ID the CNS disease, Part 2
Faith
Pt. 9 A
9 B (arrow)
10. A
10. B
10 C1, 2
NUMBER TWO
NUMBER ONE
10 D
11: Metastases to the Brain
• Common source of metastatic tumors to
the brain.
• Clinical presentation
• CT/MRI
• Gross
• ...
Take these to the bank…
• CNS tumors include several neoplasms of clinical
importance in pediatric and adult populations
•...
Take these to the bank…
• Circumscribed astrocytomas and extra extra-
axial tumors generally have benign histologic
charac...
12
Answers
Diagnoses, slide 1
1. Oligodendroglioma (Gross: pinkish white hemorrhagic calcifications; Histo: chicken wire
vasculature ...
Diagnoses, slide 2
7. Medulloblastoma: (Small round blue cell tumor in kids from primitive
precursor cells; hi mitoses, ap...
9. Neurofibroma. A: unencapsulated, diffuse fusiform expansion of nerve, shiny
jelly cut surface; B: comma-shaped schwann ...
• CT/MRI: Multiple (or single) heterogeneous masses with
contrast enhancement and surrounding edema
• Gross: Circumscribed...
ID the CNS disease, Part 2
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ID the CNS disease, Part 2

  1. 1. ID the CNS disease, Part 2 Faith
  2. 2. Pt. 9 A
  3. 3. 9 B (arrow)
  4. 4. 10. A
  5. 5. 10. B
  6. 6. 10 C1, 2 NUMBER TWO NUMBER ONE
  7. 7. 10 D
  8. 8. 11: Metastases to the Brain • Common source of metastatic tumors to the brain. • Clinical presentation • CT/MRI • Gross • Micro • Natl Hx
  9. 9. Take these to the bank… • CNS tumors include several neoplasms of clinical importance in pediatric and adult populations • Pediatric tumors are most common in the posterior Fossa. – Medulloblastoma, brainstem astrocytoma, pilocytic astrocytoma, ependymoma • Adult tumors are most common in the cerebral hemispheres or extra extra-axial compartments – High grade astrocytomas (GBM, anaplastic astrocytoma), metastatic tumors, meningioma, schwannoma
  10. 10. Take these to the bank… • Circumscribed astrocytomas and extra extra- axial tumors generally have benign histologic characteristics and are amenable to surgical cure if complete resection possible. • Diffuse astrocytomas and other gliomas tend to infiltrate widely making complete resection impossible. – Surgical excision followed by recurrence, often at higher grade, with dissemination in CSF – Metastasis outside CNS rare.
  11. 11. 12
  12. 12. Answers
  13. 13. Diagnoses, slide 1 1. Oligodendroglioma (Gross: pinkish white hemorrhagic calcifications; Histo: chicken wire vasculature with fried egg cells- central nuclei with clear cytoplasm) 2. Ependymoma (A: child: 4th ventricle, B: adult: spinal cord; C: perivascular pseudorosettes) 3. Glioblastoma multiforme (A: butterfly glioma- crossing over corpus callosum; B: palisading necrosis, C: glomeruloid vascular proliferation; CT: ring-enhancing lesion: Diff dx= GBM (or primary brain tumors to include medulloblastoma), brain abscess, brain metastasis) 4. Pilocytic Astrocytoma (A: well-circumscribed lesion; B: cystic space with mural nodule, well- circumscribed; C: top left- loose microcystic zone, bottom- dense piloid cells, i.e. spindle cells w/long cytoplasmic “Hairlike” extensions) 5. Subfalcine herniation 6. Transtentorial herniation (uncal or hippocampal herniation) 6B. 1= subfalcine ( ACA infarct); 2 = transtentorial (PCA infarct, ipsilat. Fixed dilated pupil b/c of crushed 3rd nerve, ipsil. Hemiparesis from pushing midbrain ag. Contralateral tentorium); 3 = tonsillar/cerebellar (crushes resp. ctrs in medulla; B/f LP, check for papilledema, do CT or MRI to check for increased ICP) Lagniappe: Tumor cell origins Primitive cell tumors- Medulloblastoma; Gliomas- Astrocytomas, Oligodendrogliomas, ependymoma; Meninges-meningioma; CNs and Spinal nerves- Schwannoma, neurofibroma
  14. 14. Diagnoses, slide 2 7. Medulloblastoma: (Small round blue cell tumor in kids from primitive precursor cells; hi mitoses, apoptosis, pleomorphism; ~60% survival @ 5y with surg+Rxs. A/B- filling 4th ventricle from cerebellum on top of slide B; C: Homer Wright rosettes (indicates neural differentiation; Don’t confuse these with the ependymoma’s perivascular pseudorosettes that surround blood vessels) 8. Meningioma: adult women, extra-axial mass from arachnoid cap of leptomeninges; A: well-circumscribed mass attached to dura, B: swirls/spindles and whorls; C: psammoma bodies (concentric calcifications) – Natural hx: • Slow growth over long period; • May entrap bvs and nerves, i.e. cranial/spinal nerves, blood vessels • May infiltrate veins and bone, i.e. dural venous sinuses and overlying bone with secondary bone thickening (hyperostosis) • Progesterone receptors may be present (assoc. with women) • Allelic losses on chromosome 22 • Multiple meningiomas are characteristic of neurofibromatosis type 2
  15. 15. 9. Neurofibroma. A: unencapsulated, diffuse fusiform expansion of nerve, shiny jelly cut surface; B: comma-shaped schwann cell nuclei on loose myxoid background with embedded parent nerve axons; Other: slow growth, affects PNS and terminal nerve branches in skin, many = Neurofibromatosis type 1, can turn malignant 10. Schwannoma. A: at cerebellopontine angle, B: at spinal nerve root, C: 1= loose Antoni B zone, 2 = dense Antoni A zone; D: Verocay bodies (palisading nuclei; don’t mix up with GBM’s palisading tumor cells around central necrosis); Other: curable with resection b/c well-circumscribed; can cause hearing loss (8th n. affected); if many = Neurofibromatosis Type 2 (like lots of Meningiomas) 11. Lung carcinoma, breast carcinoma, malignant melanoma, GI tract carcinomas, renal cell carcinoma (Memory: in the chest- lung breast; over the breast- skin, pigmented; lower in abdomen: GI tract; deeper and in back- kidney) • Clinical presentation: Multiple (but sometimes single) CNS masses; Gray-white junction of cerebral hemispheres favored site, but may occur anywhere; Diffuse spread in subarachnoid space aka “Carcinomatous meningitis”; Dural infiltration usu. By Breast and prostate carcinoma
  16. 16. • CT/MRI: Multiple (or single) heterogeneous masses with contrast enhancement and surrounding edema • Gross: Circumscribed tumors with necrosis, hemorrhage • Microscopic: Histology matches primary neoplasm • Natural history: Influenced by number and location of metastases, sensitivity of primary tumor to therapy. – Median survival of patients with multiple brain metastases treated with radiation: 3-6 month 12. Astrocytoma Grade II: hypercellularity with pleomorphism. NO mitoses (>/= Grade3), neovascularization, necrosis or hemorrhage (= Grade 4)

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