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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
Q

Diffuse Astrocytoma Growth rate

A

very slowly over several years

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26
Q

Diffuse Astrocytoma prognosis

A

depends on how long the tumor has grown

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27
Q

Anaplastic Astrocytoma Grade

A

WHO Grade 3

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28
Q

Anaplastic Astrocytoma histological features

A
  • 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
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29
Q

Anaplastic Astrocytoma growth rate

A

more rapidly growing

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30
Q

Anaplastic Astrocytoma prognosis

A

3-5 year survival

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31
Q

Glioblastoma Grade

A

WHO Grade 4

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32
Q

Glioblastoma Age of onset

A

common in middle-aged and older adults

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33
Q

Glioblastoma common location

A

common in frontal and temporal lobes

can cross the corpus callosum (butterfly glioma)

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34
Q

Butterfly glioma

A

a glioblastoma that crosses the corpus callosum

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35
Q

Glioblastoma can be ________ or _________ to a ____________.

A

Glioblastoma can be primary or secondary to a lower grade astrocytoma.

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36
Q

Glioblastoma Prognosis

A

Very aggressive tumor with a short survival (1 year)

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37
Q

Glioblastoma gross appearance

A

present as poorly defined intra-axial masses with multiform appearance due to necrosis and hemorrhage

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38
Q

Glioblastoma Histological features

A
  • pseudopalisading with central necrosis, anaphasia and vascular proliferation.
  • cellular anaplasia (pleomorphism) in large cell glioblastoma
  • Glioblastoma
  • vascular endothelial proliferation
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39
Q

Oligodendroglioma tumor type

A

Gliomas

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40
Q

Oligodendroglioma description

A

Malignant tumors derived from oligodendrocytes

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41
Q

Oligodendroglioma age of onset

A

Adult

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42
Q

Oligodendroglioma common location

A
  • supratentorial, often white matter
  • the frontal lobes are commonly affected
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43
Q

Oligodendroglioma gross appearance

A
  • well circumscribed (compared to astrocytoma)
  • calcifications are common
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44
Q

Oligodendroglioma Histological Features

A
  • Fried-egg cellular appearance (round nuclei and clear cytoplasm)
  • chicken wire (or chicken feet) vessels
45
Q

Oligodendroglioma Prognosis

A

somewhat better than astrocytoma

46
Q

Ependymoma tumor type

A

Glioma

47
Q

Ependymoma Description

A

Ependymal cells

48
Q

Ependymoma common location

A

most commonly associated with the 4th ventricle

49
Q

Ependymoma age of onset

A
  • most commonly in children (infratentorial)
  • rarely in adults but typically (supratentorial)
50
Q

Ependymoma Gross appearance

A
  • intraventricular
  • well-circumscribed
  • sometimes with calcification
51
Q

Ependymoma Histological Features

A

key histological feature perivascular pseudorosettes and less commonly true ependymal rosettes

52
Q

Ependymoma Prognosis

A

Largely dependent on the completeness of resection

53
Q

Medulloblastoma Tumor type

A

Embryonal Neoplasms

54
Q

Medulloblastoma description

A

primitive neuroectoderm tumor

55
Q

Medulloblastoma common location

A

typically arise in the midline cerebellum

56
Q

Medulloblastoma age of onset

A
  • Is the most common childhood tumor
  • usually present in children
  • very rare in (>20)
57
Q

Medulloblastoma common location

A
  • Typically arise in the midline cerebellum
  • can compress the 4th ventricle causing non-communicating hydrocephalus
58
Q

Medulloblastoma Gross appearance

A
  • solid and enhancing most common
  • infiltrates the cerebellum
59
Q

Medulloblastoma Histological Features

A
  • Small blue cell tumor
  • Homer-Wright Rosettes (no true lumen)
60
Q

Medulloblastoma Prognosis

A
  • 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
Q

Small blue cell tumor description

A

embryonal tumors with closely packed cells with little cytoplasm

62
Q

Pituitary Adenoma tumor type

A

Tumors of the Sella region

63
Q

Pituitary Adenoma description and common presentation

A
  • can be silent or functioning (can produce hormones)
  • Prolactinoma is the most common (lactotrophs)
64
Q

Pituitary Adenoma types

5 listed

A
  • Lactotrophs (prolactin)
  • somatotrophs (Growth hormone)
  • corticotrophs (ACTH)
  • tyrotrophs (Thyroid stimulating hormone)
  • gonadotrophs (gonadotropins)
65
Q

Pituitary Adenoma common clinical presentation

A
  • bitemporal hemianopsia
  • endocrine abnormalities
  • headaches
66
Q

Pituitary Adenoma Histological Features

A

shows hyperplasia of one type of cell (e.g. lactotrophs)

67
Q

Craniopharyngioma age of onset

A

most commonly found in children and adolescents

68
Q

Craniopharyngioma can be confused with?

A

Pituitary adenoma (both cause bitemporal hemianopsia)

69
Q

Craniopharyngioma derived from?

A

remnants of Ratke Pouch (ectoderm)

70
Q

Craniopharyngioma Histological features

A
  • 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
Q

Primary CNS Lymphoma derivation

A

Microglia or rare lymphocytes present in meninges and around blood vessels

72
Q

Primary CNS Lymphoma age of onset

A

rare tumor that occurs more commonly in immunocompromised patients

73
Q

Primary CNS Lymphoma cells are usually positive for

A

EBV

74
Q

Primary CNS Lymphoma common locations

A

most cases are supratentorial

75
Q

Primary CNS Lymphoma Histological features

A
  • Dense perivascular sheets or diffuse masses
  • Usually positive for EBV
76
Q

Primary CNS Lymphoma Prognosis

A
  • aggressive tumors with poor response to chemotherapy (as opposed to peripheral lymphomas)
77
Q

Meningioma derivation

A

Arachnoid cells

78
Q

Meningioma Age of onset

A
  • 15% of all CNS tumors (25% are spinal)
  • More common in women
79
Q

Meningioma Gross appearance

A
  • Extra-axial and well-circumscribed (may have dural attachment; dural tail)
  • enhancing (external carotid blood supply)
80
Q

Meningioma Common Locations

A
  • Parasagittal
  • falx
  • lateral convexity
  • sphenoid ridge
  • olfactory groove
  • posterior fossa
  • spinal canal
81
Q

Meningioma histological patterns

3 listed

A
  • Transitional with whorls
  • Fibroblastic
  • Psammatous
82
Q

Meningioma Histological Features

A
  • 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
Q

CNS Metastasis derivation

A

Usually similar in histology to the primary tumor

84
Q

CNS Metastasis common locations

A
  • originate at gray-white junctions
  • often present at multiple lesions
85
Q

CNS Metastasis age of onset

A

5-25% of people with malignant tumors will develop CNS metastases

86
Q

CNS Metastasis common primary sites

A
  • lung
  • breast
  • melanoma
  • renal cell carcinoma
  • colon cancer
  • Choriocarcinoma in younger patients
87
Q

CNS Metastasis Gross appearance

A

usually parenchymal in brain - may be bone associated in spine often enhancing and circumscribed

88
Q

CNS Metastasis Histological features

A

Usually correlated with the primary malignancy

89
Q

CNS Metastasis Prognosis

A

Bad, may depend on systemic control of disease

90
Q

Familial tumor syndromes

3 listed

A
  • Tuberous Sclerosis
  • Von Hippel-Lindau Disease
  • Neurofibromatosis type I and II
91
Q

Optic Nerve Glioma is associated with?

A

Neurofibromatosis Type I

92
Q

Acoustic Schwannomas are associated with?

2 listed

A

Neurofibromatosis Type II

&

Lateral pontine syndrome

93
Q

Meningiomas are associated with this(ese) neurocutaneous disorders

2 listed

A
  • Neurofibromatosis Type II
  • Sturge-Weber (ipsilateral meningiomas)
94
Q

Ependymomas in the spinal cord are associated with this(ese) neurocutaneous disorders

A

Neurofibromatosis Type II

95
Q

Ipsilateral Meningiomas are associated with this(ese) neurocutaneous disorders

A

Sturge-Weber

96
Q

subependymal astrocytomas are associated with this(ese) neurocutaneous disorders

A

Tuberous Sclerosis

97
Q

Hemanagioblastoma (cerebellum/retina) are associated with this(ese) neurocutaneous disorders

A

Von Hippel-Lindau

98
Q

Schwannomas overview

A
  • Cerebellopontine angle tumor
  • hallmark of NF2
  • fasicles of spindle cells and complete pallisading pattern
  • S-100 Positive
99
Q

Histological features: fascicles of spindle cells and complete palisading pattern

A

Schwannomas

100
Q

Hemangioblastoma overview

A
  • Von Hippel Lindau Disease
  • Multiple (cerebellum, spinal cord, retina)
  • Typically cerebellar hemangioblastoma is a mural nodule within a cyst
  • Can produce erythropoietin
101
Q

509 first aid

A
102
Q

HAMARTOMAS can be present in

A

CNS in tuberous sclerosis

103
Q

Adult tumors

A

510 and 511 images

104
Q

Childhood tumors

A
  • pg 512
  • pinealoma (gaze palsy)
105
Q

Common location of pilocytic astrocytoma

A

Cerebellum

but also

optic chiasm and hypothalamus

106
Q

Diffuse astrocytoma most common location

A

common in the cerebral hemispheres and especially in the frontal lobes

107
Q

Schwannoma cells are usually positive for?

A

S-100

108
Q

histological features:

Small blue cell tumor

Homer-Wright Rosettes (no true lumen)

A

Medulloblastoma

109
Q

may have dural attachment; dural tail

A

Meningioma

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