Revision with a Master Quiz of 21 questions based on NEET PG Sample Questions on Medulloblastoma (Pathology) from Previous Year NEET PG Online Exams.

1. Craniospinal irradiation is employed in the treatment of:
A: Oligodendroglioma
B: Pilocytic astrocytoma
C: Mixed oligoastrocytoma
D: Medulloblastoma
Correct Ans:D
Explanation
Craniospinal irradiation is employed in the treatment of medulloblastoma.
Ref: Harrison’s Principles of Internal Medicine, 15th Edition, Page 2449
Which of the following tumor causes polycythemia due to increased erythropoietin
production?
A: Cerebellar hemangioblastoma
B:
Medulloblastom
a
C: Ependymoma
D: Oligodendroglioma
Correct Ans:A
Explanation
Secondary erythrocytosis involves increased erythropoietin (EPO) signalling in the bone
marrow. Several types of neoplasm are known to produce excess EPO, including renal cell
carcinoma, uterine fibroids, hemangioblastoma, and hepatocellular carcinoma. EPO
production can also be increased following renal transplant
Ref: Verhovsek M., McFarlane A. (2012). Chapter 173. Abnormalities in Red Blood Cells. In
G.V. Lawry, S.C. McKean, J. Matloff, J.J. Ross, D.D. Dressler, D.J. Brotman, J.S. Ginsberg
(Eds), Principles and Practice of Hospital Medicine.
A 50-year-old woman undergoes neurosurgery for resection of a well-circumscribed
intracranial neoplasm attached to the dura. The tumor compressed the underlying brain
parenchyma without infiltration. Which of the following is the most likely diagnosis?

2. A: Arteriovenous malformation
B:
Glioblastoma
multiforme
C: Medulloblastoma
D: Meningioma
Correct Ans:D
Explanation
The gross features of this dural-based tumor are consistent with meningioma, the most
frequent benign intracranial neoplasm. It arises from meningothelial cells and histologically
consists of whorls of elongated cells with scattered psammoma bodies. The benign behavior
of this tumor is apparent from its "pushing" pattern of growth. The tumor tends to expand
downward, compressing the brain, but without invading it. For this reason, this tumor can
be easily removed at surgery.
An arteriovenous malformation is a vascular aggregate of arteries, veins, and vessels with
intermediate characteristics. These lesions are usually intracerebral and manifest with
hemorrhage or seizures.
Glioblastoma multiforme is the most frequent malignant intracerebral tumor. It arises from
neoplastic transformation of astrocytes within the white matter. Grossly, it is characterized
by a variegated appearance, with areas of solid tumor alternating with necrosis and
hemorrhage.
Medulloblastoma develops from the cerebellar vermis, usually in children. It is composed of
small, primitive-appearing neoplastic cells.
A 10-year-old child with new onset of visual field abnormalities and diabetes insipidus
undergoes a head CT. The CT scan demonstrates a 3cm mass lesion with focal calcification
involving the area above the sella turcica. Needle biopsy of this mass shows that the tumor
is composed of tissue resembling tooth enamel. Which of the following diagnoses is most
likely?
A: Craniopharyngioma
B: Glioblastoma multiforme
C: Large pituitary adenoma
D: Medulloblastoma
Correct Ans:A
Explanation
The tumor is a craniopharyngioma, alternatively known as an adamantinoma or
ameloblastoma. Craniopharyngiomas may arise in, or more commonly above, the sella
turcica. The histological pattern recapitulates the enamel organ of the tooth, with nests or
cords of stratified squamous or columnar epithelium embedded in a loose fibrous stroma.

3. Calcification (and even metaplastic bone formation) is common in these benign tumors,
which are thought to arise from vestigial remnants of Rathke's pouch.
Glioblastoma multiforme characteristically shows at least some enlarged cells with bizarre
nuclei.
Large pituitary adenomas contain nests of uniform glandular cells.
Medulloblastoma is made of small basophilic cells with relatively large nuclei for their size.
Mutations in merlin protein is associated with:
A: Astrocytoma
B:
Meningiom
a
C: Medulloblastoma
D: Oligodendroglioma
Correct Ans:B
Explanation
The most common cytogenetic abnormality is loss of chromosome 22, especially the long
arm (22q). The deletions include the region of 22q12 that harbors the NF2 gene, which
encodes the protein merlin.
Meningiomas are a common lesion in the setting of NF2.
Ref: Robbins 8th edition Chapter 28.
Which of the following tumors is associated with drop metastasis?
A: Astrocytoma
B: Ependymoma
C: Medulloblastoma
D: Oligodendroglioma
Correct Ans:C
Explanation
At the edges of the main tumor mass, medulloblastoma cells have a propensity to form
linear chains of cells infiltrating through cerebellar cortex to aggregate beneath the pia,

4. penetrate the pia, and seed into the subarachnoid space. Dissemination through the CSF is
a common complication, presenting as nodular masses elsewhere in the CNS, including
metastases to the cauda equina that are sometimes termed drop metastases.
Ref: Robbins 8th edition Chapter 28.
Which among the following is the commonest type of intracranial tumour?
A: Astrocytoma
B: Medulloblastoma
C: Meningioma
D:
Secondarie
s
Correct Ans:D
Explanation
Secondary metastatic deposits are more common than primary brain tumors in adults and
the opposite is true in children. Brain metastases are three times more common than all
primary brain tumors combined.
Must know:
 Brain metastases arise from hematogenous spread and frequently arise
from either a lung primary or are associated with pulmonary metastases.
 Most metastases develop at the gray matter–white matter junction in the
watershed distribution of the brain where intravascular tumor cells lodge
in terminal arterioles.
 The distribution of metastases in the brain approximates the proportion of
blood flow such that about 85% of all metastases are supratentorial and
15% occur in the posterior fossa.
 The most common sources of brain metastases are lung and breast
carcinomas; melanoma has the greatest propensity to metastasize to the
brain, being found in 80% of patients at autopsy.
 Ovarian and esophageal carcinoma rarely metastasize to the brain.
 Prostate and breast cancer also have a propensity to metastasize to the
dura and can mimic meningioma.
 Leptomeningeal metastases are common from hematologic malignancies
and also breast and lung cancers.
 Spinal cord compression primarily arises in patients with prostate and
breast cancer, tumors with a strong propensity to metastasize to the axial
skeleton.
Ref: DeAngelis L.M., Wen P.Y. (2012). Chapter 379. Primary and Metastatic Tumors of the
Nervous System. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J.
Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.

5. A 3 year old boy is brought to the emergency department after the acute onset of headache,
vomiting, nuchal rigidity, and impaired mental status. MRI reveals a posterior fossa tumor
that fills the 4th ventricle. Surgery is immediately started, and intraoperative consultation
leads to a "frozen section" diagnosis of medulloblastoma. Which of the following pathologic
mechanisms most likely accounts for this child's clinical presentation?
A: Acute hemorrhage into the 4th ventricle
B:
Alteration of medullary
function
C: Increased intracranial pressure
D: Infiltration of the cerebellar vermis by the neoplasm
Correct Ans:C
Explanation
Any tumor "filling the 4th ventricle" blocks the circulation of cerebrospinal fluid (CSF). This
blockage leads to increased intracranial pressure, which manifests with nausea, vomiting,
headache,nuchal rigidity, and mental status changes. If surgery is not performed promptly,
cerebellar tonsillar herniation and rapid death will ensue. In children, medulloblastoma and
ependymoma are the most frequent neoplasms presenting in this manner.
There is no evidence in this case suggesting that acute hemorrhage into the 4th ventricular
cavity has occurred, nor is medulloblastoma typically associated with this complication. CNS
tumors that frequently bleed are metastases from melanoma, renal cell carcinoma, and
choriocarcinoma.
Alterations in medullary function lead to cardiorespiratory instability and may be caused by
direct tumor compression or infiltration of the medulla, neither of which is supported by
MRI findings in this case.
Infiltration of the cerebellar vermis is certainly seen in many cases of medulloblastoma, a
tumor that arises from this midline cerebellar structure. However, this would lead to truncal
ataxia and gait instability, not symptoms of increased intracranial pressure.
Ref: Ropper A.H., Samuels M.A. (2009). Chapter 30. Disturbances of Cerebrospinal Fluid and
Its Circulation, Including Hydrocephalus, Pseudotumor Cerebri, and Low-Pressure
Syndromes. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of
Neurology, 9e.
A newborn with congenital heart failure, which is not responding to treatment, has bulging
anterior fontanelles with a bruit on auscultation. On trans fontanelle USG a hypoechoic
midline mass is seen with dilated lateral ventricles. Most probable diagnosis is:
A: Vein of Galen malformation
B:
Arachnoid
cyst
C: Medulloblastoma
D: Encephalocele

6. Correct Ans:A
Explanation
A neonate with fulminant CHF, bulging anterior fontanelles with USG showing hypoechoeic
midline mass is with dilated lateral ventricles suggests a diagnosis of Vein of Galen
Malformation.
Ref: Pediatric Brain And Spine: An Atlas Of MRI And Spectroscopy, Springer, 2005 – Pg 332,
333, 334; Neurosurgery Case Review: Questions and Answers, Thieme, 02-Dec-2009 – Pg
66, 67; Pediatric Neurovascular Disease: Surgical, Endovascular, and Medical Management,
Thieme, 17-Oct-2005 – Pg 116, 117; Volpe’s neurology of newborn 3rd/802.
An 8 year old child presented with signs of increased intracranial tension. Imaging studies
showed a growth in the brain. Which is the commonest tumor in a child in the posterior
fossa of head?
A: Astrocytoma
B: Medulloblastoma
C: Craniopharyngioma
D: Meningioma
Correct Ans:B
Explanation
Medulloblastoma arises in the posterior part of the cerebellar vermis and neuroepithelial
roof of the fourth ventricle in children. It accounts for 20 percent of childhood brain tumors.
Primitive neuroectodermal tumor is the most common type of medulloblastoma. Most occur
in the first decade of life, but there is a second peak around age 30. Medulloblastoma is the
most common malignant pediatric brain tumor. They are usually midline. Most occur in the
cerebellum and present with symptoms of increased ICP.

7. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 31. Intracranial Neoplasms and
Paraneoplastic Disorders. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's
Principles of Neurology, 9e.
A newborn presents with congestive heart failure. On examination there is bulging anterior
fontanelle with a bruit on auscultation. Transfontanellar USG shows a hypoechoic midline
mass with dilated lateral ventricles. What is the MOST likely diagnosis?
A: Medulloblastoma
B:
Encephalocel
e
C: Vein of Galen malformation
D: Arachnoid cyst
Correct Ans:C
Explanation
This newborn is suffering from vein of Galen malformation which often presents with
features of hydrocephalus and congestive heart failure. Prenatal ultrasonography shows
characteristic midline tubular anechoic structure superior to the thalamus which is
contiguous with the dilated sagittal sinus (comet tail sign). Final diagnosis of this
malformation is provided by cerebral angiography.
The vein of Galen is a centrally located short venous structure formed by the confluence of
the internal cerebral veins and the basal vein of Rosenthal.
 It empties into the straight sinus at its junction with the inferior sagittal
sinus.
 Structures drained by vein of Galen are thalamus, medial temporal lobe,
occipital lobe and superior cerebellar vermis.
Ref: Nursing Care of the Pediatric Neurosurgery Patient page 47, Textbook of Neurosurgery
edited by Prakash Narain Tandon, page 1105.

8. A 4 year old boy diagnosed of having a malignancy. On physical examination, he found to
have aniridia. Which of the following tumor is associated with aniridia?
A: Hepatoblastoma
B: Medulloblastoma
C: Nephroblastoma
D: Retinoblastoma
Correct Ans:C
Explanation
Wilms Tumor (Nephroblastoma):
After neuroblastoma, this is the second most common abdominal tumor in children.
Symptoms consist of abdominal enlargement, pain, hematuria, malaise, weakness,
anorexia, weight loss and fever.
Malformations or syndromes associated with Wilms tumor:
 Aniridia
 Hemihypertrophy
 Genitourinary malformations
o Cryptorchidism
o Hypospadias
o Gonadal dysgenesis
o Pseudohermaphroditism
o Horseshoe kidney
 Beckwith-Wiedemann syndrome
 Denys-Drash syndrome

9.  WAGR syndrome (Wilms tumor, aniridia, ambiguous genitalia, mental
retardation)
Ref: Graham D.K., Quinones R.R., Keating A.K., Maloney K., Foreman N.K., Giller R.H., Greffe
B.S. (2012). Chapter 31. Neoplastic Disease. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding,
J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
Which of the following malignancy is classified by Chang staging system?
A: Retinoblastoma
B: Rhabdomyosarcoma
C: Ewings sarcoma
D: Medulloblastoma
Correct Ans:D
Explanation
Medulloblastoma is the most common malignant pediatric brain tumor. They are usually
midline. Most occur in the cerebellum and present with symptoms of increased ICP.
Histologic characteristics include densely packed small round cells with large nuclei and
scant cytoplasm. The Chang staging system is currently used to stage medulloblastomas; it
categorizes the tumor by size and metastatic spread. They should undergo surgical
resection followed by radiation therapy and chemotherapy.
Ref: Principles and Practice of Pediatric Neurosurgery edited by A. Leland Albright, P. David
Adelson, Ian F. Pollack, 2008, Page 607.

10. Which of the following brain tumors does not metastasize via the Cerebrospinal fluid (CSF)?
A: Germ cell tumors
B:
Medulloblastom
a
C: CNS Lymphoma
D: Craniopharyngioma
Correct Ans:D
Explanation
Craniopharyngiomas are rare, usually suprasellar, partially calcified, solid or mixed solid-
cystic benign tumors that arise from remnants of Rathke's pouch. They do not metastasise.
They have a bimodal distribution, occurring predominantly in children but also between the
ages of 55 and 65 years. They present with headaches, visual impairment, and impaired
growth in children and hypopituitarism in adults. Treatment involves surgery, radiotherapy,
or the combination of the two.
Ref: Harrison’s Internal Medicine, 18th Edition, Page 2271 ; Scwartz’s Principles of Surgery,
9th Edition, Chapter 42 ; Williams Hematology, 8th Edition, Chapter 97
Which of the following is the most common type of Glial tumors?
A: Astrocytomas
B: Medulloblastomas
C: Neurofibromas
D:
Ependymoma
s
Correct Ans:A
Explanation
Astrocytomas are the most common type of glial tumor. So astrocytomas is the single best
answer of choice.
Ref: Harrison's Principles of Internal Medicine, 16th Edition, Page 2453; Microneurosurgery
By Mahmut Gazi Yasargil, Chad D, Page 95.

11. Which of the following brain tumors does not metastasize via the Cerebrospinal fluid (CSF)?
A: Germ cell tumors
B:
Medulloblastom
a
C: CNS Lymphoma
D: Craniopharyngioma
Correct Ans:D
Explanation
Craniopharyngiomas are rare, usually suprasellar, partially calcified, solid or mixed solid-
cystic benign tumors that arise from remnants of Rathke's pouch. They do not metastasise.
They have a bimodal distribution, occurring predominantly in children but also between the
ages of 55 and 65 years. They present with headaches, visual impairment, and impaired
growth in children and hypopituitarism in adults. Treatment involves surgery, radiotherapy,
or the combination of the two.
Ref: Harrison’s Internal Medicine, 18th Edition, Page 2271 ; Scwartz’s Principles of Surgery,
9th Edition, Chapter 42 ; Williams Hematology, 8th Edition, Chapter 97
Which of the following tumors has got the best prognosis?
A: Cerebellar pilocytic astrocytoma
B:
Grade IV
astrocytoma
C: Medulloblastoma
D: Ependymoma
Correct Ans:A
Explanation
Cerebellar pilocytic astrocytoma is Grade - I
astrocytoma and is associated with best prognosis. Grade -
IV astrocytoma is Glioblastoma multiforme and has worst
prognosis.
Grade - II astrocytoma is low-grade (fibrillary) astrocytoma,
mixed oligoastrocytoma. They are relatively slow growing
astrocytomas. These patients have 5 yr survival rate of 34%
without treatment and 70% with radiation therapy.

12. Grade - III astrocytoma is anaplastic astrocytoma. These
patients often related to seizures, neurologic deficits,
headaches, or changes in mental status. Individuals with
grade 3 astrocytoma have a median survival time of 18
months with treatment (radiation and chemotherapy).
Which of the following intracranial tumors has the best prognosis?
A: Glioblastoma
B: Cerebellar astrocytoma
C: Medulloblastoma
D: Ependymoma
Correct Ans:B
Explanation
Cerebellar astrocytoma is the most common type of posterior
fossa tumor in childhood and has an excellent prognosis
following surgical removal. Next to cerebellar astrocytoma,
medulloblastoma is the most frequent tumor involving
posterior cranial fossa structures and has a poor prognosis
for recovery.
Which of the following is the most frequent primary malignant tumor of the CNS?
A: Glioblastoma multiforme
B:
Medulloblastom
a
C: Meningioma
D: Oligodendroglioma
Correct Ans:A
Explanation
Glioblastoma multiforme (GBM) is the most frequent primary malignant tumor of the CNS.
It usually affects middle-aged or elderly patients and most frequently arises in the cerebral
white matter. GBM is a malignant astrocytoma; it is referred to as grade IV astrocytoma in
the WHO classification and grade 4 astrocytoma in the St. Anne-Mayo grading system. This

13. tumor is very aggressive; median survival is approximately 12-14 months following optimal
treatment, ie, a combination of surgery and radiation therapy.
Medulloblastoma, a much less frequent malignant tumor, affects children; it arises in the
posterior fossa in this population. The histogenetic origin of this tumor is uncertain,
although it is thought to develop from immature cell precursors that give rise to glial and
neuronal cells.
Meningioma and pituitary adenoma are frequent but benign brain tumors that arise from
meningothelial cells and endocrine cells of the adenohypophysis, respectively.
Oligodendrogliomas constitute 5% of all primary brain tumors. Although most
oligodendrogliomas have benign histologic features (e.g., low mitotic rate and mild nuclear
atypia), their complete surgical excision is virtually impossible owing to a diffuse, poorly
circumscribed pattern of growth. This tumor allows a much longer survival (up to 7-10
years) than GBM, but eventually transforms into a malignant glioma indistinguishable from
GBM.
Ref: Ropper A.H., Samuels M.A. (2009). Chapter 31. Intracranial Neoplasms and
Paraneoplastic Disorders. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's
Principles of Neurology, 9e.
Aniridia is associated with:
A:
Retinoblastom
a
B: Hepatoblastoma
C: Nephroblastoma
D: Medulloblastoma
Correct Ans:C
Explanation
Aniridia and Wilm's tumor (nephroblastoma) are components of a rare genetic
syndrome - WAGR syndrome W - Wilm's tumor A - Aniridia G - Genitourinary
problems R - Mental Retardation Aniridia is a condition of complete or partial
iris hypoplasia and foveal hypoplasia, resulting in reduced visual acuity and
nystagmus. It may be found in isolation or in association with other syndromes.
PAX6 is present on band p13 of chromosome 11, and its mutation results in
aniridia. Syndromes associated with Aniridia: Miller syndrome Aniridia
associated wilm's tumor WAGR syndrome Wilm's tumor, aniridia, genital
abnormalities and mental retardation Gillespie’s syndrome Aniridia, mental
retardation and cerebellar ataxia Axenfeld–Rieger syndrome Iris hypoplasia,
corectopia and polycoria. Ref: Yanoff & Duker’s Opthalmology, 3rd Edition,
Page 1208.

14. Which is the second common malignancy in patients with retinoblastoma?
A: Osteosarcoma
B: Ewing's sarcoma
C: Medulloblastoma
D: Osteoblastoma
Correct Ans:A
Explanation
Heritable germ line cases of retinoblastoma develop bilateral tumours and multifocal
tumours, and carry a predisposition to develop tumours most notably pinealoblastomas and
osteosarcomas.
 Retinoblastoma is most common primary intraocular malignanacy of
childhood.
 It is characterized by Flexner winterstiener rosette, homer - wright
rosette
 Leucocoria or cat's reflex is most common manifestation.
 Strabismus is second most common manifestation.
 Predisposing gene is 13ql4