

Answer 38

Well-defined tumour, ventricles, pseudo rosettes, round small uniform cells

Question 39

Meningioma I

Answer 39

(Can be grade 2/3 aggressive), females, dura, adults, well-defined extra-axial tumour, whorls/swirls, psammonma bodies (lamellate calcified structures)

Question 40

PNET (medulloblastoma) IV

Answer 40

Children, cerebellum, very high cellular density, anaplastic hyper chromatic cells, frequent mitoses and apoptosis, rosette formation

Question 41

Nerve sheath tumours - Spindle-cell tumours

Answer 41

Benign

Question 42

Nerve sheath tumours - Schwannoma I

Answer 42

8th cranial nerve, biphasic pattern (loose and dense areas), Reticulin

Question 43

Nerve sheath tumours - Neurofibroma I

Answer 43

Spinal nerves, rich in collagen

Question 44

Aetiology

Answer 44

Radiotherapy - meningioma Immunosuppression - lymphoma Familial syndromes - NF1, NF2

Question 45

Stem cell pathways - Wnt signalling

Answer 45

Haematopoietic, epidermal, gut self-renewal > colon carcinoma/epidermal tumours

Question 46

Stem cell pathways - Shh

Answer 46

Haematopoietic, neural, germ line self-renewal > medulloblastoma, basal cell carcinoma

Question 47

Stem cell pathways - Notch

Answer 47

Haematopoietic, neural, germ line > Leukaemia, mammary tumours

Question 48

4 markers of molecular diagnostics of gliomas

Answer 48

1. MGMT promotor methylation 2. 1p/19q deletion 3. IDH1/IDH2 mutation 4. BRAF duplication/fusion

Question 49

Prognosis

Answer 49

Glioblastoma IV -

Question 50

Factors affecting prognosis

Answer 50

Age, site, surgical resection, adjuvant therapy, genetic