Usera: CNS Neoplasms Flashcards
Ciliated cells that line the ventricular system and the spinal cord
ependymal cells
Schwann cells of the CNS
oligodendrocytes
stellate cells that are very important in supporting neurons
astrocytes
macrophages of CNS
microglia
Most common CNS tumors (70-80% of all CNS tumors)
astrocytomas
What area of the brain do astrocytomas usually occur in?
cerebral hemispheres
**can occur anywhere
Astrocytomas range in grade from (blank) to (blank)
1; 4
List the astrocytomas from Grade 1 through Grade 4
Pilocytic astrocytoma
Diffusely infiltrating astrocytoma
Anaplastic astrocytoma
Glioblastoma multiforme
Who grade I (i/iv)
Often cystic and Well circumscribed
Unique histologic appearance, benign behavior
Typically in children and young adults
Usually in the cerebellum, but can occur elsewhere
No p53 mutation
Pilocytic astrocytoma
Who typically gets pilocytic astrocytomas?
children and young adults
Where do pilocytic astrocytomas occur?
in the cerebellum
**can occur elsewhere
What are 2 histological features you would notice if looking at a pilocytic astrocytoma?
dense, “hair-like” fibrillary meshworks
Rosenthal fibers (large red fibers)
little to no nuclear atypia
Who grade II (ii/iv)
Poorly defined, infiltrating tumor. Expands and distorts normal brain architecture
Surgical implications?
Increased cellularity with Mild to moderate nuclear atypia
No mitotic figures
Variable prognosis, but usually indolent lesion
p53 mutation common
Diffusely infiltrating astrocytoma
Histological features of diffusely infiltrating astrocytoma?
increased cellularity with mild/moderate nuclear atypia;
no mitotic figures
Who grade iii (iii/iv)
Similar to grade ii, but with increased, cellularity nuclear atypia and mitotic figures
Median survival 3 years
p53 mutation common
Anaplastic astrocytoma
How is a diffusely infiltrating astrocytoma (grade II) different from an anaplastic astrocytoma (grade III)?
anaplastic astrocytomas have
- increased cellularity
- increased nuclear atypia
- mitotic figures
Who grade iv (iv/iv) Most common CNS neoplasm Highly aggressive, ~6-15 month survival Marked nuclear pleomorphism and atypia p53 mutation common
Glioblastoma multiforme
What four histological features are indicative of glioblastoma multiforme?
Atypia
Mitotic figures
Endothelial proliferation
Necrosis
Glioblastoma multiforme will often cross the (blank) of the brain and may be called a (blank) lesion
midline; butterfly
*Who grade ii (ii/iv)
5-15% of gliomas
More common 4th-5th decades
Cerebral hemispheres:
Infiltrating, Cystic, hemorrhagic, frequent calcifications
*Low proliferative rate
Genetics: loss of 1p, 19q associated with good response to chemo/radiation
Oligodendroglioma
What Who grade do oligodendrogliomas get?
Who grade II
What is one feature you might see in the cerebral hemispheres with a patient with an oligodendroglioma?
calcifications
What do oligodendrogliomas look like histologically?
fried-egg nuclei and chicken-wire vasculature
What chromosome deletion is a positive predictor of response to chemo/radiation in patients with oligodendroglioma?
1p, 19q
Benign tumor of adults (female predominance 3:2)
Frequently PR+
Arise from meningothelial cells of the arachnoid
Associated with loss of chromosome 22
Many histologic subtypes that vary in biologic behavior
meningiomas
Meningiomas are frequently positive for what receptor?
progesterone receptor
What chromosome deletion is often associated with meningiomas?
chromosome 22
Are meningiomas benign or malignant?
benign, but can become malignant
2 distinct histological features of a meningioma?
whorled pattern of growth psammoma bodies (starry night calcifications)
Arise from ependymal cells lining ventricular system
Children and adults
Associated with nf2
0-20 yrs: paraventricular (4th ventricle most common)
Spinal cord most common site in adults
Ependymoma
Ependymomas arise from (blank) cells which line the ventricular system
ependymal
Ependymomas are associated with (blank)
neurofibromatosis type II
Where do people ages 0-20 most frequently get ependymomas?
4th ventricle
Where do adults most commonly get ependymomas?
spinal cord
Histologic features of ependymomas?
rosettes (empty lumen surrounded by ciliated cells) and pseudorosettes (tumor cells extend toward a blood vessel in the center of the lumen)
Cerebellar tumor in children
Derived from external granular cell layer
Associated with 17p- and myc amplification
aggressive, poor prognosis
radiosensitive
“small round blue cell tumor” with both neuronal and glial phenotypes
Homer-wright rosettes (neuronal)
Gfap+ (glial)
medulloblastoma
Where do medulloblastomas occur? Who gets them?
cerebellum; children
Medulloblastomas are associated with amplification of (blank) and (blank)
17p and MYC
Medulloblastomas have both neuronal and glial features. What is one neuronal feature? What is one glial feature?
homer-wright rosettes
GFAP+
Children most often get brain tumors (blank)
infratentorially (under the tentorium)
Ebv-related high-grade b-cell lymphoma (NHL) associated with immunosuppression
AIDS, post-transplant
2% extranodal lymphomas, 1% intracranial tumors
Frequently multifocal
Bcl-6+
Primary CNS lymphoma
Primary CNS lymphomas are associated with (blank) and are (blank) positive
EBV; BCL-6
Most common CNS malignancy; 25-50% of all intracranial malignancy
metastases
Which carcinomas are most likely to metastasize to the CNS?
lung
breast
melanoma
