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Path II > Tumors of CNS > Flashcards

Tumors of CNS Flashcards

1
Q

What is the most common type of brain tumor in adults?

A

Mets same frequency as Primary (relatively uncommon)
Above Tentorium (cerebrum_
Mets go to Infratentorium

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2
Q

What is the most common type of brain tumor in adults?

A

Mets

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3
Q

What is the most common type of brain tumor in children?

A

Primary brain tumor (below tentorium=cerebellum/brain stem)

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4
Q

What is the most common type of brain tumor in children?

A

Primary brain tumor (below tentorium=cerebellum/brain stem)

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5
Q

What type of tumor do adults get more commonly?

A

Fibrillary astrocytoma and Glioblastoma

Higher grade

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6
Q

What type of tumors do children get more commonly?

A 
Pilocytic astrocytoma (low grade)
Medulloblastoma (embryonal)
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7
Q

What type of spinal cord tumor do adults get more?

A

Meningioma/schwannoma

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8
Q

What type of spinal cord tumor do children get more common?

A

Astrocytoma/ependyoma (adult ones are rare)

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9
Q

What makes CNS neoplasma special about histology benign apearance?

A

Although look benign mass effect can cause major problems makes them malignant fasion

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10
Q

Do primary CNS neoplasms metastasize?

A

Rarely

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11
Q

What are the most common types of neoplasms to metastasize to CNS?

A

Lung, Breast, Colon

Choriocarcinoma/melanoma are rare but very frequently go to CNS

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12
Q

What are tumors of glial origin?

A

Astrocytoma
Oligos
Ependymal

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13
Q

Where are astrocytomas found?

A

Supporting cells of brain, maintain neurons, immuno surveilance, neurotransmitter clearance, neuropil repair

GFAP positive (glial fibrillary acidic protein)

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14
Q

Where are oligodendrocytes found?

A

Myelinating cells of CNS

GFAP positive

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15
Q

Where are ependymal cells found?

A

Ventricular system of CNS
Ventricles, foramens
GFAP positive

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16
Q

What is the most common glial tumor?

A

Astrocytomas
Next is oligo
Next is epedyoma

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17
Q

What is astrocytoma WHO I?

A

Pilocystic astrocytoma
FOUND IN CHILDREN
INFRATENTORIAL

Imaging: Cystic Cerebellum mass with ENHANCING MURAL NODULE
- Outside cerebellum rare and are not cystic

Pathology: Densely fibrillated tumor

  • Areas of microcytic/fibrillar: Biphasic
  • ROSENTHAL FIBERS (eosinophilc granular bodies)
  • Does not progress to increased grade

Treatment: Complete resection

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18
Q

What is Astrocytoma WHOII?

A

FIbrillary Astrocytoma

  • Occurs in Cerebral Hemispheres (adults)
  • Occurs in Pons (children

Imaging: Infiltrative

  • DO not have ENHANCING
  • CAN PROGRESS to WHO III, IV
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19
Q

What is Astrocytoma WHOIII?

A

Anaplastic astrocytoma

Major feature is MITOSES, increased cellularity, atypia

Imaging

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20
Q

What is Astrocytoma WHOIII?

A

Anaplastic astrocytoma

Major feature is MITOSES, increased cellularity, atypia

Imaging: May be enhancing

21
Q

What is a glioblastoma?

A

Astrocytoma WHO IV

Imaging: RING ENHANCING MASS, craggy appearance
-The ring is blood vessels

DDX: ABSCESS, METS, MS, Lymphoma

Histology: Very cellular, pleomorphic with palisading necrosis/glomeruloid vessels (multiple layers)

Two age peaks: Young adults and Older individuals

  • Young as a result of astrocytoma progression
  • Old is de novo GBM: VERY POOR Prognosis
22
Q

What is are the mutations associated with de novo GBM?

A

EGFR amp

PTEN mutation

23
Q

What are the mutations associated with low grade astrocytoma prgoression?

A

TP53 mutation

24
Q

What are common features of GBM?

A

LOH 10q

p16INK41 deletion

25
Q

Where are oligodendrocytes found?

A

Myelinating cells of CNS

GFAP NEGATIVE

26
Q

What are the two grades of oligos?

A

WHO II, WHO III

27
Q

What is a oligodendroglioma?

A

WHO II

Imagin: May or may not enhance

Path:
ROUND CELLS with pale cytoplasm: FRIED EGG
-Thin walled microvas in background
- Have microcalcs

28
Q

What is anaplastic oligodendroglioma?

A

WHO III

Imaging : same as WHO II

Path: More pleomorphism but have FRIED EGG
- More MITS, and NECROSIS

29
Q

What is the cytogenic assessment of oligodendros?

A

1p and 19q deletions

  • Important response to therapy
  • Have a good survivalability with PVU (procarbazine, vincristine, CCNU)
30
Q

What are ependyomas?

A

GFAP positive

Only WHO II, WHO III

31
Q

What are ependyomas?

A

WHO II

Imaging may or may not enhance

Path: Perivascular
Fibrillar nuclear free zone, surrounding aggregates of uniform nuclei
-PERIVASCULAR PSEUDOROSETTES

32
Q

What is a anaplastic ependyoma?

A

WHO III

Same as WHO II but has more pleomorphism and MITS

OCCUR in SPINAL CORD MORE COMMONLY IN ADULTS

33
Q

What are tumors of the DURA and ARACHNOID?

A

Meningioma
Arise from arachnoid are are attached to teh dura

RARE IN CHILDREN
HERALD NEUROFIBROMATOSIS

KIDS: 4th ventricle
ADULTS: lateral vents

More common in women (progresterone positive)

Can be small but lethal due to location (foramen magnum is lethal

IMAGING: Enhance uniformly and brightly, DURAL TAIL

Boat shaped, oval nuclei with eos cytoplasma

Meningothelial whorls
Psammoma bodies

34
Q

What is WHOI meningioma?

A

Few mits, well circumscribed, DO NOT INFILTRATE

35
Q

What is WHO II meningioma?

A 
4-20 mts/HPF,
brain INVASION
Increased ugliness
- Increased cellularity
- Small cell
- Macronucleoli
-Sheeting
-SPontaneous
36
Q

Who is WHO III meningionma?

A

ANAPLASTIC

>20mits/HPF,

37
Q

Who is WHO III meningionma?

A

ANAPLASTIC
>20mits/HPF
Papillary/rhabdoid morphology

Might have MONOSOMY 9p21

38
Q

What are embryonal tumors?

A

CHILDREN/ YOUNG ADULT
Small round blue cell tumor (sheets of small cells with hyperchromatic nuclei)

SEED CSF

NEUROBLASTOMa Rare
Medulloblastoma: External granular layer of Cerebellar cortex, VERMIS

39
Q

What is a medulloblastoma?

A

MOST COMMON Embryomal tumor

  • Forms from granular layer of cerebellum cortex
  • Should disappear, usually in VERMIS

Morph variants:

  • Classical
  • Nodular/desmoplastic
  • Medullo with extensive nodularity
  • Anaplastic/large cell variant (older children aggressive)

Treatment: Complete resection

Cytogenetics: 17p loss
- PTCH, SMOH, SONIC HH
-WNT
- Gain 1q, 2p, 4p, 7, 19
Loss: 10,11
  • nmyc: Cellular anaplasia
  • LOH 9q (gorlins)
  • APC gene: DNA methylation
40
Q

Cerebral Neuroblastoma?

A 
RARE but BAD
Loss of 3p
Loss of Chr 10
P53 mutation rare
Poor prognosis overall
41
Q

What are chorid plexus tumors?

A

PAPILLOM>CARCINOMA

  • KIDS lateral Vent
  • Adults: 4th vent

Occasionally causes hydrocephalus due to CSF production

42
Q

What is a suprasellar mass that presents with visual, endocrine, hypothalamic syndromes?

A

Craniopharyngioma

From remnants of Rathekye’s pouch (hypopharynx

Wet keratin epithelium (adamantinomatus/squamous)

Calficied to help make diagnosis

Can be removed unless involves optic chiasm, parenchyma of hypothalaus, floor of 3rd ventricle

43
Q

What is a suprasellar mass that presents with visual, endocrine, hypothalamic syndromes?

A

Craniopharyngioma

From remnants of Rathekye’s pouch (hypopharynx

Wet keratin epithelium (adamantinomatus/squamous)

Calficied to help make diagnosis

Can be removed unless involves optic chiasm, parenchyma of hypothalaus, floor of 3rd ventricle

44
Q

What are the most common tumors in adults?

A

Glioblastoma/fibrillary astrocytoma

45
Q

What is the most common tumor in children?

A

Pilocystic astrocytoma/medulloblastoma

46
Q

What are signs of supratentorial mass?

A

HA, Seizures, Increased ICP

47
Q

What are some infratentorial signs?

A

Raised ICP, Cranial Nerve defects, Cerebellar signs

48
Q

What are some spinal cord signs?

A

Pain
MOtor deficit/Sensory deficit
Bladder/bowel problems

Path II (11 decks)

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