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Neuroscience > Neuroscience Week 5: Tumors of the CNS > Flashcards

Neuroscience Week 5: Tumors of the CNS Flashcards

1
Q

What % of tumors are supratentorial?

A
  • 80% of adult tumors are supratentorial
  • 80% of pediatric tumors are infratentorial
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2
Q

Intra-axial vs extra-axial tumors

A
  • Extra-axial tumors are well demarcated and have a better prognosis
  • Infiltrating tumors are rarely cured
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3
Q

Mass effect of neoplasms in the CNS

A
  • Headache
  • focal symptoms
  • herniation
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4
Q

Infiltrating tumors can cause ___________ depending on location and also ___________.

A
  • focal symptoms
  • Seizures
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5
Q

Clinical presentations of CNS neoplasms non-focal

A
  • head-ache​
  • seizures
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6
Q

Clinical presentations of CNS neoplasms focal

A
  • motor
  • sensory
  • cerebellar
  • seizure
  • etc.
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7
Q

Types of herniations

A
  • cingulate herniation
  • transtentorial herniation
  • Uncal herniation
  • Cerebellar tonsilar herniation
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8
Q

Types of hydrocephalus

A
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9
Q

Main Types of CNS tumors

5 listed

A
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10
Q

Astrocytoma tumor type

A

Glioma

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11
Q

Most common type of glioma

A

Astrocytoma (>70% of gliomas)

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12
Q

Grades of Astrocytoma

4 listed

A
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13
Q

Pilocytic Astrocytoma grade

A

WHO grade 1

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14
Q

Pilocytic Astrocytoma age of onset

A

most common primary tumor in childhood

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15
Q

The most common primary tumor in childhood

A

Pilocytic Astrocytoma

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16
Q

Pilocytic Astrocytoma common location

A

common in cerebellum (also hypothalamus and optic chiasm)

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17
Q

Pilocytic Astrocytoma gross appearance

A

circumscribed and often cystic with a solid mural nodule

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18
Q

Pilocytic Astrocytoma Histological features and histological markers

A
  • Cells of origin are GFAP positive
  • biphasic pattern consisting of cellular and fibrillary perivascular areas, alternating with loose microcystic zones
  • The tumor cells often contain Rosenthal fibers and eosinophilic granular bodies. Pilocytic (hair cell) refers to the fiber-like appearance of the tumor cells
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19
Q

Pilocytic Astrocytoma prognosis

A
  • excellent
  • because surgically resectable
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20
Q

Diffuse Astrocytoma Grade

A

WHO Grade 2

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21
Q

Diffuse Astrocytoma age of onset

A

most frequent in young adults

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22
Q

Diffuse Astrocytoma location

A

most frequent in the cerebral hemispheres, especially the frontal lobes

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23
Q

Diffuse Astrocytoma gross appearance

A
  • poorly demarcated
  • produce an enlargement of the involved portion of the brain and blurring of anatomical landmarks
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24
Q

Diffuse Astrocytoma Histological features

A

low grade cellularity and pleomorphism but no atypia or mitoses

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25
Diffuse Astrocytoma Growth rate
very slowly over several years
26
Diffuse Astrocytoma prognosis
depends on how long the tumor has grown
27
Anaplastic Astrocytoma Grade
WHO Grade 3
28
Anaplastic Astrocytoma histological features
* has intermediate characteristics between grade 2 and glioblastoma * can originate on a grade 2 tumor or appear de novo * it is more cellular and has more prominent atypia and a higher mitotic rate
29
Anaplastic Astrocytoma growth rate
more rapidly growing
30
Anaplastic Astrocytoma prognosis
3-5 year survival
31
Glioblastoma Grade
WHO Grade 4
32
Glioblastoma Age of onset
common in middle-aged and older adults
33
Glioblastoma common location
common in frontal and temporal lobes can cross the corpus callosum (butterfly glioma)
34
Butterfly glioma
a glioblastoma that crosses the corpus callosum
35
Glioblastoma can be ________ or _________ to a \_\_\_\_\_\_\_\_\_\_\_\_.
Glioblastoma can be primary or secondary to a lower grade astrocytoma.
36
Glioblastoma Prognosis
Very aggressive tumor with a short survival (1 year)
37
Glioblastoma gross appearance
present as poorly defined intra-axial masses with multiform appearance due to necrosis and hemorrhage
38
Glioblastoma Histological features
* pseudopalisading with central necrosis, anaphasia and vascular proliferation. * cellular anaplasia (pleomorphism) in large cell glioblastoma * Glioblastoma * vascular endothelial proliferation
39
Oligodendroglioma tumor type
Gliomas
40
Oligodendroglioma description
Malignant tumors derived from oligodendrocytes
41
Oligodendroglioma age of onset
Adult
42
Oligodendroglioma common location
* supratentorial, often white matter * the frontal lobes are commonly affected
43
Oligodendroglioma gross appearance
* well circumscribed (compared to astrocytoma) * calcifications are common
44
Oligodendroglioma Histological Features
* Fried-egg cellular appearance (round nuclei and clear cytoplasm) * chicken wire (or chicken feet) vessels
45
Oligodendroglioma Prognosis
somewhat better than astrocytoma
46
Ependymoma tumor type
Glioma
47
Ependymoma Description
Ependymal cells
48
Ependymoma common location
most commonly associated with the 4th ventricle
49
Ependymoma age of onset
* most commonly in children (infratentorial) * rarely in adults but typically (supratentorial)
50
Ependymoma Gross appearance
* intraventricular * well-circumscribed * sometimes with calcification
51
Ependymoma Histological Features
key histological feature perivascular pseudorosettes and less commonly true ependymal rosettes
52
Ependymoma Prognosis
Largely dependent on the completeness of resection
53
Medulloblastoma Tumor type
Embryonal Neoplasms
54
Medulloblastoma description
primitive neuroectoderm tumor
55
Medulloblastoma common location
typically arise in the midline cerebellum
56
Medulloblastoma age of onset
* Is the most common childhood tumor * usually present in children * very rare in (\>20)
57
Medulloblastoma common location
* Typically arise in the midline cerebellum * can compress the 4th ventricle causing non-communicating hydrocephalus
58
Medulloblastoma Gross appearance
* solid and enhancing most common * infiltrates the cerebellum
59
Medulloblastoma Histological Features
* Small blue cell tumor * Homer-Wright Rosettes (no true lumen)
60
Medulloblastoma Prognosis
* although malignant, they are responsive to radiotherapy and chemotherapy and can sometimes be cured * the issue is that they spread through CSF pathways (drop metastases in subarachnoid space and neuraxis treatment may be necessary)
61
Small blue cell tumor description
embryonal tumors with closely packed cells with little cytoplasm
62
Pituitary Adenoma tumor type
Tumors of the Sella region
63
Pituitary Adenoma description and common presentation
* can be silent or functioning (can produce hormones) * Prolactinoma is the most common (lactotrophs)
64
Pituitary Adenoma types 5 listed
* Lactotrophs (prolactin) * somatotrophs (Growth hormone) * corticotrophs (ACTH) * tyrotrophs (Thyroid stimulating hormone) * gonadotrophs (gonadotropins)
65
Pituitary Adenoma common clinical presentation
* bitemporal hemianopsia * endocrine abnormalities * headaches
66
Pituitary Adenoma Histological Features
shows hyperplasia of one type of cell (e.g. lactotrophs)
67
Craniopharyngioma age of onset
most commonly found in children and adolescents
68
Craniopharyngioma can be confused with?
Pituitary adenoma (both cause bitemporal hemianopsia)
69
Craniopharyngioma derived from?
remnants of Ratke Pouch (ectoderm)
70
Craniopharyngioma Histological features
* Islands of keratin often calcify * often cystic changes * cholesterol crystals float in the greasy fluid that fills the cysts * all of this is embedded in an island of neural tissue
71
Primary CNS Lymphoma derivation
Microglia or rare lymphocytes present in meninges and around blood vessels
72
Primary CNS Lymphoma age of onset
rare tumor that occurs more commonly in immunocompromised patients
73
Primary CNS Lymphoma cells are usually positive for
EBV
74
Primary CNS Lymphoma common locations
most cases are supratentorial
75
Primary CNS Lymphoma Histological features
* Dense perivascular sheets or diffuse masses * Usually positive for EBV
76
Primary CNS Lymphoma Prognosis
* aggressive tumors with poor response to chemotherapy (as opposed to peripheral lymphomas)
77
Meningioma derivation
Arachnoid cells
78
Meningioma Age of onset
* 15% of all CNS tumors (25% are spinal) * More common in women
79
Meningioma Gross appearance
* Extra-axial and well-circumscribed (may have dural attachment; dural tail) * enhancing (external carotid blood supply)
80
Meningioma Common Locations
* Parasagittal * falx * lateral convexity * sphenoid ridge * olfactory groove * posterior fossa * spinal canal
81
Meningioma histological patterns 3 listed
* Transitional with whorls * Fibroblastic * Psammatous
82
Meningioma Histological Features
* Meningothelial * fibroblastic * **Psammomatous** (grain of sand-like) and others * whorls such as in the transition meningioma * radiating pattern such as in the fibroblastic meningioma
83
CNS Metastasis derivation
Usually similar in histology to the primary tumor
84
CNS Metastasis common locations
* originate at gray-white junctions * often present at multiple lesions
85
CNS Metastasis age of onset
5-25% of people with malignant tumors will develop CNS metastases
86
CNS Metastasis common primary sites
* lung * breast * melanoma * renal cell carcinoma * colon cancer * **Choriocarcinoma in younger patients**
87
CNS Metastasis Gross appearance
usually parenchymal in brain - may be bone associated in spine often enhancing and circumscribed
88
CNS Metastasis Histological features
Usually correlated with the primary malignancy
89
CNS Metastasis Prognosis
Bad, may depend on systemic control of disease
90
Familial tumor syndromes 3 listed
* Tuberous Sclerosis * Von Hippel-Lindau Disease * Neurofibromatosis type I and II
91
Optic Nerve Glioma is associated with?
Neurofibromatosis Type I
92
Acoustic Schwannomas are associated with? 2 listed
Neurofibromatosis Type II & Lateral pontine syndrome
93
Meningiomas are associated with this(ese) neurocutaneous disorders 2 listed
* Neurofibromatosis Type II * Sturge-Weber (ipsilateral meningiomas)
94
Ependymomas in the spinal cord are associated with this(ese) neurocutaneous disorders
Neurofibromatosis Type II
95
Ipsilateral Meningiomas are associated with this(ese) neurocutaneous disorders
Sturge-Weber
96
subependymal astrocytomas are associated with this(ese) neurocutaneous disorders
Tuberous Sclerosis
97
Hemanagioblastoma (cerebellum/retina) are associated with this(ese) neurocutaneous disorders
Von Hippel-Lindau
98
Schwannomas overview
* Cerebellopontine angle tumor * hallmark of NF2 * fasicles of spindle cells and complete pallisading pattern * S-100 Positive
99
Histological features: fascicles of spindle cells and complete palisading pattern
Schwannomas
100
Hemangioblastoma overview
* Von Hippel Lindau Disease * Multiple (cerebellum, spinal cord, retina) * Typically cerebellar hemangioblastoma is a mural nodule within a cyst * Can produce erythropoietin
101
509 first aid
102
HAMARTOMAS can be present in
CNS in tuberous sclerosis
103
Adult tumors
510 and 511 images
104
Childhood tumors
* pg 512 * pinealoma (gaze palsy)
105
Common location of pilocytic astrocytoma
Cerebellum but also optic chiasm and hypothalamus
106
Diffuse astrocytoma most common location
common in the cerebral hemispheres and especially in the frontal lobes
107
Schwannoma cells are usually positive for?
S-100
108
histological features: Small blue cell tumor Homer-Wright Rosettes (no true lumen)
Medulloblastoma
109
may have dural attachment; dural tail
Meningioma

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