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60 Cards in this Set

  • Front
  • Back
What are brain neoplasms?
Space Occupying lesions within the skull and spinal canal
Are brain tumor more prevelant in adults or children?
Children (20%)

Adults only 2%
The age distribution of brain tumors has what shape?
Bimodal

First peak in kids <5
Second, larger peak in adults 45-70
What tumors occur more frequently in males?
Gliomas and embryonal tumors
What tumors occur more frequently in females?
Meningiomas
What is the etiology of most brain tumors?
Sporadic and of unknown etiology
What is the sole environmental factor clearly associated with increased risk of brain tumors?
X-irradiation
What are the 4 main signs/symptoms of brain tumors?
1. Focal Epilepsy (seizures)

2. Mental Changes

3. Neurological deficit

4. Obstructive hydrocephalus
What are the 4 signs/symptoms of raised intercranial pressure?
1. Headache (particularly due to POSITION at night or early morning)

2. Projectile Vomiting

3. Papilledema

4. Clouding of consciousness and coma
What can often occur as a result of increased ICP?
herniation
What are 4 herniations that can result from increased ICP?
1. Subfalcine

2. Transtentorial (Uncal)

3. Tonsillar

4. Bilateral (central) transtentorial
What type of herniation can lead to cardio-respiratory arrest?
Tonsillar Hernation

(due to compression of vascular supply)
Subfalcine hernation can result in infarction of what vessel?
ACA
Transtentorial (uncal) herniation can result in infarction of what vessel?
PCA
What are duret hemorrhages?

What causes them?
Brainstem hemorrhages caused by transtentorial (uncal) herniation
What are the 2 main consequences of herniation?
1. Blood vessel compression

2. Nerve compression
What 3 cerebral structures (ie nerves) are most likely compressed by a herniation?
1. Abducens (CN VI)

2. Occulomotor (CN III)

3. Cerebral Peduncle
The majority of pediatric neoplasms are what type of tumors?
Tumors of neuroepithelial origin
What cells give rise to most primary CNS neoplasms?
Glial Cells

Give GLIOMAS
What are the 2 main categories of astrocytic tumors?
1. Infiltrating Astrocytomas

2. Non-Infiltrating
What are the 3 types of Infiltrating Astrocytomas?
1. Diffuse Astrocytoma (Grade II)

2. Anaplastic Astrocytoma (Grade III)

3. Glioblastoma (Grade IV)
What are the 3 types of non-infiltrating astrocytomas?
1. Pilocytic astrocytoma

2. Pleomorphic xanthoastrocytoma (PXA)

3. Subependymal giant cells astrocytoma (SEGA)
What is seen on CT/whole brain in a diffuse astrocytoma?
- Diffusely invading tumor

- Causes distortion/expansion of normal structures

- Midline shift
What is seen histologically in a Diffuse Astrocytoma (II)?
Pink meshwork of fibrillary processes

Condensed around irregularly scatter, hyperchromatic nuclei
What is NOT seen in a Diffuse Astrocytoma?
1. Mitosis

2. Necrosis

3. Vascular Changes
What does a gemistocytic astrocytoma look like histologically?
Largely plump cells with glassy pink cytoplasm
What is seen histologically in Anaplastic Astrocytoma (III)?
Foci or increased cell density and pleomorphism

Mitotic figures present
What does a glioblastoma tumor (IV) have that lesser grades do not?
Necrotic and hemorrhagic masses
What is seen histologically in a glioblastoma?
- Very diverse appearance

- High cellularity

- Multiple foci of necrosis
In addition to diverse cytologic features, what else characterizes a glioblastoma (IV)?
Neovascularization (microvascular proliferation)
What is the term for the areas of necrosis observed in Glioblastomas (IV)?
Pseudopalisading necrosis
What important astrocytomas occurs mainly in children and young adults?
Pilocytic Astrocytoma (recall: non-infiltrative tumor type)
Where in the brain in a pilocytic astrocytoma usually found in children?
Cerebellum
Does a pilocytic astrocytoma infiltrate surrounding tissues?
No
What is the prognosis of pilocytic astrocytomas?
Good
What do pilocytic astrocytomas usually look like histologically?
Biphasic architecture with compact and cystic/spongy pattern
What tumor type have smell centrally located nuclei with halo (fried egg) appearance around them

Also has branching vessels resembling "chicken wire"
Oligodendroglioma
What is the most common genetic alteration in oligodendrogliomas?
Loss of heterozygozity for chromosomes 1p and 19q
Does the loss of heterozygozity for chromosomes 1p and 19q in oligodendroglioma give a good or bad prognosis?
GOOD
What tumor type produces "pseudorosettes" of neoplastic cells clustered around blood vessels?
Ependymoma
What is the most important embryonal tumor?
Medulloblastoma
What is seen histolologically in a medulloblastoma?
"Round Blue Cell Tumor"

Densely packed cells with round nuclei

Mitoses are frequent
What histologic feature is seen in about 40% of medulloblastomas?
Homer Wright (neuroblastic) rosettes

BUT are NOT centered around a vessel
How can neuroepithelial differentiation be detected in a medulloblastoma?
Antibody to neurofilament proteins
What is a tumor of the meninges called?
Meningioma
What is seen histologically in a menigioma?
Whorls and Cords of neoplastic cells
Menigiomas are typically what grade?
I
Menigiomas may arise from what?
Neurofibramatoma type I/II
What is the tumor most frequently associated with radiation exposure?
Meningioma
What is usually seen in terms of number of metastatic tumors?
Multiple CNS tumors
What are the 4 most common primary sites of metastatic brain tumors?
1. Lung

2. Breast

3. Kidney

4. Colon
What is the main tumor of cranial and paraspinal nerves?
Schwannoma
What is the most common nerve associated with a schwannoma?
Vestibulocochlear (CN VIII)

and also CN V
Are most schwannomas benign or malignant?
Benign
What 2 patterns are seen in schwannomas histologically?
1. Antoni A pattern - compact areas with spindle shaped cells arranged in fasicles

2. Antoni B pattern - areas of loosely arranged meshwork of cells in a myxoid background
Apart from a schwannoma, what is the other tumor of cranial/paraspinal nerves?
Neurofibroma
What are the 2 types of neurofibroma?
1. Dermal

2. Intraneural (peripheral nerves)
The presence of multiple neurofibromas is usually seen in the context of what?
NF1
What is seen histologically in a neurofibroma?
HYPOCELLULAR with haphazardly arranged cells
How is neurofibroma different from a schwannoma?
Arises diffusely from endoneural fibroblastsa and eventually infiltrates entire nerve rather than just displacing it