CNS tumors

What are the most common types of tumor for each sex?

Most primary CNS tumors are caused by what cells?

Astrocytoma that does not infiltrate or progress to a higher grade with a better prognosis

Well circumscribed mural nodule associated with a cyst

Rosenthal fibers and thickened blood vessels

Astrocytoma with increased pleomorphism and diffusely
infiltrative growth pattern

Grade 1

worst, marked vascular proliferation with production of VEGF, hemorrhage, necrosis, pseudopalisading pattern of cells in the tumor, large fungating, multicentric lesion with ring density

Grade II astrocytoma

Diffusely expand white matter, poorly demarcated

dense meshwork of cytoplasmic processes

Which astrocytoma grades usually progress to GBM?

associated with epilepsy, seizures, calcification, hemorrhage (can lead to infarction, stroke)

Chromosome 1p and 19q deletions

Diffusely infiltrate of cortex

Uniform cells with perinuclear halos and round nuclei. Fried egg look, with branching capillaries

Third most common brain tumor in children

Often grow near ependyma lined ventricles or spinal cord central canal (can excise if on SC)

Ependymal canals and rosettes
Perivascular pseudorosettes –cells lining vessel

In filum terminale of spinal cord

Cuboidal cells around papillary cores in myxoid background

Prognosis of myxopapillary ependyoma

Grade 1 tumor arising in the 4th or lateral ventricles

Small, may be calcified, Highly fibrillar background, Low cellularity

Highly malignant and poorly differentiated tumor causing 20% of childhood brain tumors

Difference in location of medulloblastomas in children and adults

May be associated with hydrocephalus and CSF spread is common

tumor cells surround proteinaceous material, tongue like protrusions to surround SC

highlights of cells in medulloblastomas

How do medulloblastomas spread?

Most common extra axial tumor

Most common non-glial brain tumor in adults

Most common populations in meningiomas

Slow growing dural based mass arising from arachnoid cap cells

associated with hyperostosis of overlying skull – excessive bone formation

concentric laminations

May arise post irradiation

Associated with neurofibromatosis type 2 and deletion of chromosome 22q

En plaque variant has a carpet like growth and can induce hyperostosis

CNS manifestations of von Hippel-Lindau disease

Autosomal dominant (chromosome 3p)

Can develop tumors of the cerebellum, retina, brainstem and spinal cord, pancreas, liver, renal cell CA

Mixture of delicate capillary vessels and stroma cells with multiloculated cytoplasm

Presents as a cerebellar cyst with mural nodule, vascular lesion

papillary neoplasm

What age period do choroid plexus neoplasms pop up the most?

What is the difference in ventricle location of choroid plexus neoplasms in child and adults?

Benign encapsulated tumor arising from Schwann cells

What age range is associated with schwannomas?

Spindle cell tumor with alternating dense regions (Antoni A) and loose regions (Antoni B) – cigar shaped cells

alignment or palisading of nuclei

Hyalinized pink blood vessels

What kind of nerves do Schwannomas tend to affect?

Chromosome 17

Associated with multiple neurofibromas and pilocytic astrocytomas

Chromosome 22

Assoc w/ Bilateral acoustic schwannomas, multiple ependymomas and meningiomas

Assoc w/ Bilateral acoustic schwannomas, multiple ependymomas and meningiomas

Neurofibromatosis with risk of malignant transformation

Arise from transformation of primordial tissue derived from ectoderm, mesoderm or endoderm

Most common site for germ cell tumors

Features resemble to seminoma in testis and dysgerminoma in ovary

cells that are large with distinct cell borders, large vesicular nuclei and prominent nucleoli

What types of cells make up germ cell tumors?

Soft gray pink with areas of necrosis and hemorrhage, often angiocentric

NHL usually arises from what cells?

NHL has an increased frequency in what population?

Most comon route of spread for metastatic brain tumors

What type of cancers may infiltrate the CSF?

In a pt over 60 yo, with new onset seizures, where do you consider metastasis?

Localized to gray white junction

Necrosis with islands of tumor cells, Most have well defined borders

CNS metastasis is more common in what part of the brain?

What cancers can metastasize to the brain?