Primary Brain Tumors

Question 1

Glioblastoma Multiforme

Answer 1

Adults

Grade IV astrocytoma

Common and highly malignant

Glial cell origin - GFAP +

Pseudopallisading cells around central necrosis and hemorrhage

In cerebral hemispheres - can cross corpus callosum (butterfly glioma)

Question 2

Oligodendroglioma

Answer 2

Adults

Rare, slow growing

Made from oligodendrocytes - fried egg cells w/ clear cytoplasm +/- calcification and chicken wire capillary pattern

Often frontal lobes

Question 3

Meningioma

Answer 3

Adults

Common

Often on outer borders (esp parasagittal)

Asymptomatic or sz / focal neural signs

Arachnoid cell origin - spindle cells w/ whorled pattern and psammoma bodies

Question 4

Hemangioblastoma

Answer 4

Adults

Usually cerebellar

Associated w/ vHL

Blood vessel origin - can inc EPO and look like thin walled capillaries w/ minimal parenchyma between them

Question 5

Schwannoma

Answer 5

Adults

Classically at cerebellopontine angle OR along peripheral nerves (esp CN VIII - “vestibular schwannoma”)

Bilateral vestibular schwannomas in NF-2

Schwann cell origin - S100+

Question 6

Pilocytic Astrocytoma

Answer 6

Kids

Well circumscribed in posterior fossa (cerebellum or supratentorial)

Benign

Glial cell origin - GFAP +

Rosenthal fibers (eosinophilic corkscrew fibers)

Grossly cystic and solid

Question 7

Medullablastoma

Answer 7

Kids

COMMON

Often in cerebellum and can compress 4th ventricle –> hydrocephalus

Can send “drop mets” to SC

Primitive neuroectodermal tumor (PNET) and Homer-Wright rosettes of small blue cells

Question 8

Ependymoma

Answer 8

Kids

Most commonly in 4th ventricle –> hydrocephalus

Poor prognosis

Ependymal cell origin

Perivascular rosettes and rod-shaped blepharoplasts (basal ciliary bodies) found near nucleus

Question 9

Craniopharyngioma

Answer 9

Kids

Most common supratentorial in kids

May be confused w/ pituitary tumor b/c also causes bitemporal hemianopia

From Rathke pouch remnants

Cholesterol crystals in motor oil like fluid in tumor and calcification is common

Question 10

Pinealoma

Answer 10

Kids

Can cause Parinaud syndrome (vertical gaze palsy) and obstructive hydrocephalus from compressing cerebral aqueduct and precocious puberty if make beta hCG

Similar to testicular seminoma in appearance