Histopathology 14 - Neuro-oncology

Question 1

Which 3 types of cancer are most likely to metastasise to the brain?

Answer 1

Lung
Breast
Malignant melanoma

Question 2

What is the most common form of primary brain tumour?

What is the spectrum?

Answer 2

Astrocytoma

Ranges from pilocytic astrocytoma –> glioblastoma multiforme

Question 3

Which genetic syndrome is associated with meningioma?

Answer 3

Neurofibromatosis type 2

Question 4

What type of tumour is being described by “a ventricular tumour that presents with hydrocephalus”?

Answer 4

Ependyoma

Question 5

Which brain tumour is an indolent CNS tumour of childhood?

Answer 5

Pilocystic astrocytoma

Question 6

Which type of brain tumour is soft, gelatinous and can become calcified?

Answer 6

Oligodendroma

Question 7

Which CNS tumour does Von Hippel-Lindau predispose to?

Answer 7

Hemangioblastoma

Question 8

Which CNS tumour does tuberous sclerosis predispose to?

Answer 8

Giant cell astrocytoma

Question 9

Recall the order in which imaging should be performed in CNS tumour investigation

Answer 9

1. CT
2. MRI (T1 and without contrast)
3. MR spectroscopy for gliomas (useful prognostically)

Question 10

Recall the 4 factors that guide grading of brain tumours

Answer 10

Morphology
Proliferative activity
Cell differentiation
Necrosis

Question 11

Recall the survival prediction for each grade of CNS tuour

Answer 11

Grade 1 = longterm
Grade 2 = >5 years
Grade 3 = <5 years
Grade 4 = <1 year

Question 12

What are the 2 broad subtypes of glial tumours, and in which age groups are they typically seen?

Answer 12

Diffuse (adults) or circumscribed (children)

Grades 1+2= circumscribed

Grades 3 + 4 = diffuse

Question 13

What grade are circumscribed glial tumours?

Answer 13

1 or 2

Question 14

What is the most common type of circumscribed glial tumour?

Answer 14

pilocytic astrocytoma

Question 15

Mutation of which gene is associated with circumscribed glial tumours?

Answer 15

BRAF gene mutation

Question 16

Describe the progression of all diffuse glial cell tumours

Answer 16

Cannot be removed surgically, so all progress to glioblastoma within 10 years

Question 17

Which gene mutation is associated with diffuse glial cell tumour prediliction?

Answer 17

IDH gene

**this is a positive prognostic factor**

Question 18

How can glioblastoma and diffuse astrocytoma be differentiated on CT?

Answer 18

Glioblastoma = enhancing
Diffuse astrocytoma = non-enhancing

enhancing aka more visible

the more aggressive tumour would be more visivle

Question 19

Which gene mutation is always seen in oligodendroglioma?

Answer 19

IDH gene

Question 20

What is the WHO grade of oligodendroglioma?

Answer 20

grade 2 - 3

Question 21

What is the pathognemonic histological finding in oligodendroglioma?

Answer 21

Fried egg cells

Question 22

How is oligodendroglioma most often managed?

Answer 22

Usually appropriate for surgical excision as often well-circumscribed

Question 23

What must be investigated in the case of multiple meningiomas?

Answer 23

Neurofibromatosis type 2

Question 24

What is the most important factor to assess when grading meningiomas?

Answer 24

Mitotic activity

Question 25

What is the most common type of embryonal CNS tumour?

Answer 25

Medulloblastoma

Question 26

Where do medulloblastomas always form?

Answer 26

In cerebellum near 4th ventricle

Question 27

What is the pathognemonic histological finding in medulloblastoma?

Answer 27

Very poorly differentiated 'small round blue cells'

Question 28

Which subtype of medulloblastoma has the best prognosis?

Answer 28

WNT-activated subtype W FOR WINNING

Question 29

What is the basis of epigenetic profiling in CNS tumours?

Answer 29

DNA methylation of CpG islands

Question 31

Which type of tumour is assoictaed with NF2?

Answer 31

Meningioma

Question 32

Ventricular tumour, hydrocephalus

Answer 32

Ependymoma

Question 33

Indolent childhood tumour

Answer 33

Pilocytic astrocytoma

Question 34

Soft, gelatinous, calcified

Answer 34

oligodendroglioma

Question 36

NF1 brain tumour

Answer 36

Optic glioma neurofibroma astrocytoma

Question 37

Whatis Li fraumeni syndrome?

Answer 37

astrocytoma, PNET; many other tumours too (sarcomas, breast cancer, leukemia)

Question 38

What is turcot syndrome?

Answer 38

glioblastoma multiforme, medulloblastoma, pineoblastoma

Question 39

Most common tumour of the sellar region?

Answer 39

Pituitary adenoma \*\* not craniopharyngioma

Question 40

Which tumours arise from neuroepithelial region?

Answer 40

Astrocytic tumours: astrocytoma\*, glioblastoma o Oligodendroglial tumours: oligodendroglioma o Oligoastrocytic tumours: oligoastrocytoma o Neuronal and mixed neuronal-glial tumours: ganglion cell tumours, cerebral neurocytomas/Neuroblastoma o Embryonal tumours: medulloblastoma, primitive neuroectodermal tumours (PNET) o Other: pineal, ependymal, and choroid plexus tumours

Question 42

2nd most common brain tumour in children

Answer 42

Medulloblastoma

Question 43

Where do the most common tumours originate from?

Answer 43

Glial cells

Question 44

What does tumour grade tell us?

Answer 44

Survival

Question 45

Which mutation identifies the mutation diffuse astrocytic tumours with a better prognosis?

Answer 45

IDH mutation

Question 46

What type of tumour is a medulloblastoma?

Answer 46

Embryonal tumour

Question 48

most common glial cell of the cns

Answer 48

astrocytoma