WT - Neuro Neoplasms

Question 1

adult primary brain tumors

Answer 1

glioblastoma multiforme
oligodendroglioma
meningioma
hemangioblastoma
pituitary adenoma
schwannoma

Question 2

childhood primary brain tumors

Answer 2

pilocytic astrocytoma 
medulloblastoma
ependymoma
craniopharyngioma
pinealoma

Question 3

glioblastoma multiforme

Answer 3

• most common ADULT
• highly malignant
• @ cerebral hemospheres
• can cross corpus callosum (butterfly glioma)

histo:
- astrocyte origin (GFAP)
- pseudopalisading cells bordering central necrosis/hemorage/microvasc prolif

Question 4

oligodenroglioma

Answer 4

• ADULT
• rare, slow growing
• @frontal lobes
• often calcified

histo:

• oligodendrocyte origin
• fried egg
• chicken wire capillary

Question 5

meningioma

Answer 5

• ADULT
• common, benign
• F>M
• @surfaces of brain and in parasagittal region
• dural attachment (tail)

sx:

• usu asymptomatic
• seizures or focal neuro signs

histo:

• arachnoid cell origin
• spindle cells concentrically arranged in a whorled pattern
• psammoma bodies

tx: reaction and/or radiosurgery

Question 6

hemangioblastoma

Answer 6

• ADULT
• often cerebellar
• VHL when found w/ retinal angiomas
• EPO prod –> sec polycythemia

histo:
- blood vessel origin
- thin-walled capillaries
- minimal intervening parenchyma

Question 7

pituitary adenoma

Answer 7

• ADULT
• nonfxn (mass effect –> bilateral hemianopia) or fxn (hormone prod)
• pituitary apoplexy –> hypER or hypOpituitarism

histo: hyperplasia of only one type of endocrine cells in pituitary (commonly lactotrophs, less comm somatotropin (GH))
tx: DA agonist, transsphenoidal resection

Question 8

Schwannoma

Answer 8

• ADULT
• @ cerebellopontine angle
• benign
• CN V, VII, VIII or any peripheral n.
• often VIII in internal acoustic meatus (vestibular schwannoma)
• bilateral vestibular schwannomas in NF-2

histo: Schwann cell origin (S-100), biphasic, dense, hypERcellular areas containing spindle cells, alt w/ hypOcellular. myxoid areas
tx: resection or stereotactic radiosurgery

Question 9

pilocytic astrocytoma

Answer 9

• most comm primary brain tumor in CHILD
• low-grade astrocytoma
• well-circumscribed
• @posterior fossa (cerebellum
• also may be supratentorial
• benign, good prognosis

histo:
- astrocyte origin
- GFAP +
- rosenthal fibers (eos, corkscrew fibers, cystic + solid (gross)

Question 10

medulloblastoma

Answer 10

• most comm MALIGNANT brain tumor in CHILD
• @ cerebellum

sx:

• can compress 4th ventricle –> noncommunicating hydrocephalus –> HA –> papilledema
• cerebellar vermis involvement –> truncal ATAXIA
• “drop metastases” to spinal cord

histo:

• form of primitive neuroextodermal tumor (PNET)
• homer-wright ROSETTES
• small blue cells
• synaptophysin +

Question 11

ependymoma

Answer 11

• CHILD
• @ 4th ventricle –> hydrocephalus
• POOR prognosis

histo:

• ependymal cell origin
• perivascular pseudo rosettes
• rod-shaped blepharoplasty (basal ciliary bodies) near nucleus

Question 12

craniopharyngioma

Answer 12

• CHILD
• most comm childhood SUPRATENTORIAL tumor
• may be confused w/ pituitary adenoma (both–>bitemporal hemianopia)

histo:

• derived from remnants of Rathke pouch (ectoderm)
• calcification=common
• CHL crystals in “motor oil” like fluid within tumor

Question 13

pinealoma

Answer 13

• CHILD
• tumor of pineal gland

sx:

• PARINAUD syndrome (compression of tectum –> vertical gaze palsy)
• obstructive hydrocephalus (compression of cerebral aqueduct)
• precocious puberty in males (hCG prod)

histo:
-sim to germ cell tumors (testicular seminoma)