Block 4 PATH Exam -- Neuro Tumors Tutorial
Terms
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- Mnemonic for grading CNS tumors
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AMEN
A -- atypical
M -- mitotic
E -- endothelial
N -- necrosis - What does a lot of enhancement on a brain image indicate?
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Mass is likely to be high grade
Enhancement is due to either vascularization or breakdown of BBB - Fibrillary processes are a hallmark of what types of CNS tumors?
- Astrocytic tumors
- Perinuclear clearing is a prominent sign of what tumor?
-
Oligodendriogloma
("fried eggs and chicken wire") - GFAP is used to identify what type of cells?
- Astrocytes
- In a T1-weighted image, how does CSF appear?
- Dark
- What is enhanced in a FLARE image?
- The cortical ribbon
- Pilocytic astrocytoma is most common in what group of people?
- Children
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What is the W.H.O. grade for Oligodendrioglioma?
For diffuse astrocytoma? -
II
II
Both of these are LOW-grade lesions -
In which is microcystic change more common?
(OGD vs. astrocytoma) - Oligodendroglioma
-
What is KI-67?
What is it used for? -
A nuclear protein expressed in all stages, except for rest
Used as a marker to grade tumors
(high amount of expression indicates aggressive tumor) - What is the significance of a 1p/19q deletion?
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Pts. w/ the deletion generally respond better to treatment
(in the context of high grade gliomas) - What is ring enhancement a sign of?
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Endothelial proliferation
(represents neovascularization) - What is the differential for ring enhancing lesions?
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--- TUMORS ---
GBM, metastasis, primary CNS lymphoma
--- INFECTIONS ---
Abscesses, Toxo
--- VASCULAR ---
Old hematoma - Describe palisading necrosis?
- A rim of nucleated cells surrounding a core of necrotic tissue
- What is the difference between a primary and secondary GBM?
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Primary -- high grade tumor, W/O underlying low-grade lesion
Secondary -- progressed from a low-grade astrocytoma - How long is the expected survival for pts. w/ GBM?
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Only about a yr., even with treatment
(these tumors are hard to resect) - 90% of CNS lymphomas are of what cell origin?
- B cell origin
- How is the appearance of a lymphoma different than that of other CNS tumors?
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Lymphomas are more homogenous in nature
Lymphomas do NOT have much fibrillarity
Lymphomas typically have cells in clumps/clusters - What are the differences in PCNSL in i-compromised vs. i-competent pts.?
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Immunocompromised -- prominent necrosis, ring enhancement, EBV-related
Immunocompetent -- homogenous appearance, non-EBV related - Mnemonic for most common sources of mets to the CNS
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LBS KG
L -- lungs
B -- breast
S -- skin
K -- kidneys
G -- germ cell - What is a characteristic histologic sign of metastatic melanomas?
- Prominent pigmentation in the cells
- Histologically, a "columnar appearance" if a characteristic sign of what?
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Medulloblastoma
Considered a primitive, neuroectodermal tumor
Most occur in kids
Most arise in or adjacent to roof of 4th ventricle - What is the differential for posterior fossa tumors in childhood?
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Medulloblastoma
Pilocytic astrocytoma
Ependymoma - What is the prognosis for most posterior fossa tumors of childhood?
- 50 - 60% good outcomes (if amenable to resection)