Histopathology - Neuro-oncology

Question 1

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

Answer 1

Lung
Breast most commonly
Malignant melanoma

Question 2

What is the most common form of primary brain tumour?

Answer 2

Glial tumours

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

Ependymoma

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

Oligodendroglioma

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)

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

Pilocystic adenoma

Question 15

Mutation of which gene is associated with circumscribed glial tumours?

Answer 15

BRAF gene mutation

Question 16

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

Answer 16

IDH gene

Question 17

How can glioblastoma and diffuse astrocytoma be differentiated on CT?

Answer 17

Glioblastoma = enhancing
Diffuse astrocytoma = non-enhancing

Question 18

Which gene mutation is always seen in oligodendroglioma?

Answer 18

IDH gene

Question 19

What is the WHO grade of oligodendroglioma?

Answer 19

Stage 2 - 3

Question 20

What is the pathognemonic histological finding in oligodendroglioma?

Answer 20

Fried egg cells

Question 21

How is oligodendroglioma most often managed?

Answer 21

Usually appropriate for surgical excision as often well-circumscribed

Question 22

What must be investigated in the case of multiple meningiomas?

Answer 22

Neurofibromatosis type 2

Question 23

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

Answer 23

Mitotic activity

Question 24

What is the most common type of embryonal CNS tumour?

Answer 24

Medulloblastoma

Question 25

Where do medulloblastomas always form?

Answer 25

In cerebellum near 4th ventricle

Question 26

What is the pathognemonic histological finding in medulloblastoma?

Answer 26

Very poorly differentiated 'small round blue cells'

Question 27

Which subtype of medulloblastoma has the best prognosis?

Answer 27

WNT-activated subtype

Question 28

What is the basis of epigenetic profiling in CNS tumours?

Answer 28

DNA methylation of CpG islands

Question 29

are primary or secondary CNS tumours more common?

Answer 29

secondary (metasases) are 10 x more common than primary

Question 30

are brain tumours more common in adults or children

Answer 30

Children by far

Question 31

2 CNS tumours associated w NF1

Answer 31

optic glioma neurofibroma astrocytoma

Question 32

2 CNS tumours associated w NF2

Answer 32

meningioma vestibular schwannoma

Question 33

CNS tumour associated w MEN1

Answer 33

pituitary adenoma

Question 34

what type of cancer is pilocytic astocytoma

Answer 34

its a GLIOMA grade 1 (WHO classification)

Question 35

2 histological findings of pilocytic astrocytoma

Answer 35

``` piloid cell (hairy cell) Rosenthal fibres ```

Question 36

name a mutation commonly seen in pilocytc astrocytoma

Answer 36

BRAF mutation in 70%

Question 37

what are the 6 glial cells

Answer 37

astrocytes oligodendrocytes ependymal Schwann microglia satellite

Question 38

most common child brain tumour?

Answer 38

pilocytic astrocytoma

Question 39

most common primary brain cancer

Answer 39

glioblastoma multiforme (grade IV)

Question 40

is IDH mutation a positive or negative prognostic factor

Answer 40

positive

Question 41

state 4 glial tumours

Answer 41

circumscribed pilocytic astrocytoma diffuse glioblastoma multiforme oligodendroglioma diffuses astrocytoma

Question 42

2nd most common brain tumour in children

Answer 42

medulloblastoma

Question 43

3 features of medulloblastoma

Answer 43

small blue round cell neuronal marker - ssynaptophysin homer wright rosettes

Question 44

where do mets in brain tend to be

Answer 44

grey-white junction