Ellen - Path 2: Cns 3 Tumors

Front 1

What's a tumor involving neurons and neuroglial cells?

Back 1

Ganglioneuroma

Front 2

Name the 4 Primitive neuroepithelial neoplasms

Back 2

Medulloblastoma
Pineoblastoma
Ependymoblastoma
Medulloepithelioma

Front 3

What's the most common type of tumor you see in the brain?

Back 3

Metastatic

Front 4

Which of the 4 CNS malformative tumors mentioned happens in the young? What are the other 3?

Back 4

Young = Colloid Cyst
Craniopharyngioma
Epidermoid cyst
Dermoid cyst

Front 5

What's biologic malignancy refer to?

Back 5

Histologically benign brain tumors may be fatal because their location precludes resection and the margins are not grossly visible

Front 6

2 major mechanisms of CNS tumor spread?

Back 6

Local extension
Intraneural seeding via meninges and ventricles

Front 7

Do CNS tumors met outside the CNS?

Back 7

Only very rarely

Front 8

What are the factors that determine the clinical effect and prognosis of a CNS tumor?

Back 8

Growth rate (fast = bad)
Location (helps determine sx)
Pt age (the older you are the worse it is)

Front 9

Location, frequency and age group affected by fibrillary/diffuse astrocytomas?

Back 9

Common (most common glioma). Typically in the cerebral hemispheres (white matter) of adults.

Front 10

Gross appearance of fibrillary/diffuse astrocytomas?

Back 10

margins poorly defined
solid
distort architecture

Front 11

What's the grading system for astrocytomas?

Back 11

I-IV based on differentiation (IV is the worst)
Astrocytoma = I or II
anaplastic astrocytoma = III
glioblastoma multiforme = IV

Front 12

Peak incidence and origin of glioblastoma multiforme?

Back 12

Peak incidence 40-60 years
May arise from dedifferentiating astrocytoma (or any glioma, really) or de novo

Front 13

Gross appearance of a glioblastoma multiforme?

Back 13

cystic/solid (well demarcated), necrotic and hemorrhagic, found in the cerebral hemispheres (likes to cross corpus callosum)

Front 14

Micro appearance of a glioblastoma multiforme?

Back 14

dedifferentiated and cellular with palisading (picket fence) necrosis and microvascular proliferation (bad sign)

Front 15

Prognosis of a glioblastoma multiforme?

Back 15

Mean length of survival after diagnosis is 15 months
Only 25% alive after two years

Front 16

Who gets pilocytic astrocytomas? Where do they appear?

Back 16

More common in children
common locations = Cerebellum (= mural nodule in a cyst), chiasm, hypothalamus

Front 17

Prognosis of pilocytic astrocytomas?

Back 17

depends on resectability, usually better than fibrillary astrocytoma

Front 18

Micro appearance of pilocytic astrocytomas?

Back 18

“hairlike” cellular processes
not very cellular

Front 19

Frequency of oligodendrogliomas? Where do they appear and who gets them?

Back 19

5-15% of gliomas
Adult
Cerebral hemispheres

Front 20

Prognosis of oligodendrogliomas?

Back 20

Average survival 5-10 years (not really correlated with histology)

Front 21

What's an oligodendroglioma that's associated with an astrocytoma called?

Back 21

oligoastrocytoma

Front 22

What feature helps improve the prognosis of an oligodendroglioma?

Back 22

1p/19q deletion tumors respond well to treatment and have a better prognosis, irrespective of histology

Front 23

Gross appearance and behavior of an oligodendroglioma?

Back 23

Calcification frequent
Many are very slow growing - Survival doesn't correlate as well with histology as astrocytomas

Front 24

Where do ependymomas appear and who gets each type?

Back 24

Brain (4th ventricle)- pt usually under 20 years
Spinal cord - adults

Front 25

Incidence of ependymomas?

Back 25

Uncommon (5-10% of gliomas)

Front 26

Morphology and behavior of ependymomas in the brain?

Back 26

Arise from ependymal lining of the 4th ventricle Solid or papillary
Dangerous due to proximity to vital brainstem nuclei and propensity to spread through CSF

Front 27

Micro appearance of ependymomas?

Back 27

rosettes (malignant epidenymal cells line around white matter/neural processes) and pseudorosettes (cells lining blood vessels)

Front 28

Morphology of ependymomas in the spinal cord?

Back 28

Myxopapillary, arising from filum terminale
May be well demarcated from normal tissue

Front 29

Prognosis of ependymomas in the spinal cord?

Back 29

depends on completeness of resection

Front 30

Signs/symptoms of ependymomas based on location?

Back 30

Fourth ventricle: hydrocephalus sxs

Cauda equina: radicular pain, sensory loss, motor weakness or paralysis, fasciculations

Front 31

Prognosis of ependymomas in the brain?

Back 31

50-70% 5 yr survival - depends on CSF dissemination and resection completeness

Front 32

Incidence of Choroid plexus papillomas? Who gets them and where?

Back 32

Uncommon
More frequent in children (typically in lateral ventricles)
Less frequent in adults (typically 4th ventricle)

Front 33

Morphology and behavior of Choroid plexus papillomas?

Back 33

Morphologically similar to normal choroid
Produce CSF—can cause hydrocephalus

Front 34

Who gets colloid cysts of the third ventricle?

Back 34

Young adults

Front 35

Clinical presentation of colloid cysts of the third ventricle?

Back 35

Clinical: headaches, coma, death
(if it obstructs the foramina of Munro)

Front 36

Gross morphology of colloid cysts of the third ventricle?

Back 36

thin walled cyst with gelatinous material

Front 37

Who gets medulloblastomas? Where do they occur?

Back 37

Pts < 20 y/o
Mostly in the cerebellar vermis

Front 38

What's the prognosis of medulloblastomas?

Back 38

Highly malignant but responds well to tx
5 year survival = 75%

Front 39

Symptoms of medulloblastomas?

Back 39

Symptoms of increased CSF pressure and cerebellar damage

Front 40

Gross morphology of medulloblastomas?

Back 40

Small cell tumor
Gross: fleshy

Front 41

Micro appearance of medulloblastomas?

Back 41

Very cellular and undifferentiated with Homer Wright rosettes (look like poorly differentiated ependyomas)

Front 42

Who gets primary CNS lymphomas? Behavior of this neoplasm?

Back 42

AIDs defining condition.
Usually B cell with angiocentric growth (grows along blood vessels). Same classifications as peripheral

Front 43

What's a meningioma? Where do they occur?

Back 43

Benign tumor of meninges arising from meningothelial cell
Common in dorsolateral convexities, olfactory region, or foramen magnum

Front 44

Incidence of meningiomas? Who gets them? Do they normally come in multiples?

Back 44

Very common - usually in adults
Inc incidence in females due to progesterone receptors
Solitary except in patients with neurofibromatosis

Front 45

Signs/sx of meningiomas?

Back 45

Generalized or local signs
(can be undetected for years depending on loction)

Front 46

Prognosis of meningiomas?

Back 46

Prognosis depends on surgical accessibility, location, microscopic appearance - Usually do well but can recur

Front 47

Morphology of meningiomas?

Back 47

Well demarcated, Firm
Attached to dura anywhere in CNS

Front 48

Where do most mets to the CNS come from?

Back 48

80% from: lung, breast, melanoma, kidney, GI

Front 49

Where do CNS mets usually go? What's a common complication?

Back 49

Can be parenchyma or meninges
Frequently multiples = can cause considerable surrounding edema