Neuro:: Cancer

what syndromes are associated with brain cancer?

NF1 Tuberous sclerosis VHL Cowden

what is ependymoma?

ependymoma is a pediatric primary brain tumor location: usually found in the 4th ventricle description: can cause hydrocephalus. poor prognosis origin: ependymal cells histology: characteristic perivascular rosettes. rod-shaped blepharoplasts (basal ciliary bodies) found near the nucleus

location of meningioma

frontal lobe

what brain tumor is associated with tuberous sclerosis?

giant cell astrocytoma

what are common adult tumors of the brain?

glioblastoma oligodendroglioma meningioma hemangioblastoma pituitary adenoma schwannoma

what is glioblastoma?

glioblastoma is an adult primary brain tumor description: glioblastoma is grade IV astrocytoma. glioblastoma is a common, highly malignant primary brain tumor with less than 1 year median survival. location: found in cerebral hemispheres. can cross corpus callosum ("butterfly glioma" origin: astrocytes histology: GFAP (+), "pseudopalisading" pleomorphic tumor cells that border central areas of necrosis and hemorrhage.

what brain tumor is associated with VHL?

hemangioblastoma

gross findings of craniopharyngioma

supratentorial tumor in kids see cell calcification in xray/mri cholesterol crystals found in oily fluid within tumor

meningioma location

surface of brain

histology of pilocytic astrocytoma

tumor cells with astrocytic differentiation *rosenthal fibers* (yellow arrow) eosinophilic granular bodies (green arrow)

gross findings of pinealoma

tumor of pineal gland obstruction of cerebral aqueduct

location of schwannomas

usually CN 8 nerve root

gross findings of schwannoma

you can see one side of brainstem has a schwannoma sticking out (cerebellar pontine angle = space between pons and cerebellum)

gross findings of oligodendroglioma

calcification, hyperintense on T2.

histology of meningioma

cellular whorls, psammoma bodies,

location of pilocytic astrocytoma

cerebellum hypothalamus optic nerve

location of ependymoma

cerebellum spinal cord

location of glioblastoma

cerebral hemispheres

location of oligodendrogliomas

cerebral hemispheres

what are symptoms of brain tumor?

chang e in consciousness headache vomiting papilledema herniation of brain from increased ICP hydrocephalus seizures focal cranial nerve issues

gross findings of ependymoma

circumscribed, solid mass

what is a neurofibroma?

clones of non-myelinating schwann cells that invade nerve fiber. seen in NF1 (chromosome 17) and NF2 (chromosome 22)

histology of hemangioblastoma

closely arranged blood vessels with thin walls and minimal intervening parenchyma tons of blood vessels floating around in the tumor

what is craniopharyngioma?

craniopharyngioma is a pediatric primary brain tumor description: craniopharyngioma is the most common childhood *supratentorial tumor* (most pediatric tumors are infratentorial). can cause bitemporal hemianopia. origin: remnants of rathke pouch findings: cholesterol crystals found in "motor oil" -like fluid inside of tumor. xray shows calcification.

gross findings of pilocytic astrocytoma

cystic mass solid enhancing component circumscribed usually found in cerebellum, hypothalamus, optic nerve

histology of craniopharyngioma

derived from remnants of Rathke pouch.

what is hemangioblastoma?

hemangioblastoma is a primary adult brain cancer location: cerebellar description: associated with VHL syndrome when found in addition to retinal angiomas. hemangioblastoma cells can produce reythropoietin, which causes secondary polycythemia. histology: originates in blood vessels. closely arranged, thin-walled capillaries with minimal intervening parenchyma.

histology of schwannoma

hypercellular and hypocellular areas verocay bodies (nuclear palisades surrounding acellular zone)

histology findings of oligodendroglioma

hypercellularity "fried egg cells", often calcified

histology of glioblastoma

hypercellularity cellular atypia necrosis *pseudopalisading* necrosis (healthy cells surrounding dead part)

histology of pituitary adenoma

hyperplasia of just one type of pituitary cells

gross findings of glioblastoma

looks like a brain abscess from infection enhancing ring

histology of pinealoma

looks like germ cell tumor

where does metastasis to the brain most often originate?

lungs (most common), breast, melanoma (highest chance of metastasis), kidney

gross findings of meningioma

mass at the outside of brain. *extra-axial*. may show "dural tails" (tumor grows out from origin tail region behind it)

location of medulloblastoma

medulla

what kid primary brain tumor is most common in babies?

medulloblastoma

what is medulloblastoma?

medulloblastoma is the most common malignant brain tumor in childhood. location: medulloblastoma commonly involves the cerebellum description: compresses the 4th ventricle, causing noncommunicating hydrocephalus. can send "drop metastases" to spinal cord origin: primitive neuroectodermal tumor (PNET) histology: homer-wright rosettes, and small blue cells.

what is the most common adult primary brain tumor?

meningioma

what is meningioma?

meningioma is an adult primary brain tumor description: meningioma is a common, benign brain tumor. location: surface of brain and parasagittal region. *extra-axial* (external to brain parenchyma). can have dural attachment "tail" symptoms: often asymptomatic but can present with seizures or focal neurologic signs. treatment: resection and radation and surgery origin: arachnoid cells histology: spindle cells concentrically arranged in a whorled pattern. psammoma bodies (you see this in mesothelioma too)

what is the most common neoplasm in the brain?

metastasis! even if it's a single lesion, this is the most common source of cancer in the brain

histology of medulloblastoma

neuronal differentiation, homer wright rosettes small round blue cells

why are adult neoplasms and childhood neoplasms of the brain different?

neurons are actively growing/developing in kids but not in old people. also for whatever reason adult tumors are *supratentorial* (above cerebellar line) and kid tumors are *infratentorial* (cerebellum, brainstem)

what is oligodendroglioma?

oligodendroglioma is an adult primary brain tumor description: oligodendroglioma is a rare, slow growing brain tumor. oligodendroglioma has a *chicken-wire* capillary pattern location: frontal lobes origin: oligodendrocyte histology: "fried egg" cell appearance = round nuclei with clear cytoplasm. cells are often calcified.

what brain tumor is associated with NF type 1?

optic nerve glioma meningioma

what primary brain tumor is most common in adolescents?

pilocytic astrocytoma

what are common pediatric tumors of the brain?

pilocytic astrocytoma medulloblastoma ependymoma craniopharyngioma pinealoma

what is pilocytic astrocytoma?

pilocytic astrocytoma is a childhood primary brain tumor description: pilocytic is a well circumbscribed tumor usually in the posterior fossa (cerebellum). you have cystic and solid regions of tumor location: posterior fossa (cerebellum), can be supratentorial or infratentorial prognosis: benign, good prognosis origin: glial cell origin histology: GFAP (+), rosenthal fibers (eosinophilic corkscrew fibiers).

what is pinealoma?

pinealoma is a pediatric primary brain tumor description: tumor of pineal gland. can cause parinaud syndrome (compression of tectum --> vertical gaze palsy), obstructive hydrocephalus (compression of cerebral aqueduct), precocious (early) puberty in males (B-hCG production) histology: similar to germ cell tumors like testicular seminoma

what is pituitary adenoma?

pituitary adenoma is an adult brain tumor description: adenoma may be nonfunctioning or hyperfunctioning. bitemporal hemianopia is due to pressure on optic chiasm (second image shows what a patient would see). symptoms: hyper or hypopituitarism, which can be caused by pituitary apoplexy. origin: most comomonly caused by lactotrophs (prolactin making cells that go crazy) --> hyperprolactinemia. can also come from somatotrophs --> acromegaly/giantism or corticotrophs (ACHT) --> cushing's syndrome. rarely, pituitary adenoma can be from thyrotrophs, gonadotrophs. histology: pituitary adenoma is always hyperplasia of *only one type of endocrine cells found in pituitary gland*

what is schwannoma?

schwannoma is a PNS adult brain tumor location: cerebellopontine angle (between cerebellum and pons), but can be along any peripheral nerve. usually localized to CN 8 in internal acoustic meatus --> vestibular schwannoma (associated with NF-2) treatment: resection or stereotactic radiosurgery origin: schwann cells histology: S-100 (+)

histology findings of ependymoma

solid growth pattern, tumor cells have *ependymal differentiation with ependymal rosettes* (surrounding a vessel) cancer cells here are around blood vessels but also just spread around everywhere

gross findings of medulloblastoma

solid mass with enhancement in contrast imaging can form *dorp metastases*