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Questions and Answers
A biopsy from a brain tumor reveals the presence of Rosenthal fibers. In which type of astrocytoma are Rosenthal fibers typically found?
A biopsy from a brain tumor reveals the presence of Rosenthal fibers. In which type of astrocytoma are Rosenthal fibers typically found?
- Glioblastoma Multiforme
- Diffuse Astrocytoma
- Pilocytic Astrocytoma (correct)
- Anaplastic Astrocytoma
What primary characteristic distinguishes a Grade IV astrocytoma from lower-grade astrocytomas according to the WHO grading system?
What primary characteristic distinguishes a Grade IV astrocytoma from lower-grade astrocytomas according to the WHO grading system?
- Endothelial proliferation
- Significant mitotic activity
- Presence of atypia
- Necrosis (correct)
The presence of 'fried egg' cells and 'chicken wire' vasculature are histological hallmarks of which type of brain tumor?
The presence of 'fried egg' cells and 'chicken wire' vasculature are histological hallmarks of which type of brain tumor?
- Pilocytic Astrocytoma
- Ependymoma
- Glioblastoma Multiforme
- Oligodendroglioma (correct)
A 10-year-old patient is diagnosed with a well-circumscribed cystic tumor in the cerebellum. Which of the following is the most likely diagnosis?
A 10-year-old patient is diagnosed with a well-circumscribed cystic tumor in the cerebellum. Which of the following is the most likely diagnosis?
Which of the following genetic alterations is associated with a better response to chemotherapy in the treatment of Glioblastoma Multiforme?
Which of the following genetic alterations is associated with a better response to chemotherapy in the treatment of Glioblastoma Multiforme?
A 65-year-old patient presents with a brain tumor that crosses the corpus callosum, forming a 'butterfly' lesion. Which type of tumor is most likely?
A 65-year-old patient presents with a brain tumor that crosses the corpus callosum, forming a 'butterfly' lesion. Which type of tumor is most likely?
Perivascular pseudorosettes are a characteristic histological finding in which type of brain tumor?
Perivascular pseudorosettes are a characteristic histological finding in which type of brain tumor?
According to the WHO grading system for astrocytomas, how many of the defined criteria (Atypia, Mitosis, Endothelial Proliferation, and Necrosis) must be present for a tumor to be classified as an Anaplastic Astrocytoma (Grade III)?
According to the WHO grading system for astrocytomas, how many of the defined criteria (Atypia, Mitosis, Endothelial Proliferation, and Necrosis) must be present for a tumor to be classified as an Anaplastic Astrocytoma (Grade III)?
What is generally considered the first-line management strategy for most brain tumors?
What is generally considered the first-line management strategy for most brain tumors?
Which imaging modality is considered the most effective for diagnosing brain tumors?
Which imaging modality is considered the most effective for diagnosing brain tumors?
A young child (< 20 years old) is diagnosed with a brain tumor located in the 4th ventricle. What type of tumor is most likely?
A young child (< 20 years old) is diagnosed with a brain tumor located in the 4th ventricle. What type of tumor is most likely?
A patient with metastatic cancer develops brain metastases. Besides treating the primary cancer site, what additional treatment is indicated for the brain metastases?
A patient with metastatic cancer develops brain metastases. Besides treating the primary cancer site, what additional treatment is indicated for the brain metastases?
What is indicated by the presence of an IDH-1 mutation in a patient diagnosed with Glioblastoma Multiforme (GBM)?
What is indicated by the presence of an IDH-1 mutation in a patient diagnosed with Glioblastoma Multiforme (GBM)?
A patient's brain biopsy shows cells that are GFAP+. Which type of tumor is most likely?
A patient's brain biopsy shows cells that are GFAP+. Which type of tumor is most likely?
What treatment is recommended for a patient diagnosed with Grade IV Glioblastoma Multiforme (GBM)?
What treatment is recommended for a patient diagnosed with Grade IV Glioblastoma Multiforme (GBM)?
What is the expected outcome for patients with brain tumors that relapse after initial treatment?
What is the expected outcome for patients with brain tumors that relapse after initial treatment?
Which of the following features is characteristic of Pilocytic Astrocytoma EXCEPT:
Which of the following features is characteristic of Pilocytic Astrocytoma EXCEPT:
A pathologist examines a brain tumor sample and notes a high degree of cellular atypia, significant mitotic activity, endothelial proliferation, and areas of necrosis. According to the WHO grading system, what grade should be assigned to this astrocytoma?
A pathologist examines a brain tumor sample and notes a high degree of cellular atypia, significant mitotic activity, endothelial proliferation, and areas of necrosis. According to the WHO grading system, what grade should be assigned to this astrocytoma?
A 45-year-old patient is diagnosed with Oligodendroglioma. Where is the tumor most likely located?
A 45-year-old patient is diagnosed with Oligodendroglioma. Where is the tumor most likely located?
Which Grade of Astrocytoma has the following criteria: Atypia, Mitosis, Endothelial Prolif, and Necrosis?
Which Grade of Astrocytoma has the following criteria: Atypia, Mitosis, Endothelial Prolif, and Necrosis?
Flashcards
WHO Grading of Astrocytomas
WHO Grading of Astrocytomas
A grading system for astrocytomas based on atypia, mitosis, endothelial proliferation, and necrosis presence.
Pilocytic Astrocytoma
Pilocytic Astrocytoma
Astrocytoma typically found in children, located in the cerebellum, well-circumscribed, often cystic with Rosenthal fibers and GFAP+ inclusions.
Glioblastoma Multiforme (GBM)
Glioblastoma Multiforme (GBM)
Astrocytoma typically found in adults, in the cerebral hemispheres, crosses the corpus callosum. Characterized by pseudopalisading necrosis, mitotic activity, endothelial proliferation, and GFAP+.
Oligodendroglioma
Oligodendroglioma
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Ependymoma
Ependymoma
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Management – Brain Tumors
Management – Brain Tumors
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Study Notes
- Astrocytomas are graded by the WHO based on four criteria: atypia, mitosis, endothelial proliferation, and necrosis.
- Grade I astrocytomas are pilocytic and meet none of the four criteria.
- Grade II astrocytomas are diffuse and meet any one of the criteria.
- Grade III astrocytomas are anaplastic and meet any two of the criteria.
- Grade IV astrocytomas are glioblastoma multiforme and must meet all four criteria with necrosis being essential.
Pilocytic Astrocytoma
- Typically found in children
- Located in the cerebellum
- Well-circumscribed and cystic in appearance
- Microscopic features include Rosenthal fibers and GFAP+ pink inclusion bodies
Glioblastoma Multiforme (GBM)
- Typically affects adults
- Located in the cerebral hemispheres, often temporal-frontal, and may cross the corpus callosum, creating a butterfly shape
- Microscopic features include pseudopalisading necrosis, mitotic activity, endothelial proliferation, and GFAP+
Oligodendroglioma
- Can occur at any age
- Located in the cerebral cortex within the white matter
- Appears as a gelatinous mass
- Microscopic features include fried egg cells, chicken wire vessels, and calcifications
Ependymoma
- Typically affects individuals younger than 20 years
- Located in the 4th ventricle
- Well-demarcated in appearance
- Microscopic features include perivascular pseudorosettes, true rosettes, and blepharoplasts
Brain Tumor Management
- Surgery is the first-line treatment, involving resection or debulking.
- Grade IV GBM is treated with radiotherapy and temozolomide.
- MRI is the best diagnostic tool.
- MGMT methylation indicates a better response to chemotherapy.
- IDH-1 mutation indicates better survival outcomes.
- Metastatic tumors are treated by addressing the primary site and using palliative brain RT.
- Relapse indicates a poor prognosis with limited chemo effect.
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