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patho II > Neuro III (a) > Flashcards

Neuro III (a) Flashcards

1
Q

Epi/ Grading of pilocytic astrocytoma

A

Benign tumours; Grade I (WHO)
* Children and young adults

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2
Q

Genetics of Pilocytic Astrocytoma

A

Specific point mutation (V600E) of the BRAF gene

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3
Q

Location of Pilocytic astrocytoma

A

* Cerebellum (most common)
* Third ventricle
* Optic pathways
* Spinal cord
* Cerebral hemispheres

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4
Q

Macroscopic Features: ‘
* Cystic lesion with a mural nodule in the wall of the cyst or
* Solid, well circumscribed mass
Microscopic Findings:
* Bipolar cells with long, thin hair-like processes
* Rosenthal fibers
* Eosinophilic granular bodies
* Microcystic changes

features of ?

A

Pilocytic astrocytoma (WHO GRADE 1)

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5
Q

Epi of Diffuse Astrocytomas

A

80% of adult gliomas

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6
Q

loc of Diffuse astrocytomas

A

Cerebral hemispheres

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7
Q

CM of Diffuse astrocytomas

A

1) Seizures
2) Headaches
3) Focal neurologic deficits (related to the site of localisation)

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8
Q

Classification of Diffuse astrocytomas

A

1) Well-differentiated astrocytoma (WHO Grade II)
2) Anaplastic astrocytoma (WHO Grade III)
3) Glioblastoma (WHO Grade IV)

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9
Q

Gentic predisposition of Diffuse Astrocytomas

A

1) Loss of function mutations in p53 and Rb genes (Glioblastomas)
2) Mutations in the IDH1and IDH2 genes (Low grade astrocytomas) –> Important diagnostic utility

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10
Q

Macro features:
* Gray, poorly defined, infiltrative tumours

Microscopic features:
* Mild to moderate hypercellularity
* Variable nuclear pleomorphism
* Fibrillary appearance  Fine (GFAP [+]) astrocytic cell processes
* Irregular and Hyper-chromatic “Naked nuclei”

features of?

A

Well-differentiated astrocytoma -WHO Grade II

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11
Q

Macro features:
* Firm and white
* Soft and yellow
* Cystic degeneration and haemorrhage

Micro features:
* “Glomeruloid” bodies: Larger tufts of microvascular hyperplasia with multiple lumens
* Marked cellularity
* Pseudo-palisading necrosis

features of?

A

Glioblastoma (WHO Grade IV)

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12
Q

Which type of Diffuse Astrocytoma has the best/worse prognosis

A

Best –> Well differentiated astrocytomas (survival >5yrs)
Wrose –> Glioblastomas (poor prognosis w/ tx 15 months mean surviaval)

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13
Q

Epi of Oligodenroglioma

A

5-15% of gliomas

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14
Q

Genetic predisposition of Oligodendroglioma

A

Deletions of chromosomes 1p and 19q

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15
Q

Loc of Oligodenroglioma

A

Frontal and temporal lobes

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16
Q

which has a better prognosis Oligodenroglioma or astrocytomas?

A

Oligodendrogliomas

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17
Q

Macroscopic Features:
* Gelatinous, gray masses, possible with cysts, focal haemorrhage and calcification

Microscopic features:
* Sheets of sphaerical cells with spherical nuclei
* Finely granular chromatin
* Perinuclear halo (“fried egg appearance”)
* Delicate network of anastomosing capillaries (“chicken-wire appearance”)
* Focal or diffuse deposits of calcification

features of?

A

Well- Differentiated Oligodendroglioma

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18
Q

Diffrence Microscopically btw well- diffrentiated and Anaplastic Oligodendroglioma

A

Anaplastic (malignant- WHO GARDE III) –> higher cellular densoty, nuclear anaplasia, mitotic activity and necrosis

Well diffrentiated –> WHO GRADE II

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19
Q

Epi of Ependymoma

A

5-10% of the primary brain tumours in individuals < 20 years old

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20
Q

Loc of Epyndymoma

A
  • Children and adolescents –> Near 4th ventricle
  • Adults –> Spinal cord
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21
Q

Macroscopic Features:
* Solid or papillary masses (originating from the ventricular floor)

Microscopic Findings:
* Cells with regular round to oval nuclei
* Abundant granular chromatin
* Dense fibrillary background
* True rosettes (around a lumen)
* Perivascular pseudo-rosettes

featues of?

A

Conventional Ependymoma (WHO GRADE II)

  • Increased cell density, nuclear pleomorphism, high mitotic index, necrosis (Anaplastic Ependymomas)
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22
Q

3 Examples of neuronal Tumours

A

1) Central Neurocytoma (low-grade)
2) Gangliogliomas (low-grade astrocytoma)
3) Dysembryoplastic Neuroepithelial Tumour (low-grade childhood tumour)

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23
Q

loc of Central Neurocytoma

A

lateral or 3rd ventricles

24
Q

Microscopic Findings:
* Evenly spaced, round, uniform nuclei
* Often islands of neuropil
* Densely packed small- to medium- sized, round bland tumour cells

features of ?

A

Central neurocytoma

25
Q

CM of Gangliogliomas

A

Seizures

26
Q

Cells found microscopically in Gangliogliomas

A

1) Astrocytic Glial cells
2) mature appearning neurons (Ganglion cells?)

27
Q

loc of Dysembryoplastic neuroepithelial tumour (DNT)

A

Superficial temporal lobe

28
Q

Microscopic Findings:
* Small round neuronal cells arranged in columns and around central cores of processes
* Intra-cortical nodules with myxoid background
* “Floating neurons” within a myxoid fluid (Mucin-filled cyst)

features of?

A

Dysembryoplastic Neuroepithelial Tumour (DNT)

29
Q

CM of Dysembryoplastic Nuro-Epithelial tumour (DNT)

A

Seizures

30
Q

Embryonal (Primitive) Neoplasms are known to have what distinctive appearance ?

A

Primitive “small round cell” appearance –> Resemblance to normal progenitor cells of CNS

31
Q

Macroscopic Features:
* Well circumscribed, gray and friable
* Extension to the leptomeninges

Microscopic Findings:
* Extremely cellular tumours
* Sheets of anaplastic (“small blue”) cells
* Hyperchromatic nuclei
* Mitoses
* Focal neuronal differentiation with Homer-Wright rosettes

featurs of?

A

Medulloblastoma

32
Q

Loc of Medulloblastoma

A
  • Midline of the cerebellum (children);
  • Lateral cerebellar tumours (adults)
33
Q

Genetic predisposition
+ prognosis of Medulloblastoma

A

1) MYC amplifications –> Poor outcome
2) Mutations in genes of the WNT signaling pathway -> More favourable course
3) Mutations activating the Sonic Hedge Hog (SHH) pathway –> Relative good prognosis

34
Q

epi of primary CNS LYMPHOMAS

A

Most common Diffuse Large B-Cell Lymphoma (DLBCL); 2% of extra-nodal lymphomas; 1% of intracranial tumours

* Aggressice disease

35
Q

who is as high risk of developing primary CNS Lymphomas

A

immune-compromised individuals <> EBV [+]

36
Q

Macroscopic Features:
* Multiple nodules within the brain parenchyma
* Well defined tumours
* Necroses (EBV[+] tumours)
* Localisation: Deep gray structures, white matter and cortex

Microscopic Findings:
* Diffuse Large B-Cell Lymphomas (DLBCL)
* Perivascular accumulation of neoplastic cells
* Infiltration of the adjacent brain parenchyma

features of?

A

Primary CNS lymphoma

37
Q

Loc of primary CNS lymphoma

A

Deep gray structures, white matter and cortex

38
Q

Epi Germ cell tumours

A

90% of cases , Individuals < 20 years old

39
Q

Most common CNS germ cell neoplasm ?

A

Germinoma (resemblance to testicular Seminoma)

* seminoma -> lymphocytic infiltrates

40
Q

Loc of Germ Cell tumours

A

i. Pineal, ii. Supra-sellar regions

41
Q

Loc of Meningioma

A
  • Anywhere on the external surfaces of the brain (meninges)
  • Within the ventricular system
42
Q

Micro findings:
* Sheets or clusters of cells without visible cell membranes
* Large nests of epithelioid cells
* Numerous nuclear clear holes

Features of what type of Grade I Meningioma?

A

Meningotheliomatous (Synctial)

43
Q

Micro features:
* Elongated cells with abundant collagen deposits between them
* Intersecting fascicles of spindled cells

features of what type of Grade I Meningioma?

A

Fibroblastic Meningioma

44
Q

Micro features:
* Combined features of syncytial and fibroblastic tumours
* Psamoma bodies
* characteristic “Whorls”

fetaures of what type of Grade I Meningioma?

A

Transitional Meningioma

45
Q

micro features:
* Presence of numerous psammoma bodies

features of what type of Grade I Meningioma?

A

Psammomatous Meningioma

46
Q

Micro features:
* Presence of pseudo-psammoma bodies (PAS [+] eosinophilic secretions)
* Tan Appearance on cut surface

features of what type of Grade I Menongioma?

A

Secretory Meningioma

47
Q

What stain is used for the identification eosinophilic pseudo-psammoma bodies in Secretory Meningioma ?

A

PAS ([+])

48
Q

Micro findings of Atypical (Grade II) Meningioma

A
  • Increased cellularity
  • Prominent nucleoli
  • Patternless growth
  • High mitotic rate
  • Foci of spontaneous necrosis
49
Q

Micro features of Anaplastic (or malignant; Grade III) Meningioma

A

Resemblance to high grade Sarcoma or Carcinoma

50
Q

Macroscopic features:
* soft fleshy appearance with papillary (cauliflower-like) configuration

Microscopic features:
* Prominant nucleoli
* Focus of “spontaneous necrosis”
* MIB-1 (Ki-67 > 4%)

features of?

A

Atypical Meningioma (WHO GRADE II)

51
Q

Macroscopic features:
* Tumour with irregular contour and inhomogeneous signal characteristics
* Central hypodensity (suggestive of necrosis)
* Tumour with soft, almost gelatinous cut surface (suggestive of high cellularity)

Microscopic featuers:
* Fibrosarcoma-like spindled region
* Carcinoma-like region ; Multiple necrosis
* patchy postitivity to EMA (stain)
* MIB-1 (Ki-67) > 20%

features of?

A

Anaplastic Meningioma (WHO Grarde III)

52
Q

Microscopic features:
* Tongue-like protrusions
* Entrapped brain parenchyma [GFAP]

features of?

A

Brain invasive meningioma (WHO GRADE II)

* GFAB stains the glial cells in the brain parenchyma

53
Q

the most comon primary sites of Metastic Brain tumours are?

A

Lung, breast, skin, GI tract

54
Q

Macroscopic Features:
* Sharply demarcated masses with peri-tumoural oedema

Microscopic features:
* Tall columnar cells
* Cribriform glands
* “Dirty necrosis”

features of?

A

Metastaic barin tumour from the GI tract (Colon Carcinoma)

55
Q

CM of Metastaic Brain Tumours

A

Paraneoplastic syndromes:
1) Subacute cerebellar degeneration
2) Limbic encephalitis
3) Subacute sensory neuropathy
4) Syndrome of rapid-onset psychosis, catatonia, epilepsy and coma

patho II (29 decks)

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