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From Flashcardlet > Neuro 49: CNS tumors > Flashcards

Neuro 49: CNS tumors Flashcards

1
Q

Clinical sx of CNS mass lesions

A
  1. altered level of consciousness
  2. focal deficits –> depens on location
  3. seizures –> esp. cortical
  4. elevated ICP and CSF protein
  5. headache
  6. papilledema on exam
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2
Q

Intracranial tumors: primary v. metastatic axial and extra-axial locations

A
  • primary: can be anywhere in the brain parenchyma (axial) or outside the brain parenchyma (extra-axial)
  • metastatic: usually in the grey/white junction (axial) or in the dura (extra-axia)
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3
Q

Metastatic carcinoma: who usually gets them? what are the 5 common primary sources?

A
  • intracranial adult tumor
  • common primary sources:
    1. lung
    2. breast
    3. kidney
    4. GI tract
    5. skin (melanoma)
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4
Q

Where are metastatic carcinomas found in the CNS?

A

-predominance of location relates to the volume of blood flow to the area:
cerebrum >cerebellum>spinal cord

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5
Q

Gross and radiologic features of metastatic CNS carcinomas

A
  • tumors usually found at the grey/white junction
  • can have more than one lesion
  • usually there is edema surrounding the tumor
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6
Q

Microscopic features of a metastaic carcinoma in the CNS?

A

-looks like the primary tumor

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7
Q

Meningiomas: what are they? age? gender?

A
  • benign nesoplasms of the meningies
  • commonly seen in adults age 40-65 yrs
  • female > male –> some have morre receptor activity & may grow faster during pregnancy
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8
Q

Meningiomas: clinical sx & prognosis

A
  • slowly progressing, but some types can be locally agressive & can invade bone or compress brain
  • sx will depend on location & can be asymptomatic
  • prognosis is generally good, but depends on the grade –> the lower the grade the less likely to recur & the better prognosis
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9
Q

Meningiomas: 3 common sites & tx

A
  • commonly found:
    1. parasagitally
    2. sphenoid ridge
    3. spinal chord
  • tx: complete surgical excision if in an easily acessible area
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10
Q

Meningiomas: histology

A

-well-circumscribed
-can be focally mineralized - concentric laminated calcifications =psammoma bodies
-cells look like a sheet of cells w/out distinct borders = syncytium
-see whorls of arachnoid cells that have vacuolated nuclei
-

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11
Q

Psammoma bodies

A

-concentricly laminated calcifications found in meningiomas

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12
Q

Schwannomas: what are they? age? tx?

A
  • primary benign tumor of schwann cells
  • age = 35-60 yrs, will have more and a younger age if have neurofibromatosis
  • tx = surgical excision
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13
Q

Schwannomas: 3 common sites?

A
  1. cranial nerves –> esp CN VIII
  2. sensory spinal roots
  3. peripheral nerves
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14
Q

Schwannomas: prognosis

A
  • favorable
  • benign
  • slow growing
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15
Q

CPA tumor

A
  • cerebello-pontine angle tumor= acoustic neuroma = bilateral schwannoma
  • can cause hearing problems!
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16
Q

Schwannoma: gross characterisitcs

A
  • nerve is focally enlarged & rubbery
  • tumor grows by expansion & is incased w/in the nerve
  • can usually be removed while sparing the nerve
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17
Q

Schwannoma: microscopic charateristics

A
  • spindle-cell proliferation w/ wavy appearance
  • biphasic architecture w/ palisading nuclei in paralell rows (Antoni A) mixed in with loose cellular areas (Antoni B)
  • can have anuclear zones too btwn the palisading areas = verocay body
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18
Q

Antoni A pattern

A
  • palisaiding nuclei in parallell rows

- seen in schwannomas

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19
Q

Antoni B pattern

A
  • loose less cellular areas

- seen in schwannomas

20
Q

Verocay body

A
  • anuclear zones seen with the antonia a pattern

- the pink area seen along with the palisading nuclei (antonia a) in schwanommas

21
Q

Circumscribed astrocytoma: age? prognosis? site?

A
  • well-circumscribed or cystic
  • usually low grade
  • favorable prognosis, slow growing
  • tend not to progress to anaplastic forms
  • tend to be in peds
  • tend to be midline
22
Q

Diffuse astrocytomas: prognosis?

A
  • have infiltrative margins
  • 3 grades
  • tend to progress to more anaplastic forms
  • unfavorable prognosis b/c of thrir growth pattern and the lack of good tx
23
Q

Juvenile pilocystic astrocytoma: prognosis? tx? gross features?

A
  • grow slowly
  • tx: surgical
  • gross: well-circumscribed, rubbery or gelatinous, can be cystic
24
Q

Juvenille pilocytic astrocytoma: microscopic features

A
  • elongated spindle-shaped astrocytes = piloid
  • biphasic pattern of hyper and hypodense areas w/ microcysts
  • areas around vessels are more dense with cells
25
Q

Rosenthal fibers

A
  • pink beaded/globular arrangement of astrocytic glial filaments
  • indicate slow growth
  • can be seen in circumscribed astrocytomas but not specific to this type of tumor!
26
Q

Grade II diffuse astrocytoma

A

-nuclear pleomorphism is mild

27
Q

Grade III diffuse astrocytoma

A

-moderate nuclear pleomorphism + cellularity and mitoses

28
Q

Grade IV diffuse astrocytoma

A

-cellularity + pleomorphism, mitoses, necrosis, and/or vascular proliferation

29
Q

Grade IV astrocytoma - glioblastoma mutiforme (GBM)

A
  • highly cellular + pleomorphism, hyperplastic vascularity, mitoses, and necrosis
  • necrosis + pseudopalasading = classic finding!
  • almost looks like the glomerulus of the kidney
30
Q

Secondary glioblastomas

A
  • can transform from a low grade astrocytoma with p53 mutations
  • aquire more mutations as they progress
31
Q

Primary glioblastomas

A
  • develop de novo

- DO NOT have p53 mutations!

32
Q

Diffuse astrocytoma: tx + prognosis

A
  1. surgical debulking when possible
  2. radiation
  3. chemotherapy –> poor response
    * *prognosis:
    - low grade = good, 10-15 yrs
    - high grade = poor, 6-12 mnths
33
Q

Oligodendroglioma: age? clinical? prognosis? tx?

A
  • 25-50 yrs
  • clinical: proressive course over several years
  • 5 yr survival: 40%
  • tx: surgical
34
Q

Oligodendroglioma: 4 characteristics of the gross appearance? site?

A
  • gross:
    1. poor circumscripton
    2. infiltrative
    3. hemorrhage
    4. focal calcifications
  • site: cerebral hemispheres
35
Q

Oligodendroglioma: microscopic characteristics

A
  • uniform, cellular pattern of oligodendrocytes + “fried egg” perinuclear halo appearance and calcifications
  • also see chicken-wire vascular pattern
36
Q

Which CNS tumor has “fried egg” cells

A

-oligodendrogliomas!

37
Q

Chicken-wire vascular pattern

A
  • seen with oligodendrogliomas
  • important clue to histogenesis
  • can be identified w/ factor VII antibody against endothelial cells
38
Q

Ependymoma: age/location? clinical presentation?

A
  • age: 5-25 yrs = brain or 20-50 yrs = spinal cord

- clinical: may present w/ sx of CSF obstruction –> esp. hydrocephalous!

39
Q

Epedymoma: site? gross appearance?

A
  • fourth ventricle
  • distal spinal cord
  • gross: intraventricular, granular, and friable
40
Q

Ependymoma: prognosis? tx?

A
  • 5 yr survival: 40% for brain & 60% for spinal cord

- tx: radiation, surgery is limited!

41
Q

Ependymoma: microscopic?

A
  • arrise as neoplastic proliferations of ependymal cells (normally line the ventricles)
  • vascular tumor w/ uniform sheets of cells w/ small, dark, round nuclei in a glial fibrillary background
  • perivascular pseudorosettes = key diagnosis features
42
Q

Perivascular pseudorosettes

A
  • key diagnostic feature of ependymomas

- vessel in the center

43
Q

Medulloblastoma: age? clinical sx? sites?

A
  • 5-20yrs
  • have rapidly progressive cerebellar sx
  • sites: cerebellar vermis in younger pts and lateral hemispheres in older pts
44
Q

Medulloblastoma: tx? prognosis?

A
  • surgery and radiation

- prognosis: 75% 5 yr survival rt –> CSF seeding is common

45
Q

Medulloblastoma: micro

A
  • “small, round, blue cell tumor” w/ primitive neuroectodermal cell precursors of glial and neurons
  • homer wright rosettes
46
Q

Homer wright rosettes

A

-classic feature of medulloblastomas

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