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23 Cards in this Set
- Front
- Back
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Clinical Presentation
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Increased ICP: mass effect, hydrocephalus
Focal Sx based on location Seizures Hemorrhage |
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Frontal Mass Lesions
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Behavioral change
Poor decision making Decreased work performance Motor weakness (if posterior) |
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Parietal Mass Lesions
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Contralateral motor weakenss (if anterior)
Contralateral sensory weakness Dominant Lobe Sx: agraphia w/o alexia, R/L disorientation, acalculia, finger agnosia, receptive language errors |
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Temporal Lobe Lesions
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Language - aphasia
Memory/Visual impairment Seizures common |
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Cerebellar Lesions
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Hydrocephalus
Ataxia of gait Dysmetria of arms Speech changes (fluency, pitch) |
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Brain Mets
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Most often from lung ca.
Breast ca. is 2nd most common source. Renal ca. also has high risk of brain met. |
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Primary CNS Tumor Incidence
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2% of all neoplasias.
20% of tumors in children |
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Histological Grading
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Correlates with prognosis and determines therapy.
I: low prolif potential, cure with surgery alone II: infiltrative, often recur, progress to higher grade III: malignant, pts receive adjuvant rad/chemo IV: malignant cells, mitotic figures, necrosis, rapid post-op evolution, often fatal |
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Meningiomas
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Slow growing, derived from arachnoid, attached to dura, W>M.
Associations: radiation, hormonal neoplasms, NF2 Histo: syncytial growth, whorls, intranuclear inclusions, psammoma bodies Grade: often I Tx: Surgical resection |
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Pilocytic Astrocytoma
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Mainly in kids. Associated with NF1. Cyst with mural nodule. Cerebellum.
Grade: I Histo: hair-like processes, Rosenthal fibers, biphasic and micro cystic changes |
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Circumscribed Astrocytic Tumors
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Pilocytic astrocytoma (I)
Subependymal Giant Cell Astrocytoma (I) Pleiomorphic Xanthoastrocytoma (II) |
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Infiltrative Astrocytic Tumors
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Types: Diffuse astrocytoma (II), anaplastic astrocytoma (III), glioblastoma (IV)
Histo: micro cysts, perineuronal/perivascular satellitosis, subpial aggregates, WM tract infiltration |
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Diffuse Astrocytoma
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Epidemiology: mean age of Dx = 34 yo
Histo: mild cellularity increase |
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Anaplastic astrocytoma
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Epidemiology: mean age of Dx = 45 yo
Histo: hypercellularity, nuclear atypia, significant mitotic/prolif activity |
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Glioblastoma
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Epidemiology: most frequent brain tumor in adults, mean age of Dx = 61 yo.
Histo: same as anaplastic astrocytoma + microvascular prolif, palisading necrosis. Poor prognosis. |
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Molecular pathology of infiltrating astrocytomas
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Primary glioblastoma (95%): EGFR mutation
Secondary glioblastoma (5%): IDH1, TP53 mutations in lower grade astrocytomas that progress over course of years |
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Oligodendroglioma
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Occur frequent in pts 30-50 yo.
Better prognosis than astrocytomas "Fried egg" histo: infiltrative, round nuclei, perinuclear halos, fine branching blood vessels, micro calcifications Molecular path: 1p19q |
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Ependymoma
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Myxopapillary Ependymoma = cauda equina neoplasm of adults (20-40 yo)
Classic Ependymoma = Intracranial neoplasm of childhood, well circumscribed Histo: Pseudorosettes, ependymal rosettes and canals |
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Medulloblastoma
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Primarily children. Disseminates in CSF. Presents as increased ICP. Rapidly fatal if untreated, grade IV.
Histo: small round blue undiff cells with high N:C, high mitotic index, apoptosis, Homer Wright rosettes. |
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Schwannoma
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Tumors of CNS and PNs.
Histo: Verocay bodies, Antoni A and B areas, basal membrane deposition. Surgeon can peel tumor off neurons. |
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Neurofibroma
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Hypocellular lesion with prolif of Schwann cells, perineural cells, fibroblasts, blood vessels, mast cells.
Can invade neuron axon. Plexiform NF looks like bag of worms. |
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Malignant Peripheral Nerve Sheath Tumor
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Arises from plexiform NF. High grade. Adults 3-6th decade.
Histo: sarcoma-looking (hypercellular), geographic necrosis, high mitotic activity. |
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Primary CNS Lymphoma
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Occurs sporadically and in immunocompromised pts
Histo: angiocentric growth, high N:C, dyshesive cells, monoclonal prolif of lymphoid cells (B-cells), few T-cells. |
