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Neuro_week3 > Neoplasms > Flashcards

Neoplasms Flashcards

1
Q

Grade 1 lesions means

A

low prolif potential
well circumscribed
cure = resection alone

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2
Q

Grade 2 lesions

A

infiltrative
low proliferative but still recurs
can’t cure just by resection

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3
Q

Grade 3 lesions means

A

nuclear atypia

incr mitotic activity = malignancy

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4
Q

Grade 4 tumors

A

mitotically active
necrosis prone
rapid disease evolution

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5
Q

Describe pilocytic astrocytoma (WHO grade 1)
age population
typically located where?

A

in children

located in cerebellar hemispheres, optic nerves/chiasm, then hypothalamus

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6
Q

Describe pilocytic astrocytoma

cellular features

A

well circumscribed, non infiltrative
cystic, occasional calcifications

biphasic features = both compact (pilocytic with elongated bipolar cells and rosenthal- eosinophilic bodies)

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7
Q

Treatment of pilocytic astrocytoma

A

if in cerebellar = excision alone

if elsewhere, need more therapy

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8
Q 
Diffuse astrocytoma (WHO grade II)
affects where?

occurs in what ages?

caused by what mutation?

A

affects white matter of cerebral hemisphere, infiltrative pattern

btwn 30-50 years

causd by p53 mutations

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9
Q

Diffuse astrocytoma

cellular features

A

ill-defined border

irregular tumor cell distrib/nuclear features but
no mitosis

many astrocytic types (fibrillary, protoplasmic, gemisocytic) in same tumor

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10
Q

if diffuse astrocytoma shows signs of hyperchromatism, nuclear atypia, or mitosis then menas

A

can progress to grade III

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11
Q

treatment of diffuse astrocytoma

A

surgery + radiation/chemo

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12
Q 
Anaplastic astrocytoma (WHO grade III)
usu due to?

shows more ___ compared to diffuse astrocytoma

age?

location?

A

usu due to progression of diffuse astrocytoma (grade II)

shows more MITOSIS than diffuse astrocytoma

45 y/o

cerebral hemispheres

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13
Q 
Anaplastic astrocytoma (WHO grade III)
can use what kind of marker to identify?
A

MIB-1 to identify which cells in M phase to find if high level of mitotic activity

MOST IMPORTANT USE TO DISTINGUISH BTWN DIFFUSE VS ANAPLASTIC

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14
Q 
Anaplastic astrocytoma (WHO grade III)
compared to grade IV, does not have what?
A

no necrosis/angiogenesis

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15
Q 
Anaplastic astrocytoma (WHO grade III)
treatment
A

surgery + radiation/chemo

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16
Q 
Glioblastoma multiforme (WHO grade IV)
frequency?

usu found in what ages?

types of mutations?

most are at what stage?

A

most common of all gliomas

presents in 50-60

EGFR and PTEN mutations

90% primary (de novo)

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17
Q 
Glioblastoma multiforme (WHO grade IV)
cellular features

exhibits what pattern?

A 
highly infiltrative and hemorrhagic
necrosis
angiogenesis
cell migration
nuclear changes
high mitotic rate 
edema

“butterfly pattern b/c cross hemispheres

with VEGF = incr BBB leakiness and microvascularity

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18
Q 
Glioblastoma multiforme (WHO grade IV)
treatment
A

surgery, radiation, chemo but prognosis

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19
Q

oligodendroglioma (WHO grade II)
most often where?

what age?

presents as?

prognosis compared to diffuse astrocytoma

A

in cerebral white matter

usu in adults (42 y/o)

presents as seizures

better prognosis than diffuse astrocytoma

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20
Q

oligodendroglioma (WHO grade II)

survival based on?

A

survival based on loss of hetoerozygosity of chromosome 1p and 19q so can respond well to chemo –> creates fusion btwn 1 and 19

share IDH1 with oligo and astrocytic lineage

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21
Q

oligodendroglioma (WHO grade II)
classically what stage?

cellular appearance

A

grade II or III

fried egg = monotonous tumor with scant eosinophilic cyto and perinuclear haloes

+ calcifications and hemorrhages

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22
Q

oligodendroglioma (WHO grade II)

tumor marker?

A

MIB-1 to find cells in M phase to see if enough mitotic activity for grade III

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23
Q

oligodendroglioma (WHO grade II)

treatment

A

surgery + radiation/chemo

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24
Q 
Anaplastic oligodendrogliomas (grade III)
usu due to?
A

progression of oligodendroglioma with more mitosis

more vascular proliferation and necrosis

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25
Q 
Anaplastic oligodendrogliomas (grade III)
shows what on preoperative neuroimaging

histological appearance

what tumor marker

A

DQ shows enhancement

fried egg apppearance like oligodendroglioma

MIB-1 for cells in M phase

26
Q

Anaplastic oligodendrogliomas (grade III)

treatment

A

surgery + radiation/chemo

27
Q

ependymoma (WHO grade II)

arises from what cells?

most present what age?

most present where?

A

arises from ependymal cells in ventricles (intraventricular)

presents by 20 years old (vs spinal cord = usu in adults only)

most in 4th ventricle with obstructive hydrocephalus

28
Q

ependymoma (WHO grade II)

cellular appearnce

A

perivascular pseudorosettes mimic ependymal canals with vessel in center

commonly calcified; protrude from 4th ventricle

29
Q

ependymoma (WHO grade II)

comparison prognosis btwn 4th ventricle vs lateral ventricles/spinal cord

A

worse if in 4th ventricle

30
Q

ependymoma (WHO grade II)

treatment

A

excision

31
Q

Anaplastic ependymoma (grade III)
progression of ?
usu found where in kids vs adults

A

progression of ependymoma

found in 4th ventricle in kids
found in spinal cord in adults

32
Q 
Anaplastic ependymoma (grade III)
cellular appearance

tumor marker?

A

same as ependymoma = perivascular pseudorosettes
with calcification

MIB-1 for cells in M phase

33
Q 
Anaplastic ependymoma (grade III)
treatment
A

surgery + radiation/chemo

34
Q

medulloblastoma (grade IV)
most common tumor in what age?

metastasizes via what pathways

related to what genetic defects?

can lead to?

A

children only 3-8 years old

metastasize via CSF pathways (only brain tumor that metastasizes systemically)

chromosome 17 deletions/mutations

causes obstructive hydrocephalus

35
Q

medulloblastoma (grade IV)

arises from?

A

external granule layer of cerebellum

36
Q

medulloblastoma (grade IV)

cellular features

A

Homer-wright pseudorosettes (circular nuclei with central anuclear area)

small blue cells (small embryonal cells with little cytoplasm)

37
Q

medulloblastoma (grade IV)

what to avoid

A

don’t do LUMBAR PUNCTURE because creates pressure gradient from incr ICP –> herniation

38
Q

medulloblastoma (grade IV)

presents with?

A

gait, nystagmus, dysmetria due to cerebellar location

39
Q

medulloblastoma (grade IV)
treatment

what is assoc with worse prognosis

A

aggressive chemo/radiation

worse prognosis if:

1) spread to CSF
2) MYC oncogene amplification

40
Q

Choroid plexus papilloma (grade I)
always located where in kids vs adults

can lead to?

A

located in lateral ventricles in kids

located in 4th ventricle in adults

lead to non-comm hydrocephalus

41
Q

Choroid plexus papilloma (grade I)

cellular appearance

A

mimic normal choroid plexus except papillary formations are more abudant

low mitotic rate

mild nuclear atypia

42
Q

Choroid plexus papilloma (grade I)

treatment

A

excision

43
Q

mixed tumors
ganglioma (grade I)

usu located where
mix of what?

A

usu in temporal lobe

mix of neurons and glia

44
Q

mixed tumors
ganglioma (grade I)

cellular appearance

A 
well circumscribed 
often cystic (like pilocystic astrocytoma)

likely with calcifications and perivascular lymphocytes

ncr jumbled, abnormal neurons with low grade glial background

45
Q

mixed tumors
ganglioma (grade I)

treatment

A

excision

46
Q 
mixed tumors
mixed oligoastrocytoma (grade II)

mix of?

A

admixed astrocytes and oligodendrocytes

47
Q 
mixed tumors
mixed oligoastrocytoma (grade II)

cell marker?

what stain to distinguish astrocytes from oligodendrocytes

A

MIB-1 to find cells in M phase

GFAP staining to distinguish

48
Q 
mixed tumors
mixed oligoastrocytoma (grade II)

treatment

better prognosis if?

A

surgery + rad/chemo

better if loss of heterozygosity of 1p, 19q

49
Q 
mixed tumors
anaplastic oligoastrocytoma (grade III)

mix of?

A

admixed astrocytes + oligodendrocytes with high mitotic activity

50
Q 
mixed tumors
mixed oligoastrocytoma (grade II)

tumor marker?

A

MIB-1 to find cells in M phase of cell cycle

51
Q 
mixed tumors
mixed oligoastrocytoma (grade II)

treatment

A

surgery + rad/chemo

52
Q

meningeal and mesenchymal tumors
meningioma

usu grade?
if in kids suspect?
peak incidence in what gender/age?

A

usu grade 1

if in kids think familial cancer

peak in women in 50’s

53
Q

meningeal and mesenchymal tumors
meningioma

which form assoc with worse prognosis

A

hemangiopericytoma worse prognosis

54
Q

meningeal and mesenchymal tumors
meningioma

usu attach to?
nickname?

A

usu attach to meninges with dural tail that extends in either direction

“pusher and shover” tumors

55
Q

meningeal and mesenchymal tumors
meningioma

treatments

A

excision

56
Q

meningeal and mesenchymal tumors
schwannoma

found where?

A

usu on cranial nerves usu CN 8

also on spinal nerve roots

57
Q

meningeal and mesenchymal tumors
meningioma

histology

A

little variability, slow growing

58
Q

meningeal and mesenchymal tumors
meningioma

treatment

A

excision

59
Q

metastatic tumors usu from where?

grade?

A

1) breast
2) lung
3) kidney
4) malignant melanoma
5) GI tract tumors

grade IV (well demarcated, noninfiltrate rare hemorrhage)

60
Q

ratio of cerebral: cerebellar mets

route of metastasis to brain

A

8:1

hematogenous NOT LYMPHATIC

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