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Questions and Answers
What is the grade of an atypical meningioma?
What is the grade of an atypical meningioma?
Which of the following characteristics is associated with malignant meningioma?
Which of the following characteristics is associated with malignant meningioma?
What are common locations for metastatic tumors in the brain?
What are common locations for metastatic tumors in the brain?
What type of tumor is a benign nerve sheath tumor that arises from Schwann cells?
What type of tumor is a benign nerve sheath tumor that arises from Schwann cells?
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Which factor is associated with a poorer prognosis for primary CNS lymphoma?
Which factor is associated with a poorer prognosis for primary CNS lymphoma?
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Which of the following tumors primarily affects older adults and is unassociated with HIV?
Which of the following tumors primarily affects older adults and is unassociated with HIV?
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What is the primary method for the spread of metastatic tumors to the brain?
What is the primary method for the spread of metastatic tumors to the brain?
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Which clinical feature is characteristic of meningiomas?
Which clinical feature is characteristic of meningiomas?
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What is the primary location where ependymomas are commonly found in adults?
What is the primary location where ependymomas are commonly found in adults?
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Which characteristic is crucial for the diagnosis of ependymoma?
Which characteristic is crucial for the diagnosis of ependymoma?
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How is oligodendroglioma primarily characterized at the microscopic level?
How is oligodendroglioma primarily characterized at the microscopic level?
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What is the usual prognosis for patients with ependymoma due to their location?
What is the usual prognosis for patients with ependymoma due to their location?
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Which molecular characteristic is associated with oligodendroglioma?
Which molecular characteristic is associated with oligodendroglioma?
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Which tumor type is defined as WHO grade IV?
Which tumor type is defined as WHO grade IV?
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What grading is assigned to oligodendroglioma typically?
What grading is assigned to oligodendroglioma typically?
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Where do medulloblastomas commonly occur?
Where do medulloblastomas commonly occur?
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What is the typical age group affected by medulloblastoma?
What is the typical age group affected by medulloblastoma?
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Which statement regarding the prognosis of medulloblastoma is accurate?
Which statement regarding the prognosis of medulloblastoma is accurate?
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Which of the following best describes the origin of meningiomas?
Which of the following best describes the origin of meningiomas?
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What is the most common site for meningioma development?
What is the most common site for meningioma development?
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In which type of medulloblastoma is the microscopic picture most characterized by pseudo-rosettes?
In which type of medulloblastoma is the microscopic picture most characterized by pseudo-rosettes?
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Which histological type of meningioma is marked by syncytial whorls of cells without evident boundaries?
Which histological type of meningioma is marked by syncytial whorls of cells without evident boundaries?
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What is the WHO grade classification for medulloblastoma?
What is the WHO grade classification for medulloblastoma?
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Which of the following is NOT a common characteristic of meningiomas?
Which of the following is NOT a common characteristic of meningiomas?
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Study Notes
Primary Intracranial Tumors
- Intra-axial tumors originate from the brain parenchyma (neural axis)
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Glial tumors (gliomas): most common primary brain tumors, can be either infiltrative or circumscribed/diffusely
- Astrocytoma (infiltrative)
- Ependymoma
- Oligodendroglioma
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Choroid plexus tumors:
- Choroid plexus papilloma
- Choroid plexus carcinoma
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Neuronal and Glioneuronal tumors:
- Central neurocytoma
- Ganglioglioma
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Embryonal tumors (primitive tumors):
- Medulloblastoma (cerebellum)
- CNS neuroblastoma (and other embryonal tumors of the cerebellar hemispheres)
- Primary CNS lymphoma
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Germ cell tumors: located in midline brain structures.
- Germinoma of the pineal body
- Tumors of the pituitary gland and the sellar region
- Pituitary adenoma (pituitary neuroendocrine tumor)
- Craniopharyngioma
- Meningeal tumors (extra-axial): meningiomas
Secondary Tumors (Metastasis)
- Grading of brain tumors: histological grading is used to predict tumor behavior and guide treatment (chemotherapy and radiation)
- WHO Grade 1: biologically benign, low proliferative potential, potential for cure with surgery alone
- WHO Grade 2: low-grade malignancy or locally malignant, generally infiltrative, can recur
- WHO Grade 3: frank malignancy; histological evidence of malignancy, nuclear atypia, brisk mitotic activity; often treated with adjuvant radiation and/or chemotherapy
- WHO Grade 4: highly malignant, cytologically malignant, rapid evolution, fatal outcomes, widespread infiltration and craniospinal dissemination; Example tumors include glioblastoma, some embryonal neoplasms (medulloblastomas), and many sarcomas; often spread by cerebrospinal fluid (CSF) dissemination
Astrocytomas
- Incidence: approximately 80% of primary brain tumors in adults
- Site of origin: primarily in cerebral hemispheres
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Types:
- Well-circumscribed astrocytomas (Grade I): good prognosis after surgery, no recurrence or grade increase; pilocytic astrocytoma is a prime example
- Diffusely infiltrating astrocytomas (Grade II, III, IV): often infiltrate surrounding brain tissue, higher-grade tumors have increased risk of progression to higher grades, may disseminate into cerebrospinal fluid (CSF)
Ependymoma
- Tissue of origin: ependymal cells (lining ventricles)
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Sites:
- Infancy/childhood: 4th ventricle, often causing hydrocephalus (obstruction); poor prognosis due to location
- Adults: spinal cord (myxopapillary ependymoma)
- Microscopic features: tumor cells with oval nuclei, ependymal canals, true or pseudo-rosettes (perivascular); important for diagnosis
Oligodendrogliomas
- Site of origin: cerebral hemispheres (frontal and temporal regions primarily)
- Age: often occurs in adults
- Gross appearance: well-circumscribed mass
- Microscopic features: uniform cells with clear halos of cytoplasm around central nuclei, areas of calcification
Embryonal (Primitive) Tumors
- Definition: WHO grade IV tumors
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Types:
- Medulloblastoma (most common type of primitive CNS tumor) with origin in cerebellum; typically affects infants and young children
- CNS Neuroblastoma: primitive tumors of the cerebral hemispheres
Meningiomas
- Tissue of origin: meningothelial cells (within arachnoid villi)
- Common sites: parasagittal areas, falx cerebri, sphenoid ridge
- Age: frequently in middle-aged adults
- Gross: well-circumscribed tumors adherent to dura matter
- Microscopic: meningothelial whorls, psammoma bodies (laminated calcifications)
Primary CNS Lymphoma
- Incidence/predisposing factors: often associated with late-stage AIDS
- Gross picture: usually periventricular, can be nodular or diffuse
- Microscopic picture: large cell B-cell non-Hodgkin's lymphomas
- Prognosis: poor, with a mean survival time of around 18 months
Metastatic Tumors
- Spread: usually via bloodstream
- Common tumors: frequently involve leptomeninges (carcinomatous meningitis); examples include leukemia (in relapse), lung, breast, melanoma, kidney, and gastrointestinal cancers
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Description
This quiz covers the key concepts related to primary intracranial tumors, including their classifications such as glial tumors, choroid plexus tumors, and embryonal tumors. Understand the various types, their origins, and characteristics. Test your knowledge on the differentiation between intra-axial and extra-axial tumors.
