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Block 4 PATH Exam -- Neuro Tumors Tutorial


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Mnemonic for grading CNS tumors

A -- atypical
M -- mitotic
E -- endothelial
N -- necrosis
What does a lot of enhancement on a brain image indicate?
Mass is likely to be high grade

Enhancement is due to either vascularization or breakdown of BBB
Fibrillary processes are a hallmark of what types of CNS tumors?
Astrocytic tumors
Perinuclear clearing is a prominent sign of what tumor?
("fried eggs and chicken wire")
GFAP is used to identify what type of cells?
In a T1-weighted image, how does CSF appear?
What is enhanced in a FLARE image?
The cortical ribbon
Pilocytic astrocytoma is most common in what group of people?
What is the W.H.O. grade for Oligodendrioglioma?

For diffuse astrocytoma?


Both of these are LOW-grade lesions
In which is microcystic change more common?
(OGD vs. astrocytoma)
What is KI-67?

What is it used for?
A nuclear protein expressed in all stages, except for rest

Used as a marker to grade tumors
(high amount of expression indicates aggressive tumor)
What is the significance of a 1p/19q deletion?
Pts. w/ the deletion generally respond better to treatment
(in the context of high grade gliomas)
What is ring enhancement a sign of?
Endothelial proliferation
(represents neovascularization)
What is the differential for ring enhancing lesions?
--- TUMORS ---
GBM, metastasis, primary CNS lymphoma

Abscesses, Toxo

--- VASCULAR ---
Old hematoma
Describe palisading necrosis?
A rim of nucleated cells surrounding a core of necrotic tissue
What is the difference between a primary and secondary GBM?
Primary -- high grade tumor, W/O underlying low-grade lesion

Secondary -- progressed from a low-grade astrocytoma
How long is the expected survival for pts. w/ GBM?
Only about a yr., even with treatment
(these tumors are hard to resect)
90% of CNS lymphomas are of what cell origin?
B cell origin
How is the appearance of a lymphoma different than that of other CNS tumors?
Lymphomas are more homogenous in nature
Lymphomas do NOT have much fibrillarity
Lymphomas typically have cells in clumps/clusters
What are the differences in PCNSL in i-compromised vs. i-competent pts.?
Immunocompromised -- prominent necrosis, ring enhancement, EBV-related

Immunocompetent -- homogenous appearance, non-EBV related
Mnemonic for most common sources of mets to the CNS

L -- lungs
B -- breast
S -- skin

K -- kidneys
G -- germ cell
What is a characteristic histologic sign of metastatic melanomas?
Prominent pigmentation in the cells
Histologically, a "columnar appearance" if a characteristic sign of what?

Considered a primitive, neuroectodermal tumor
Most occur in kids
Most arise in or adjacent to roof of 4th ventricle
What is the differential for posterior fossa tumors in childhood?
Pilocytic astrocytoma
What is the prognosis for most posterior fossa tumors of childhood?
50 - 60% good outcomes (if amenable to resection)

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