Path - Tumors

Question 1

most CNS tumors in children are located where and are what type

Answer 1

• subtentorial (cerebellum and brainstem)

- embryonal, medulloblastoma, pilocytic astrocytoma

Question 2

most CNS tumors in adults are located where and are what type

Answer 2

• supratentorial

- glioblastoma

Question 3

new onset of seizure in an adult should make you think _____

Answer 3

brain tumor

Question 4

anaplasia and mitoses are indicative of what grade of tumor

Answer 4

III

Question 5

microvascular proliferation and necrosis are indicative of what tumor grade

Answer 5

IV

Question 6

brainstem astrocytomas can affect what cranial nerve

Answer 6

6

Question 7

child comes in with a tumor in the posterior fossa, what should be first on the ddx list

Answer 7

pilocytic astrocytoma

Question 8

GFAP positive tumor indicates _____

Answer 8

pilocytic astrocytoma

Question 9

compare primary and secondary gliobastoma

Answer 9

primary: later in life, no precursor lesion, EGFR and PTEN mutations
secondary: younger patients, precursor lesion, IDH1 mutation, better prognosis

Question 10

3 histologic hallmarks you need to diagnose a glioblastoma

Answer 10

1) serpentine pattern of necrosis
2) pseudo-palisading
3) vascular/endothelial proliferation

Question 11

compare an oligodendroglioma and an anaplastic oligodendrolgioma

Answer 11

O: 2/4 grade, favorable prognosiss

AO: 3/4 grade, poor prognosis, increased N:C, increased mitoses, increased cellularity, vascular hypertrophy, necrosis

Question 12

what tumor exhibits “drop mets” where dissemination of pieces of the primary tumor through the CSF occurs

Answer 12

medulloblastoma

Question 13

compare ependymoma and medulloblastoma

Answer 13

ependymoma: perivascular pseudo rosettes, less cellular and more fibrillar
medulloblastoma: homer wright rosettes

Question 14

compare pilocytic astrocytoma and medulloblastoma

Answer 14

pilocytic astrocytoma: cystic

medulloblastoma: solid

Question 15

compare atypical teratoid/rhabdoid tumor and medulloblastoma

Answer 15

AT/RT: < 2 y/o patients, large cells w/ paranuclear filamentous inclusions

Question 16

a tumor immunoreactive for EMA and Vimentin indicates what

Answer 16

atypical teratoid/rhabdoid tumor

Question 17

mutation in HSNF5/INI1 gene indicates what tumor

Answer 17

atypical teratoid/rhabdoid tumor

Question 18

“hooping” of cells in a tumor indicates ____

Answer 18

primary CNS lymphoma

Question 19

what tumors are associated with hemorrhage when they metastasize to the brain

Answer 19

• melanoma
• choriocarcinoma
• renal cell carcinoma
• lung CA

Question 20

PCA-1 antibody is indicative of what dz process

Answer 20

subacute cerebellar degeneration (paraneoplastic syndrome)

Question 21

where do schwannomas occur

Answer 21

cerebellar pontine angle

Question 22

what cranial nerve do schwannomas have a tendency to affect, and what sx occur

Answer 22

CN VIII

tinnitus and hearing loss

Question 23

schwannomas are positive for what protein marker

Answer 23

S100

Question 24

schwannomas are associated with what genetic mutation and loss of what protein

Answer 24

NF2 mutation

loss of merlin

Question 25

compare the two areas of a schwannoma: Antoni A and Antoni B

Answer 25

A: cellular, spindle cells, verocay bodies

B: hypo cellular, myxoid ECM

Question 26

describe verocay bodies and what tumor they are associated with

Answer 26

palisading nuclei around “nuclear free zones”

schwannoma

Question 27

describe a malignant peripheral nerve sheath tumor (MPNST)’s grade and genetic predisposition

Answer 27

85% are high grade

50% arise in NF1 patients