NeuroOncology - Bemis

Question 1

What do you call a treatment that follows the primary treatment?

Answer 1

Called adjuvant

With tumors, adjuvant therapy goal is to remove any residual cancer cells

Question 2

Rosenthal fibers and a biphasic pathology pattern are particularly associated with what kind of tumors?

Answer 2

Pretty benign Pilocytic Astrocytoma

Question 3

What is GFAP?

What does it show?

Answer 3

GFAP = glial fibrillary acidic protein

Indicator of astrocyte injury

Question 4

What is a key feature of a primary glioblastoma?

Answer 4

pseudo-palisading necrosis

Question 5

Feature of butterfly gliomas?

Answer 5

they cross the midline (via corpus callosum?)

Question 6

What is the i(17q) mutation associated with?

Answer 6

poor prognosis in medulloblastoma

short arm of chromosom 17 is completely gone and replaced with another long arm

Question 7

Where do you see medulloblastomas?

Answer 7

In children, usually cerebellum

Question 8

What symptoms do you see with medulloblastoma?

Answer 8

Headache, morning vomiting gets worse with time, problems with back pain and motion

Question 9

About 70% of brain tumors are metastatic from other sites. How can you tell the different between a primary brain tumor and a metastasis to the brain?

Answer 9

Primary Brain Tumors:

• poorly circumscribed
• Usually single
• Location varies

Metastasis to brain:

• well circumscribed
• often multiple
• Usually located in gray/white matter junction

Question 10

What is the difference between adults and children as far as the general location of CNS tumors?

Answer 10

Children - 70% of tumors are in the posterior fossa

Adults - 70% of tumors are located in the supratentorial

Question 11

Describe the general rules for tumor grading in the CNS:

Answer 11

Grade 1: Low prolif potential - just cut it out!
Grade 2: Infiltrative, but low proliferative activity
Grade 3: See more mitosis
Grade 4: Fast progression, active mitosis, necrosis prone

Question 12

Why are high grade gliomas so hard to treat?

Answer 12

Infiltrative borders make them hard to completely excise

Question 13

Possible symptoms of glioblastoma?

Answer 13

• Slowly progressing neuro deficit (like motor weakness)
• Headache
• Seizures

Question 14

What are the classic features of oligodendrogliomas?

Answer 14

Sharply circumscribed masses
Round nuclei with cytoplasm halo (fried egg)
Calcified

Question 15

As you are looking at a pathology slide from a brain neoplasm, you see pseudorosettes and rosettes. Immediately you think:

Answer 15

Must be an ependyoma!

Question 16

The next path slides you look at reveal Homer-Wright Rosettes… What kind of neoplasm are you thinking of now???

Answer 16

Medulloblastoma

Question 17

You diagnose a patient with a fairly common benign tumor of arachnoid cells.
What is this neoplasm callded?
What would you see in pathology slides?

Answer 17

Meningioma

You would see a synctial pattern (look like little whirlpools of tissue)
Psammoma bodies (Ca deposits)

Question 18

What is the most likely time you will see a primary brain lymphoma? (because they are rare)

How do you diagnose it?

Answer 18

In an immuosuppressed patient

Very simple diagnosis in CSF

Question 19

Relatively common brain tumor that is found often at CN 7. Often get hearing loss and tinnitis.
Name that tumor!

Answer 19

Schwannoma

Question 20

What is a craniopharyngioma?

Answer 20

• Derived from odotogenic epithelium (tooth dev.)
• Benign
• Usually in kids/young adults
• often have vision problems