Neoplasms Flashcards
Grade 1 lesions means
low prolif potential
well circumscribed
cure = resection alone
Grade 2 lesions
infiltrative
low proliferative but still recurs
can’t cure just by resection
Grade 3 lesions means
nuclear atypia
incr mitotic activity = malignancy
Grade 4 tumors
mitotically active
necrosis prone
rapid disease evolution
Describe pilocytic astrocytoma (WHO grade 1)
age population
typically located where?
in children
located in cerebellar hemispheres, optic nerves/chiasm, then hypothalamus
Describe pilocytic astrocytoma
cellular features
well circumscribed, non infiltrative
cystic, occasional calcifications
biphasic features = both compact (pilocytic with elongated bipolar cells and rosenthal- eosinophilic bodies)
Treatment of pilocytic astrocytoma
if in cerebellar = excision alone
if elsewhere, need more therapy
Diffuse astrocytoma (WHO grade II) affects where?
occurs in what ages?
caused by what mutation?
affects white matter of cerebral hemisphere, infiltrative pattern
btwn 30-50 years
causd by p53 mutations
Diffuse astrocytoma
cellular features
ill-defined border
irregular tumor cell distrib/nuclear features but
no mitosis
many astrocytic types (fibrillary, protoplasmic, gemisocytic) in same tumor
if diffuse astrocytoma shows signs of hyperchromatism, nuclear atypia, or mitosis then menas
can progress to grade III
treatment of diffuse astrocytoma
surgery + radiation/chemo
Anaplastic astrocytoma (WHO grade III) usu due to?
shows more ___ compared to diffuse astrocytoma
age?
location?
usu due to progression of diffuse astrocytoma (grade II)
shows more MITOSIS than diffuse astrocytoma
45 y/o
cerebral hemispheres
Anaplastic astrocytoma (WHO grade III) can use what kind of marker to identify?
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
Anaplastic astrocytoma (WHO grade III) compared to grade IV, does not have what?
no necrosis/angiogenesis
Anaplastic astrocytoma (WHO grade III) treatment
surgery + radiation/chemo
Glioblastoma multiforme (WHO grade IV) frequency?
usu found in what ages?
types of mutations?
most are at what stage?
most common of all gliomas
presents in 50-60
EGFR and PTEN mutations
90% primary (de novo)
Glioblastoma multiforme (WHO grade IV) cellular features
exhibits what pattern?
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
Glioblastoma multiforme (WHO grade IV) treatment
surgery, radiation, chemo but prognosis
oligodendroglioma (WHO grade II)
most often where?
what age?
presents as?
prognosis compared to diffuse astrocytoma
in cerebral white matter
usu in adults (42 y/o)
presents as seizures
better prognosis than diffuse astrocytoma
oligodendroglioma (WHO grade II)
survival based on?
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
oligodendroglioma (WHO grade II)
classically what stage?
cellular appearance
grade II or III
fried egg = monotonous tumor with scant eosinophilic cyto and perinuclear haloes
+ calcifications and hemorrhages
oligodendroglioma (WHO grade II)
tumor marker?
MIB-1 to find cells in M phase to see if enough mitotic activity for grade III
oligodendroglioma (WHO grade II)
treatment
surgery + radiation/chemo
Anaplastic oligodendrogliomas (grade III) usu due to?
progression of oligodendroglioma with more mitosis
more vascular proliferation and necrosis
Anaplastic oligodendrogliomas (grade III) shows what on preoperative neuroimaging
histological appearance
what tumor marker
DQ shows enhancement
fried egg apppearance like oligodendroglioma
MIB-1 for cells in M phase
Anaplastic oligodendrogliomas (grade III)
treatment
surgery + radiation/chemo
ependymoma (WHO grade II)
arises from what cells?
most present what age?
most present where?
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
ependymoma (WHO grade II)
cellular appearnce
perivascular pseudorosettes mimic ependymal canals with vessel in center
commonly calcified; protrude from 4th ventricle
ependymoma (WHO grade II)
comparison prognosis btwn 4th ventricle vs lateral ventricles/spinal cord
worse if in 4th ventricle
ependymoma (WHO grade II)
treatment
excision
Anaplastic ependymoma (grade III)
progression of ?
usu found where in kids vs adults
progression of ependymoma
found in 4th ventricle in kids
found in spinal cord in adults
Anaplastic ependymoma (grade III) cellular appearance
tumor marker?
same as ependymoma = perivascular pseudorosettes
with calcification
MIB-1 for cells in M phase
Anaplastic ependymoma (grade III) treatment
surgery + radiation/chemo
medulloblastoma (grade IV)
most common tumor in what age?
metastasizes via what pathways
related to what genetic defects?
can lead to?
children only 3-8 years old
metastasize via CSF pathways (only brain tumor that metastasizes systemically)
chromosome 17 deletions/mutations
causes obstructive hydrocephalus
medulloblastoma (grade IV)
arises from?
external granule layer of cerebellum
medulloblastoma (grade IV)
cellular features
Homer-wright pseudorosettes (circular nuclei with central anuclear area)
small blue cells (small embryonal cells with little cytoplasm)
medulloblastoma (grade IV)
what to avoid
don’t do LUMBAR PUNCTURE because creates pressure gradient from incr ICP –> herniation
medulloblastoma (grade IV)
presents with?
gait, nystagmus, dysmetria due to cerebellar location
medulloblastoma (grade IV)
treatment
what is assoc with worse prognosis
aggressive chemo/radiation
worse prognosis if:
1) spread to CSF
2) MYC oncogene amplification
Choroid plexus papilloma (grade I)
always located where in kids vs adults
can lead to?
located in lateral ventricles in kids
located in 4th ventricle in adults
lead to non-comm hydrocephalus
Choroid plexus papilloma (grade I)
cellular appearance
mimic normal choroid plexus except papillary formations are more abudant
low mitotic rate
mild nuclear atypia
Choroid plexus papilloma (grade I)
treatment
excision
mixed tumors
ganglioma (grade I)
usu located where
mix of what?
usu in temporal lobe
mix of neurons and glia
mixed tumors
ganglioma (grade I)
cellular appearance
well circumscribed often cystic (like pilocystic astrocytoma)
likely with calcifications and perivascular lymphocytes
ncr jumbled, abnormal neurons with low grade glial background
mixed tumors
ganglioma (grade I)
treatment
excision
mixed tumors mixed oligoastrocytoma (grade II)
mix of?
admixed astrocytes and oligodendrocytes
mixed tumors mixed oligoastrocytoma (grade II)
cell marker?
what stain to distinguish astrocytes from oligodendrocytes
MIB-1 to find cells in M phase
GFAP staining to distinguish
mixed tumors mixed oligoastrocytoma (grade II)
treatment
better prognosis if?
surgery + rad/chemo
better if loss of heterozygosity of 1p, 19q
mixed tumors anaplastic oligoastrocytoma (grade III)
mix of?
admixed astrocytes + oligodendrocytes with high mitotic activity
mixed tumors mixed oligoastrocytoma (grade II)
tumor marker?
MIB-1 to find cells in M phase of cell cycle
mixed tumors mixed oligoastrocytoma (grade II)
treatment
surgery + rad/chemo
meningeal and mesenchymal tumors
meningioma
usu grade?
if in kids suspect?
peak incidence in what gender/age?
usu grade 1
if in kids think familial cancer
peak in women in 50’s
meningeal and mesenchymal tumors
meningioma
which form assoc with worse prognosis
hemangiopericytoma worse prognosis
meningeal and mesenchymal tumors
meningioma
usu attach to?
nickname?
usu attach to meninges with dural tail that extends in either direction
“pusher and shover” tumors
meningeal and mesenchymal tumors
meningioma
treatments
excision
meningeal and mesenchymal tumors
schwannoma
found where?
usu on cranial nerves usu CN 8
also on spinal nerve roots
meningeal and mesenchymal tumors
meningioma
histology
little variability, slow growing
meningeal and mesenchymal tumors
meningioma
treatment
excision
metastatic tumors usu from where?
grade?
1) breast
2) lung
3) kidney
4) malignant melanoma
5) GI tract tumors
grade IV (well demarcated, noninfiltrate rare hemorrhage)
ratio of cerebral: cerebellar mets
route of metastasis to brain
8:1
hematogenous NOT LYMPHATIC
