Pathology - S2B4 - Neuro 3

Front 1

This accounts for 80% of all Adult Primary brain tumors

Back 1

Diffuse Fibrillary Astrocytomas
-includes Glioblastoma Multiforme

Front 2

When do most Diffuse Fibrillary Astrocytomas occur? What are the clinical manifestations?

Back 2

40-60 years of age

Seizures, Headache, Focal signs

Front 3

What defines the prognosis of Astrocytomas?

Back 3

Microscopic appearance varies as to Grade:
Atypia = II
Mitoses = III
Endothelial proliferation &/or Necrosis = IV

Front 4

Grade II Astrocytoma = low grade
-least frequent type

Back 4

What is seen here?

Front 5

Anaplastic Astrocytoma = Grade III = Mitoses

Back 5

What is seen here?

Front 6

Glioblastoma Multiforme
-Central areas of necrosis & hemorrhage surrounded by multiple tumor cells
-arranged in Pseudopalisading fashion

Back 6

What is seen here?

Front 7

Glioblastoma Multiforme
-varible, noncircumscribed lesion found in cerebral hemisphere

Back 7

What is seen here?

Front 8

Glioblastoma Multiforme
-ring with central area of necrosis

Back 8

What is seen here?

Front 9

What are the molecular genetic characteristics of Low Grade Astrocytomas?

Back 9

1. inactivation of p53
2. overexpression of PDGF-A

Front 10

What are the molecular genetic characteristics of High Grade Astrocytomas?

Back 10

1. RB gene
2. P16/CDKNZA gene
3. 19q

Front 11

What are Secondary Glioblastoma Multiforme's?

Back 11

develop from Diffuse Astrocytomas

usually occur in younger patients

associated with p53 mutation

Front 12

What are Primary Glioblastoma Multiforme's?

Back 12

Begins as a highly malignant Glioblastoma Multiforme de novo

Usually occurs in older patients

associated with EGFR amplification

Front 13

What is the therapy for Glioblastoma Multiforme? What is the prognosis?

Back 13

Surgery + Radiation + Chemotherapy

8-10 month survival

Front 14

Brain tumor that microscopically has Central areas of necrosis & hemorrhage surrounded by multiple tumor cells, arranged in a Pseuddopalisading fashion

Back 14

Glioblastoma Multiforme

Front 15

This is a low-grade Astrocytoma that is benign, slow-growing & usually occurs in the Cerebellum in Children

Back 15

Pilocytic Astrocytoma

Front 16

What are the most common sites of Pilocytic Astrocytoma?

Back 16

1. Cerebellum
2. near Optic nerve
3. Wall of 3rd ventricle

Front 17

Brain tumor that contains Rosenthal Fibers

Back 17

Pilocytic Astrocytoma

Front 18

Pilocytic Astrocytoma
-cyst with mural nodule

Good prognosis

Back 18

What brain tumor is seen here?

What is the prognosis?

Front 19

Pilocytic Astrocytoma
-Cerebellum = MC site
-piloid cells
-benign tumors of children

Back 19

What is seen here?

Front 20

What is the red arrow pointing at? What brain tumor?

Back 20

Rosenthal fibers

Pilocytic Astrocytoma

Front 21

Pleomorphic Xanthoastrocytoma

Back 21

This brain tumor has large, bizarre cells with inflammation

Front 22

What are the properties of Pleomorphic Xanthoastrocytoma's?

Back 22

1. Superficial
2. Temporal lobe
3. Seizure history
4. large, bizarre cells
5. inflammation
6. Good prognosis

Front 23

Brain tumor that has motononous fried-egg appearing cells that often contains calcifications

Back 23

Oligodendrogliomas

Front 24

What % of Gliomas do Oligodendrogliomas represent? What age do they most often appear in?

Back 24

5-15%

4th-5th decades

Front 25

OLIGODENDROGLIOMAS:
1. Symptoms
2. Treatment
3. Prognosis

Back 25

1. Seizures, headaches, long history of neurological symptoms
2. Surgery + radiotherapy + CHEMOTHERAPY
3. 5-10 years after diagnosis

Front 26

Oligodendroma
-calcification

Back 26

What is seen here?

Front 27

Where do Oligodendrogliomas most often occur?

Back 27

Frontal Lobe

Front 28

Oligodendroglioma = Frontal Lobe

Back 28

Based on location, what brain tumor is this?

Front 29

Oligodendroglioma
-sheets of uniform cells with "fried egg" appearance
-round nuclei with clear cytoplasm

Back 29

What brain tumor is this?

Front 30

Oligodendroglioma
-loss of arms 1p & 19q

Response to Chemotherapy

Back 30

What brain tumor? What does this finding signify?

Front 31

Tumor arising from the Ependyma of the Ventricular System

Back 31

Ependymoma

Front 32

What age do Ependymomas most commonly occur in? What part of the brain do they most commonly occur in?

Back 32

Children

4th Ventricle

Front 33

When Ependymomas occur in Adults, where do they often present?

Back 33

Spinal Cord

Front 34

What is the prognosis of Ependymomas?

Back 34

Poor = 4 years after surgery

Front 35

Brain tumor with Perivascular acellular regions with pseudorosettes; Rod-shaped blepharoplasts (basal ciliary bodies) found near the nucleus

Back 35

Ependymoma

Front 36

Ependymoma
-lesion has filled the 4th Ventricle
-occurs in children

Back 36

What brain tumor is this?

Front 37

Ependymoma
-uniform cells with round nuclei set in a fibrillary stroma & arranged in a Perivascular Pseudorosette formation

Back 37

What brain tumor is this?

Front 38

An 8-year-old girl presents to your clinic complaining of severe headaches & blurry vision. During physical exam, you note bilateral papilledema. CT demonstrates a mass extending from the floor of the 4th Ventricle & dilated Lateral & Third Ventricles. You suspect that a CT-guided biopsy would demonstrate cells with Blepharoplasts in a perivascular pseudorosette arrangement

Back 38

Ependymoma

Front 39

Neuronal tumor that most commonly occurs in the Temporal Lobe

Characterized by inflammation, EGB's & Rosenthal fibers

Glial component may become anaplastic

Back 39

Ganglioglioma

Front 40

Neuronal tumor that is Ventricle associated

Back 40

Central Neurocytoma

Front 41

Neuronal tumor that usually produces a long seizure history. Is Quasi-hamartomatous & has a good prognosis

Back 41

DNT = Dysembryoplastic Neuroepithelial Tumor

Front 42

Central Neurocytoma = associated with Ventricles

Back 42

What neuronal tumor is this?

Front 43

Highly malignant Cerebellar tumor of Children associated with a deletion of short arm of chr. 17 (17p-)

Back 43

Medulloblastoma

Front 44

Radiosensitive highly malignant brain tumor arising most commonly in children

Back 44

Medulloblastoma

Front 45

Brain tumor that is a form of Primitive Neuroectodermal Tumor (PNET)

Back 45

Medulloblastoma

Front 46

Where do Medulloblastoma's most commonly occur in children? Adults?

Back 46

Children = Cerebellum midline

Adults = Cerebellar hemispheres

Front 47

What is the 5-year survival rate for Medulloblastoma?

Back 47

75% with total excision & radiation

Front 48

Medulloblastoma = midline Cerebellum

Back 48

What brain tumor is this?

Front 49

What brain tumor is this?

Back 49

Medulloblastoma
-hypercellular sheets of anaplastic cells
-cells arranged in a rosette or perivascular pseudorosette formation

Front 50

This is the #1 brain tumor in AIDS

Back 50

Lymphoma

Front 51

Brain tumor that has both Neuronal & Glial differentiation. Can cause hydrocephalus & seed the CSF

Back 51

Medulloblastoma

Front 52

Medulloblastoma

Back 52

Brain tumor that may be referred to as "small blue cell tumor"

Front 53

What type of cells are primarily found in AIDS Lymphoma's? What is associated with AIDS Lymphoma?

Back 53

B-cells

EBV

Front 54

What do you want to avoid giving patients at all costs who you suspect of having AIDS Lymphoma?

Back 54

Steroids - b/c can "melt" away the tumor & all you see are T cells = fucks up the diagnosis on biopsy

Front 55

AIDS Lymphoma

Back 55

What is this?

Front 56

List the properties of Germ Cell tumors of the brain

Back 56

1. Usually Midline in the Pineal Gland (MC) or Suprasellar areas
2. most commonly in Young Men in Pineal Gland
3. Germinoma = Seminoma
4. Radiation & Chemosensitive

Front 57

Suprasellar Germinoma

Back 57

What is seen here?

Front 58

Brain tumor that arises from Arachnoid cells external to the brain

Back 58

Meningioma

Front 59

The 2nd most common Primary intracranial neoplasm

Back 59

Meningioma

Front 60

What type of Meningioma carries a worse prognosis?

Back 60

Papillary

Front 61

What gender do Meningiomas most commonly occur in? Why?

Back 61

Women after age 30

tumors have Progesterone receptors

Front 62

In what condition do people have Multiple Meningiomas?

Back 62

Neurofibromatosis-2 = loss of NF2 gene on chr. 22

Front 63

Meningioma
-Whorled pattern of tightly packed tumor cells
-calcified Psamomma bodies

Back 63

What benign, slow-growing tumor is this?

Front 64

Whorled pattern of tightly packed tumor cells & calcified Psamomma bodies

Back 64

Meningioma

Front 65

From where do most Metastases come from in the brain?

Back 65

1. Lung
2. Breast
3. Skin
4. Kidney
5. GI tract

Front 66

Meningioma

Back 66

What brain tumor is this?

Front 67

What is the most common brain malignancy?

Back 67

Metastases

Front 68

Melanoma

Back 68

What metastatic tumor is this?

Front 69

These brain tumors are sharply demarcated & occur at the Gray-White jxn

Back 69

Metastases

Front 70

What is Meningeal Carcinomatosis? What metastatic tumors tend to do this?

Back 70

condition in which a solid tumor diffusely spreads to the leptomeninges

Small cell
Adenocarcinomas of the breast
Lung