Fa: Neurology - Pathology - 3

Front 1

Which type of adult brain tumor occurs in the convexities of hemispheres (near the surfaces of the brain) and parasagittal region?

Back 1

Meningioma

Front 2

What kind of cells are involved in a Meningioma? Significance for location of tumor?

Back 2

- Arises from arachnoid cells
- Extra-axial (external to brain parenchyma)
- May have dural attachment ("tail")

Front 3

What are the symptoms and prognosis for a Meningioma?

Back 3

- Typically benign
- Often asymptomatic
- May present with seizures or focal neurologic signs

Front 4

How do you treat Meningioma?

Back 4

Resection and/or radiosurgery

Front 5

What is the histologic appearance of a Meningioma?

Back 5

- Spindle cells, concentrically arranged in a whorled pattern
- Psammoma bodies (laminated calcifications)

Front 6

What type of adult brain tumor is often cerebellar and is associated with von Hippel-Lindau syndrome when found with retinal angiomas?

Back 6

Hemangioblastoma

Front 7

What brain tumor can lead to polycythemia? How?

Back 7

Hemangioblastoma - can produce erythropoietin → 2° polycythemia

Front 8

What is the histologic appearance of a Hemangioblastoma?

Back 8

Closely arranged, thin-walled capillaries with minimal interleaving parenchyma

Front 9

Which type of adult brain tumor is often found at the cerebellopontine angle and can be localized to CN VIII? Origin of cells?

Back 9

Schwannoma (if localized to CN VIII it is an acoustic schwannoma / acoustic neuroma)
- Schwann cell origin

Front 10

Which adult brain tumor is S-100 (+)?

Back 10

Schwannoma

Front 11

How do you treat a Schwannoma?

Back 11

Resected or treated with stereotactic radiosurgery

Front 12

What should you think of if you see bilateral acoustic Schwannomas?

Back 12

NF-2

Front 13

Which adult brain tumor is often found in the frontal lobes?

Back 13

Oligodendroglioma

Front 14

What is the histologic appearance of an Oligodendroglioma?

Back 14

- Chicken-wire capillary pattern
- Oligodendrocytes = "fried egg" cells with round nuclei and clear cytoplasm
- Often calcified

Front 15

What type of adult brain tumor can put pressure on the optic chiasm causing bitemporal hemianopia?

Back 15

Pituitary Adenoma (most commonly a prolactinoma)

Front 16

What are the possible sequelae of a pituitary adenoma?

Back 16

Hyper or hypo-pituitarism

Front 17

What is the location of the adult brain tumors?

Back 17

- Glioblastoma Multiforme: cerebral hemispheres and corpus callosum
- Meningioma: external to brain parenchyma
- Hemangioblastoma: cerebellar
- Schwannoma: cerebellopontine angle, may localize to CN VIII
- Oligodendroglia: frontal lobes
- Pituitary adenoma: pituitary / optic chiasm

Front 18

What are the types of childhood primary brain tumors?

Back 18

- Pilocytic (low-grade) astrocytoma
- Medulloblastoma
- Ependymoma
- Craniopharyngioma

Front 19

Which type of childhood brain tumor is GFAP (+)?

Back 19

Pilocytic (low-grade) Astrocytoma

Front 20

Where are Pilocytic (low-grade) Astrocytoma usually found? Prognosis?

Back 20

- Most often in posterior fossa (eg, cerebellum), but can be supratentorial
- Benign with good prognosis

Front 21

Which type of childhood brain tumor is associated with Rosenthal fibers (eosinophilic, corkscrew fibers)?

Back 21

Pilocytic (low-grade) Astrocytoma

Front 22

What is the gross and histologic appearance of Pilocytic (low-grade) Astrocytoma?

Back 22

- Usually well circumscribed
- Rosenthal fibers: eosinophilic, corkscrew fibers
- Cystic + solid

Front 23

Which type of childhood brain tumor is a form of primitive neuroectodermal tumor?

Back 23

Medulloblastoma

Front 24

What can a Medulloblastoma cause?

Back 24

- Can compress the 4th ventricle → hydrocephalus
- Can send "drop metastases" to spinal cord

Front 25

What type of childhood brain tumor is associated with Homer-Wright rosettes? Prognosis?

Back 25

Medulloblastoma - highly malignant

Front 26

What is the gross and histologic appearance of Medulloblastoma?

Back 26

- Solid cerebellar tumor
- Homer-Wright rosettes
- Small blue cells

Front 27

What type of childhood brain tumor is derived from ependymal cells? Prognosis?

Back 27

Ependymoma - poor prognosis

Front 28

What can an Ependymoma cause?

Back 28

Most commonly found in 4th ventricle so it can cause hydrocephalus

Front 29

What type of childhood brain tumor is associated with perivascular rosettes

Back 29

Ependymoma

Front 30

What is the gross and histologic appearance of an Ependymoma?

Back 30

- Commonly in 4th ventricle
- Perivascular rosettes
- Rod-shaped blepharoblasts (basal ciliary bodies) found near nucleus

Front 31

What type of childhood brain tumor may be confused with a pituitary adenoma? Source?

Back 31

Craniopharyngioma - derived from remnants of Rathke pouch

Front 32

What is the prognosis and clinical syndrome caused by Craniopharyngioma?

Back 32

- Benign tumor
- May be confused with pituitary adenoma because they both cause bitemporal hemianopia

Front 33

What is the most common childhood supratentorial brain tumor?

Back 33

Craniopharyngioma

Front 34

What is the histologic appearance of a Craniopharyngioma?

Back 34

Calcification is common (tooth-enamel like)

Front 35

What are the types of herniation syndromes?

Back 35

1. Cingulate (subfalcine) herniation under falx cerebri
2. Downward transtentorial (central) herniation
3. Uncal herniation
4. Cerebellar tonsillar herniation into foramen magnum

Front 36

What type of herniation can compress the anterior cerebral artery?

Back 36

Cingulate (subfalcine) herniation under falx cerebri (#1)

Front 37

What type of herniation can compress the ipsilateral CN III causing a blown pupil and down and out gaze?

Back 37

Uncal Herniation (#3) - medial temporal lobe

Front 38

What type of herniation can compress the posterior cerebral artery causing contralateral homonymous hemianopsia)?

Back 38

Uncal Herniation (#3) - medial temporal lobe

Front 39

What type of herniation can compress the contralateral crus cerebri causing ipsilateral paralysis / false localization sign?

Back 39

Uncal Herniation (#3) - medial temporal lobe

Front 40

What type of herniation can compress the brainstem, inhibiting respiration, and possibly causing coma and death?

Back 40

Cerebellar tonsillar herniation into the foramen magnum (#4)

Front 41

What are the potential consequences of a cingulate (subfalcine) herniation under the falx cerebri?

Back 41

Can compress anterior cerebral artery

Front 42

What are the potential consequences of an uncal herniation?

Back 42

Compresses:
- Ipsilateral CN III → blown pupil and down and out gaze
- Ipsilateral PCA → contralateral homonymous hemianopsia
- Contralateral crus cerebri → ipsilateral paralysis, "false localization sign"

Front 43

What are the potential consequences of a cerebellar tonsillar herniation into the foramen magnum?

Back 43

Coma and death result when these herniations compress the brain stem (and inhibit respiration)