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NMSK-B IV > Pathology 4.4 > Flashcards

Pathology 4.4 Flashcards

1
Q

Where are astrocytomas and other primary brain tumors typically found in adults?

A

cerebral hemispheres

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2
Q

Where are astrocytomas and other primary brain tumors typically found in children?

A

cerebellum

pons

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3
Q

What is the pertinent information about Glioblastoma Multiforme (GBM)?

A

40% of primary intracranial neoplasms
later decades in life
18 month prognosis

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4
Q

What are the gross findings of Glioblastoma Multiforme (GBM)?

A

infiltrates extensively in the cortex

  • crosses corpus calloum
  • bilateral extension into white matter of both hemispheres
mottled red (recent hemorrhage)
mottled yellow (remote hemorrhage)
**butterfly on gross examination
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5
Q

What are the histologic findings of Glioblastoma Multiforme (GBM)?

A

1) marked cellularity w/ variable degrees of:
- cellular pleomorphism
- multinucleated cels
- frequent mitoses (anaplasia)

2) serpentine areas ofnecrosis surrounded by zones of crowded tumor cells (peripheral palisading)
3) endothelial cell proliferation which creates clusters of small blood vessels (glomeruloid formations)

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6
Q

Where do oligodendriomas originate?

A

white matter

adult cerebral hemispheres

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7
Q

What are the histological findings of oligodendriomas?

A
  • well-circumscribed
  • gelatinous
  • gray mass w/ cysts
  • focal hemorrhage and calcifications
  • sheets of cells with round nuclei
  • clear halo of cytoplasm (“fried egg”)
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8
Q

How do patients with oligodendriomas present clinically?

A
  • calcospherites (calcifications on radiography)

- seizures and several years of neurological complaints

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9
Q

Where is an ependymoma typically located and what is the symptomology?

A

fourth ventricle

hydrocephalus

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10
Q

Where are ependymomas most commonly found in the first two decades of life?

A

4th ventricle

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11
Q

Where are ependymomas typically found in adults?

A

spinal cord (filum terminale)

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12
Q

What are the most common tumors of the spinal cord?

A

1) astrocytoma

2) ependymoma

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13
Q

What are the gross features of ependymomas?

A
  • solid or papillary mass
  • extends from floor of 4th ventricle or intraspinal masses
  • sharply demarcated from normal tissue
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14
Q

What are the histologic findings of ependymomas?

A
  • sheets of cells with oval or round nuclei
  • granual chromatin
  • perivascular pseudorosettes
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15
Q

How do patients present clinically with ependymomas?

A
  • hydrocephalus

- slow growing tumor, but can seed subarachnoid space with CSF dissemination

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16
Q

Which cancer is #1 in metastasizing to the brain?

A

1) melanoma
2) breast
3) lung

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17
Q

Why might a patient with an oligodendrioma have a seizure?

A

located in white matter

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18
Q

What are colloid cysts?

A
  • located in 3rd ventricle

- round cysts most often occur in young adults

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19
Q

Where are colloid cysts typically located and what do they cause?

A
  • roof of 3rd ventricle in mindline
  • occlude Foramina of Monro
  • cause hydrocephalus
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20
Q

How does a patient present with a colloid cyst?

A
  • hydrocephalus
  • headache
  • lower leg weakness
  • loss of bladder control
  • idiopathic
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21
Q

What is the most common intracranial primitive neuroblastic tumor?

A

medulloblastoma; 20% of brain tumors in children

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22
Q

Where are medulloblastomas typically located?

A

exclusively in cerebellum

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23
Q

What are the histologic findings of medulloblastomas?

A
  • small, round, hyperchromatic blue-cell tumors of children
  • extremely cellular
  • sheets of anaplastic cells
  • scant cytoplasm
  • rosette formation
  • abundant mitoses
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24
Q

What are the gross findings of medulloblastomas?

A
  • well-circumscribed
  • gray
  • friable
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25
Q

How do patients present clinically with medulloblastomas?

A
  • cerebellar dysfunction
  • hydrocephalus
  • subarachnoid dissemination is common
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26
Q

What is the most common genetic alteration in a medulloblastoma?

A

-loss of material from short from of Ch 17

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27
Q

What are meiningiomas?

A
  • intracranial tumors (20% of all) from arachnoid villi

- compress brain tissue

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28
Q

Where are meningiomas most commonly located?

A
  • parasagittal areas
  • convexities of cerebral hemispheres
  • olfactory groove
  • lateral wing of sphenoid
29
Q

What is the most common genetic alteration in a meningioma?

A

deletion or mutation of Ch 22

30
Q

How do meningiomas present grossly?

A
  • well-circumscribed
  • firm
  • bosselated masses of variable size

-gray, fibrous pattern on cut section

31
Q

What are the histologic findings of meningiomas?

A
  • fibroblastic, whorled patternof “meningothelial” cells**

- Psammoma Bodies (laminated, spherical calcifications)

32
Q

What is the clinical presentation of meningiomas?

A
  • seizure + headache
  • anosmia (@ olfactory groove)
  • visual defects (suprasellar region)
33
Q

What is a Schwannoma?

A
  • benign neural crest tumor
  • derived from Schwann cells
  • “Neurilemmoma” or “neurinoma”
34
Q

What does a CT of a meningioma show?

A

sharp demarcation from under-surface of dura

35
Q

What are the gross findings of a Schwannoma?

A
  • well-circumscribed
  • encapsulated mass
  • attached to nerves
36
Q

What are the histologic findings of Schwannomas?

A

Antoni A pattern
-fascicles of elongated spindle cells

Antoni B pattern
-loosely staining, myxoid areas

37
Q

What is an Acoustic Neuroma?

A

intracranial Schwannoma restricted to 8th CN

38
Q

Where is an acoustic neuroma found?

A

cerebellar pontine angle

39
Q

What is the clinical presentation of Acoustic Neuromas?

A
  • tinnitus
  • deafness
  • compress other CNs
40
Q

What is a Craniopharyngioma?

A
  • solid and cystic lesions

- arise from epithelium of Rathke’s pouch

41
Q

What is the Rathke’s pouch?

A

a part of the embryonic nasopharynx that migrates cephalad and gives origin to the anterior hypophysis

42
Q

What is the clinical presentation of craniopharyngioma?

A
  • slow-growing tumor
  • childhood and adolescence
  • 50% occur after 20 y/o
43
Q

What are the gross findings of craniopharyngiomas?

A
  • 3-4 cm

- > 3/4 contain sufficient calcification (seen on radiography)

44
Q

How do children typically present with a craniopharyngioma?

A
  • endocrine deficiencies (growth retardation)

- visual disturbance and headache in adults

45
Q

What is the most common CNS neoplasm in patients with AIDS?

A

primary brain lymphoma; 1000 x’s greater in AIDS population than general public

46
Q

What are the histologic findings of primary brain lymphomas?

A
  • angiocentric distribution of small and large neoplastic lymphocytes
  • B-cell origin
  • EBV can be recovered in tumors of AIDS patients (etiology)
47
Q

How do metastatic tumors reach the CNS?

A
  • reach intracranial compartment through bloodstream

- generally in patients with advanced carcinoma

48
Q

Where do most metastatic tumors to the brain seed?

A

gray-white matter junction

49
Q

What is the pathophysiologic cause of seizure?

A

paroxysmal discharges from groups of neurons as a result of:

a. excessive excitation
b. loss of inhibition
* malfunction of ion channels*

50
Q

What are the causes of seizure?

A

1/3 genetic

1/4 structural abnormalities

51
Q

What is a seizure?

A

transient disturbance of cerebral function caused by abnormal neuronal discharges

52
Q

What are the types of seizures anatomically?

A

partial/focal: affecs part of the brain

generalized: affects entire brain [Grand Mal Seizures]

53
Q

What are the characteristics of generalized/clonic seizures?

A

1) sudden cry (diaphragmatic spasm)
2) fall
3) momentary rigidity
4) jerking of muscles, shallow breathing, cyanosis
(loss of bladder control)

54
Q

What are the after-symptoms of a generalized/clonic seizure?

A
  • confusion
  • drowsiness
  • fatigue
  • memory loss
  • unconsciousness
55
Q

What is an absence seizure?

A

-type of generalized seizure
-most common in children and teens
[Petit Mal Seizure]

56
Q

What are the characteristics of absence seizures?

A
  • brief staring spells/blinking

- rapid return after 2-3 minutes

57
Q

What are complex partial seizures?

A

1) visual sensation/aura

2) state of impaired consciousness, automatic motor activities, convulsions

58
Q

What is the most common seizure in children and adults?

A

complex partial seizure

59
Q

Where do complex partial seizures originate?

A

temporal lobe

60
Q

What is hippocampal sclerosis?

A
  • neuronal cell loss in Hippocampus

- segmental loss of pyramidal neurons and reactive gliosis

61
Q

What is the most common type of neuropathologic damage in individuals w/ complex partial seizures?

A

hippocampal sclerosis

62
Q

What is status epilepticus?

A
  • recurrent convulsive or non-convulsive seizures

- full consciousness not restored between episodes

63
Q

Is status epilepticus a medical emergency?

A

Yes; can result in:

  • hyperthermia
  • circulatory shock
  • neuronal loss
  • permanent brain damage
64
Q

What is a febrile seizure?

A
  • children 6 mo-5 y/o
  • few minutes in length
  • only occur with fever
65
Q

What must be ruled out when a patient presents with a febrile seizure?

A

bacterial meningitis

-perform lumbar puncture

66
Q

What are the most common lesions in generalized seizures?

A
  • cerebral changes resulting from birth
  • cerebral infarct
  • brain tumor
  • stroke
  • AVMs
  • trauma
67
Q

What is the histology of seizures?

A
  • neuronal loss
  • gliosis
  • loss of dendritic afferents (GABA-producing neurons)
  • *lack of inhibition causes seizure
68
Q

What are the clinical and physical findings of a seizure?

A
  • normal temp unless infection
  • elevated heart rate
  • bp variable
  • may be evidence of trauma
  • postictal state if seizure is recent (confusion, drowsiness, behavioral changes)
69
Q

What is a characteristic action of seizure disorder?

A

Tongue biting

NMSK-B IV (12 decks)

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