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Questions and Answers
A patient presents with a brain tumor that crosses the corpus callosum, forming a 'butterfly glioma'. Which genetic abnormality is most closely associated with this tumor type?
A patient presents with a brain tumor that crosses the corpus callosum, forming a 'butterfly glioma'. Which genetic abnormality is most closely associated with this tumor type?
- Inactivation of mismatch repair genes (MMR)
- Overexpression of the RB protein
- EGFR amplification (correct)
- Loss of function of tumor suppressor gene TP53
A 55-year-old female is diagnosed with a meningioma. Imaging reveals a well-circumscribed, extra-axial tumor with a dural attachment. Which of the following is the most likely origin of this tumor?
A 55-year-old female is diagnosed with a meningioma. Imaging reveals a well-circumscribed, extra-axial tumor with a dural attachment. Which of the following is the most likely origin of this tumor?
- Oligodendrocytes
- Ependymal cells
- Astrocytes
- Arachnoid cap cells (correct)
A pathologist examines a brain tumor biopsy under the microscope and observes cells with 'fried egg' appearance surrounding a 'chicken-wire' capillary pattern. What is the most likely diagnosis?
A pathologist examines a brain tumor biopsy under the microscope and observes cells with 'fried egg' appearance surrounding a 'chicken-wire' capillary pattern. What is the most likely diagnosis?
- Glioblastoma
- Ependymoma
- Oligodendroglioma (correct)
- Medulloblastoma
A patient presents with cerebellar dysfunction and secondary polycythemia. Imaging reveals a cerebellar mass. Which associated systemic condition should be suspected?
A patient presents with cerebellar dysfunction and secondary polycythemia. Imaging reveals a cerebellar mass. Which associated systemic condition should be suspected?
A patient is diagnosed with a prolactinoma. Which of the following hormonal imbalances is most likely to be observed in this patient?
A patient is diagnosed with a prolactinoma. Which of the following hormonal imbalances is most likely to be observed in this patient?
A 40-year-old female presents with galactorrhea and amenorrhea. Further investigation reveals a pituitary adenoma. Which class of medications would be most appropriate for initial treatment?
A 40-year-old female presents with galactorrhea and amenorrhea. Further investigation reveals a pituitary adenoma. Which class of medications would be most appropriate for initial treatment?
A patient presents with hearing loss, tinnitus, and unsteady gait. MRI reveals a tumor in the cerebellopontine angle. Which cranial nerve is most likely affected?
A patient presents with hearing loss, tinnitus, and unsteady gait. MRI reveals a tumor in the cerebellopontine angle. Which cranial nerve is most likely affected?
A patient is diagnosed with a vestibular schwannoma. Genetic testing reveals a mutation in the NF2 gene. What is the significance of finding a bilateral vestibular schwannoma?
A patient is diagnosed with a vestibular schwannoma. Genetic testing reveals a mutation in the NF2 gene. What is the significance of finding a bilateral vestibular schwannoma?
A pathologist examines a tumor sample and notes the presence of psammoma bodies arranged in a whorled pattern. Which of the following tumors is most likely to exhibit these histological features?
A pathologist examines a tumor sample and notes the presence of psammoma bodies arranged in a whorled pattern. Which of the following tumors is most likely to exhibit these histological features?
Which of the following primary brain tumors is most likely to be associated with a mutation in a gene that encodes a cytoskeletal protein?
Which of the following primary brain tumors is most likely to be associated with a mutation in a gene that encodes a cytoskeletal protein?
Flashcards
Glioblastoma
Glioblastoma
Highly malignant primary brain tumor (~1-year median survival). Crosses corpus callosum, forming a "butterfly glioma". Associated with EGFR amplification.
Oligodendroglioma
Oligodendroglioma
Relatively rare, slow-growing tumor often in frontal lobes. Characterized by "fried egg" cells and a "chicken-wire" capillary pattern.
Meningioma
Meningioma
Typically benign tumor, more common in females. Arises from arachnoid cells, often attached to the dura ("tail"). May be asymptomatic or present with seizures.
Hemangioblastoma
Hemangioblastoma
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Pituitary Adenoma
Pituitary Adenoma
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Schwannoma
Schwannoma
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Study Notes
- Adult primary brain tumors are discussed
Glioblastoma
- Glioblastoma is a common and highly malignant primary brain tumor
- The median survival is around 1 year
- Glioblastoma is found in the cerebral hemispheres
- It can cross the corpus callosum, forming what's known as a "butterfly glioma"
- Glioblastoma is associated with EGFR amplification
- Histologically it is of astrocyte origin, GFAP+
- "Pseudopalisading" pleomorphic tumor cells border central areas of necrosis, hemorrhage, and microvascular proliferation
Oligodendroglioma
- Oligodendroglioma is relatively rare, and slow growing
- It is most often found in the frontal lobes
- Oligodendroglioma is often calcified
- Histologically the cell of origin is the oligodendrocyte.
- "Fried egg" cells are round, with clear cytoplasm
- "Chicken-wire" capillary pattern
Meningioma
- Meningioma is common and typically benign, and more frequent in females than males
- It occurs along the surface of the brain or spinal cord
- Meningioma is extra-axial and may have a dural attachment ("tail" sign)
- It is well circumscribed, with a spherical or lobular shape
- Meningioma can often be asymptomatic, but may present with seizures or focal neurologic signs
- Treatment includes resection and/or radiosurgery
- Histologically it is of arachnoid cell origin
- Spindle cells are concentrically arranged in a whorled pattern
- Psammoma bodies are laminated calcifications
Hemangioblastoma
- Hemangioblastoma is most often cerebellar
- It is associated with von Hippel-Lindau syndrome when found with retinal angiomas
- Hemangioblastoma can produce erythropoietin, leading to secondary polycythemia
- Histologically it is of blood vessel origin
- Closely arranged, thin-walled capillaries with minimal intervening parenchyma
Pituitary Adenoma
- Pituitary adenomas may be nonfunctioning (silent) or hyperfunctioning (hormone-producing)
- Nonfunctional tumors may present with mass effect, such as Bitemporal hemianopia due to pressure on the optic chiasm
- Pituitary apoplexy can lead to hypopituitarism
- Prolactinoma classically presents as galactorrhea, amenorrhea, and decreased bone density due to suppression of estrogen - also decreased libido and infertility in males
- Treatment for prolactinoma includes dopamine agonists and transsphenoidal resection
- The histology is a hyperplasia of only one type of endocrine cells found in the pituitary
- They most commonly arise from lactotrophs, leading to hyperprolactinemia
- Less commonly, from somatotrophs (GH), leading to acromegaly and gigantism or corticotrophs (ACTH) causing Cushing disease
- Rarely, from thyrotrophs causing excess TSH or gonadotrophs causing excess FSH and LH
Schwannoma
- Schwannoma is classically found at the cerebellopontine angle
- It is benign, involving cranial nerves V, VII, and VIII, but can be along any peripheral nerve
- Often localized to CN VIII in the internal acoustic meatus, leading to vestibular schwannoma
- Vestibular schwannoma can cause hearing loss, tinnitus, and unsteady gait
- Bilateral vestibular schwannomas are found in NF-2
- Treatment includes resection or stereotactic radiosurgery
- Histologically of Schwann cell origin, S-100+
- Biphasic, dense, hypercellular areas containing spindle cells alternating with hypocellular, myxoid areas
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