Tumors Dr. Martin Flashcards
Most tumors in kids arise where
Posterior fossa : brainstem, cerebellum 4th ventricle, top of cord
Most common tumors are found where in adults
Cerebral hemispheres : above tentorium, or into temporal lobes
Most common adult tumor
Glioblastoma
Most common adult tumor
Embryonal = medulloblastoma , Pilocytic Astrocytoma
New onset headache or seizure what should you thing
Tumor
GRADE 1 2 3 4
1 : resect (Pilocytic astrocytoma)
2 : infiltration (recur), usually (diffuse astrocytoma or oligodendroglioma)
3 : radiation, chemo a, anaplastic astrocytoma
4 : Glioblastoma , usually fatal after 2years + NECROSIS, VEGF vascular proliferation
Glioblastoma usually comes from
Radiation therapy
Lower grades are for and higher grades are for
The lower the younger pts and the higher the older the pt
Infiltrating astrocytoma GRADE 2
- What type and location
- SX
- Stains
- Prognosis
- Cerebrum, primary astrocytoma
- Headache or seziures that’s new onset
- IDH1 R132H AND IDH1 + IDH2 if needed AND GFAP+ stain in astrocytes
- IDH Mutant has higher then IDH wild , usually over 5ys and then become higher grade
Diffuse Astrocytoma looks how
Glassy and side effect is bulging towards septum pellucidum
= loose suicide at location + loose grey/white junction
Astrocyte vs Oligodendrocyte shape
Astrocyte = oval Oligodendrocyte = round
Pilocytoma Astrocytoma GRADE 1
- Who and location
- Gene and predisposed by what
- Looks like
- 1st 2 decades in life cerebellum + 3rd ventricle
- IAA1549-BRAF gene, NF1 loss in neurofibromas predisposes
- Looks like : well -circumscribed, CYSTIC + MURAL NODULE(ball) =resect
Pilocytic astrocytoma
HISTOLOGY : cells seen and other characteristics
- Hair like cells with long bipolar processes
- Rosenthal Fibers (has time to form in this since its very slow)
- Eosinophilic granular bodies EGB
- Can extend into subarachnoid space only not aggressive and only can effect optic N
GFAP+ stain means what
ASTROCYTOMA any type
Glioblastoma GRADE 4 1. Gene mutation and causes what to be unregulated 2. Looks like what 3. Primary 4 secondary
- CDKN2A deletion = activated EGFR or PDGFR, + resist apoptosis TP53
- Contrast ring enhancing lesion + central necrosis
- Older pt, no precursor lesion
- Younger pt, from low grade lesion TP53, IDH1 R132H mutation has better prognosis then IDH-wild
Glioblastoma IDH-wild mutations
TERT + EGFR
Glioblastoma 3 HISTOLOGICALLY Thigns SEEN = HALLMARK
- necrosis = serpentine looks like a line irregular form
- Pseudo-palisading : cells around necrosis lining vertically
- Vascular proliferation (looks like a glomerulus) = Due TO VEGF
Glioblastoma survival
25% alive after 2 years if wild
2-3years if mutant
When do you see ring enhancing lesion
- Glioblastoma
2. Abscess
Oligodendroglioma
- Who and location
- Sx
- Looks like
- 4th-5th decade, cerebral hemispheres PRIMARY in the WHITE MATTER
- Neuro problems like seizures for example for years
- Calcification in cortex along gyri
Oligodendroglioma histology
- Perineuronal satellitosis, (hug neurons)
- Perivascular aggregation (hug BVs)
- Perinuclear halos = FRIED EGGS
- delicate anastomosing capillaries = CHICKEN WIRE (BVs all over like honeycomb like wire fence)
Oligodendroglioma GRADE 2
- Gene
- Mutation
- Grade 3 is called what and histology
- Prognosis
- IDH1 and IDH2 mutation,
- 1p19q loss
- Anaplastic Oligodendroglioma: necrosis, vascularization
- 15-20yrs grade 2, 10-15yrs grade 3
Ependymoma GRADE 2 (can be grade 3)
- Who and location
- Gene
- Mutation
- 1st decade children (4th ventricle) + Adults (Spinal cord)
Ependymoma Histology
- Rosettes ** (TRUE ROSETTES + can see perivascular rosettes)
= FLEXNER ROSSETTS are true
Ependymoma prognosis
Depends on how much is respected and how much is left behind