Sem 4 Week 5 Lecture 5

Front 1

Incidence rate of Primary CNS tumours in Australia ?

Back 1

9/100,000/year

Front 2

Incidence rate for secondary tumours ?

Back 2

8/100,000/year

Front 3

Tumours of the CNS classified acc to ?

Back 3

2000 WHO protocol

Front 4

Tumours are categorized acc. to ?

Back 4

Tissue/cell of origin

Front 5

How many major categories of tumours are there ?

Back 5

7

Front 6

Name them

Back 6

-Neuroepithelial tissue
-Cranial and peripheral nerves
-Meninges
-Lymphomas & haemopoietic tumours
-Germ cell tumours
-Sellar region
-Metastatic(secondary tumours)
-

Front 7

Neurons do not give rise to neoplasms.

Back 7

True

Front 8

Neoplasms of glial cells called

Back 8

Gliomas

Front 9

Most common operated tumours ?

Back 9

-Astrocytomas
-Oligodendroglioma
-Ependymoma
-Meningioma
-Neurilemmoma(Schwannoma)
-Lymphoma
-Metastatic tumours

Front 10

Ependyma

Back 10

lines ventricular cavities.

Front 11

Tumours of neuroepithelial tissue ?(gliomas)

Back 11

-Astrocytoma
-Oligodendroglioma
-Mixed oligoastrocytoma
-Ependymoma

Front 12

Tumours of cranial and peripheral nerves ?

Back 12

-Neurilemmoma
-Neurofibroma

Front 13

Tumours of meninges ?

Back 13

Meningioma

Front 14

Germ cell tumours ?

Back 14

Germinoma

Front 15

Tumours of Sellar region ?

Back 15

-Pituitary adenoma
-Craniopharyngioma

Front 16

Commonest tumours in ADULTS ?

Back 16

-Astrocytomas involving cerebral hemispheres
-Meningioma
-Acoustic Schwanomma
-Lymphoma
-Metastatic tumours

Front 17

Commonest tumours in KIDS ?

Back 17

-Ependymoma
-Astrocytomas of cerebellum & brainstem
-Germ cell tumours
-Mixed neuronal-glial tumours

Front 18

Presenting features of tumours of CNS ?

Back 18

-Headache(on waking in the morning)
-Dizziness/vertigo
-Tinnitus/Hearing loss
-Personality change/depression
-Seizures
-Symptoms of raised ICP

Front 19

Where do astrocytomas arise?

Back 19

White matter of cerebral hemispheres,cerebellar hemispheres,spinal cord.

Front 20

What tend to expand white matter(mass effect) & sometimes are complicated by haemorrhage?

Back 20

Astrocytomas

Front 21

What happens histologically in astrocytomas?

Back 21

Proliferation of cells with delicate cytoplasmic processes.(pinkish network of astrocytes nuclei)

Front 22

On what basis are low,intermediate and high grades astrocytomas diff. ?

Back 22

-Nuclear variation in size and shape(pleomorphism)
-Mitotic figures
-Proliferation of vascular endothelial cells and necrosis

Front 23

When do you diagnose highest grade(glioblastoma multiforme) ?

Back 23

-When necrosis detected.

Front 24

Even though astrocytomas are MALIGNANT,

Back 24

they DO NOT metastasize.

Front 25

Survival rate for low grade astrocytomas(well differentiated & occur in pons,hindbrain,medulla,optic chiasm)?

Back 25

60-70 months

Front 26

Survival rates for Glioblastomas (WHO grade 4)?

Back 26

< 12 months

Front 27

Survival rate for intermediate grade astrocytomas(Anaplastic) ?

Back 27

20-40 months

Front 28

Do gliomas metastasize ?

Back 28

NO

Front 29

Meningiomas arise from

Back 29

Dura and arachnoid.

Front 30

Meningiomas tend to

Back 30

-Grow slowly and indent underlying brain
-Invade underlying brain parenchyma

Front 31

Majority of meningiomas are

Back 31

Benign tumours

Front 32

Microscopic appearance of meningiomas?

Back 32

Formation of syncytia and whorls with scattered Psammoma bodies characterised by a concentric layering structure and calcification

Front 33

An occasional meningioma may behave aggressively.

Back 33

True(anaplastic meningioma)

Front 34

What kind of CNS tumour has appearance of " fried egg on pan " ?

Back 34

Oligodendroglioma

Front 35

Most likely cause of fits in middle-aged person ?

Back 35

Tumour(nausea worse in morning)

Front 36

Ependymomas ?

Back 36

-Gliomas around ventricles
-form BV

Front 37

Multiple nodules most likely to be

Back 37

Metastatic.

Front 38

GBM ?

Back 38

-Epidermal Growth factor receptor amplification/rearrangement
-pt > 40 y.o
-short Hx
-poor prognosis
-high grade astrocytomas at first Dx

Front 39

Intermediate or High Grade astrocytomas?

Back 39

-TP53 gene mutations
-Pt < 40 y.o
-Long history
-Better prognosis(20-40 mos)
-may progress to GBM

Front 40

Oligodendrogliomas ?

Back 40

-Deletions chromosome 1p and/or 19q
-complete response to chemotherapy
-prolonged survival(114 mos v/s 24 mos)

Front 41

Schwannomas arise from

Back 41

Schwann cells responsible for myelination of axons and dendrites in PNS.

Front 42

These tumours involve

Back 42

Cranial nerves(mostly 8th) which has long intracranial segment with a Schwann cell component.

Front 43

Macroscopically,Schwannomas form

Back 43

Eccentric bulge from surface of involved nerve.

Front 44

Where do tumours involving 8th CN expand?

Back 44

In the angle between cerebellum and pons on ventral surface of brainstem.(CPO angle)

Front 45

What is the microscopic appearance of Schwanommas?

Back 45

-Spindle shaped cells arranged in intersecting fasciculi
-ladder pattern(Verocay body)

Front 46

Schwannomas are Benign or Malignant?

Back 46

Benign!!(on rare occasions,can behave aggressively with local reccurence and invasion of surrounding tissues)

Front 47

Primary lymphomas of CNS comprise

Back 47

1.8 % of CNS tumours

Front 48

Macroscopic appearance of lymphomas?

Back 48

Mass lesions in white matter-"icing sugar cake" lining to ventricles or a mass lesion in meningeal covering of the brain.

Front 49

Histologically,lymphomas are

Back 49

High grade tumours composed of B lymphocytes(small % composed of T lymphocytes)

Front 50

Primary CNS lymphomas is

Back 50

Very aggressive tumour with poor response to all tx modalities.

Front 51

Where do metastatic tumours become establised where?

Back 51

-Between cortex and white matter in MCA territory of cerebral hemispheres.
-in cerebellum also

Front 52

What do metastatic tumours tend to do histologically ?

Back 52

Recreate features of Primary tumour but many are undifferentiated.

Front 53

Common sites of origin for metastatic tumours of CNS ?

Back 53

-Lung
-breast
-Skin(melanoma)
-Kidney

Front 54

What could metastatic tumours do to Spinal cord?

Back 54

Compress it by extradural deposits of metastatic tumours,lymphoma,involvement of vertebrae by metastatic tumour.