Neuro-oncology Flashcards
What is the most common primary brain tumor?
Meningioma
Differentiate high and low grade glioma based on MRI
Low: Non enhancing on T1 need FLAIR or T2 to see full picture
High: Enhancing intra-axial mass lesions
What is the first choice steroid to relieve headache and lateralizing signs?
Dexamethasone
Where are true rosettes and pseudorosettes seen?
T: Flexner-Wintersteiner– Retinoblastoma
F: Homer Wright– Neuroblastoma, Medulloblastoma
Perivascular pseudorosettes also seen in ependymomas
Where are rosenthal fibers seen?
Pilocytic astrocytoma but also seen as “reactive Rosenthal fibers” in craniopharyngioma, hemangioblastoma and pineal cysts
What are the 2 pathologic features either of which is required to make a diffuse astrocytoma a grade 4– glioblastoma?
Microvascular proliferation
Necrosis
What low grade glioma needs more aggressive treatment because of the worse prognosis associated with it?
Gemistocytic low grade astrocytoma
What are the pathologic feature is required to make a diffuse astrocytoma a grade 3– anaplastic astrocytoma?
Mitosis
What feature makes a GBM tumor responsive to Temozolomide, a DNA alkylating agent?
DNA repair enzyme (MGMT– methylguanine DNA methyltransferase) methylation (inactivation)
What is the key pathologic description of oligodendroglial tumors?
Uniform “fried egg” appearance, due to perinuclear cytoplasmic clearing
What is the most common primary spinal cord tumor?
Ependymoma
Gangliocytoma and dysplastic gangliocytoma, hamartomatous cerebellar lesion with mature ganglion cells are associated with a mutation in which gene?
PTEN, Cowden syndrome
These tumors are called Lhermitte-Duclos dz
Central neurocytoma is located in?
Intraventricular –> Hydrocephalus!
What is the only malignant neuronal tumor?
Neuroblastoma
What is a marker of neuronal differentiation that may be utilized to identify neuronal tumors?
Synaptophysin
What 3 intracranial neoplasms have a characteristic cyst with enhancing mural nodule?
Pilocytic astrocytoma
Ganglioglioma
Hemangioblastoma
In stark contrast to neuronal/ neuroglial tumors embryonal tumors are all _______?
Malignant and highly aggressive
What is the typical pathologic description of infratentorial PNET/ medulloblastoma?
Small blue cells with Homer Wright rosettes
What are the 3 most common tumors in the pineal region? Which one of them is VERY sensitive to radiation?
Germinoma > Pineal parenchymal tumors > Astrocytoma
Germinoma sensitive to radio
Which is malignant? Pineocytoma or Pineoblastoma?
Pineoblastoma! Needs aggressive multiagen chemotherapy while pineocytoma only needs resection!
What stain can be used to identify germinomas?
Alkaline phosphatase
What is the most common locations of meningiomas?
Cerebral convexities
What are the 4 aggressive histologic subtypes of meningioma?
2CPR
Clear cell, Choroid, Papillary and Rhabdoid
What are the ddx for dural based lesions?
Meningioma
Hemangiopericytoma
Dural mets
Why is it important to differentiate meningioma from a hemangiopericytoma?
Hemangiopericytoma needs RT while meningioma only needs resection in most cases
What is the characteristic pathologic description of hemangiopericytoma?
Staghorn pattern of typical branching vascular pattern
What mutation leads to bilateral vestibular schwannomas?
NF2 gene on chromosome 22
What pathologic features may be seen in Schwannomas?
Antoni A regions with dense cellular componene and Verocay bodies, organized linear palisades of nuclei
Differentiate NF1 and NF2 based on the tumors associated with them.
Which one has Lisch nodules in the iris?
1: NO– Neurofibroma and Optic glioma
2: SMEG– Schwannoma, Meningioma, Ependymoma, Glioma RARELY
Lisch: 1
What is the pathologic picture of primary malignant lymphomas?
Perivascular cuffing by malignant lymphocytes which are CD 20 positive B cells
What is the treatment for primary CNS lymphoma?
High dose methotrexate based chemo regimen
What endocrine symptoms are seen in large nonsecreting sellar tumors?
Hyperprolactinemia and hypopituitarism
What is the most common finding in pituitary macroadenoma?
Bitemporal hemianopsia
What diagnostic exams are used to identify endocrinologic derangements in pituitary microadenomas?
Serum prolactin >200ng/ml
Serum IGF 1
24 hour urine cortisol excretino and ACTH concentration
What is the pathologic description of craniopharyngioma?
Crank-case oil fluid in a cyst arising from the Rathke’s Cleft
What is treatment for Craniopharyngioma?
Sx then RT
What are the ddx for intraventricular tumors?
Meningioma Neurocytoma subependymal giant cell Astrocytoma Subependymoma Ependymoma CHoroid plexus papilloma MAN ChES
What does a Choroid plexus papilloma look like on imaging?
Calcified enhancing intraventricular mass
What is the most common location of an CNS hemangioblastoma?
Cerebellum or SC
Name the cancer syndromes associated with the ff CNS tumors:
Cortical hamartomas
Subependymal giant cell Astrocytoma SEGA
Hemangioblastoma
Astrocytoma
Gangliocytoma of the cerebellum (Lhermitte-Duclos)
Medulloblastoma
Cortical hamartomas– TUBEROUS SCLEROSIS
Subependymal giant cell Astrocytoma SEGA – TUBEROUS SCLEROSIS
Hemangioblastoma– VHL
Astrocytoma– LI FRAUMENI
Gangliocytoma of the cerebellum (Lhermitte-Duclos)– COWDEN
Medulloblastoma – TURCOT
What cancer has _____ as paraneoplastic syndrome?
Limbic encephalitis
Stiff man syndrome
Lambert eaton syndrome
ALL Small Cell Lung Cancer
