Neoplasms (Sosnowski)

Sosnowski

Normal

Tumor locations

Top right anywhere in cortex

Pineal gland tumor usually young kids

Germinoma

Most common metastatic neoplasms to the brain

Lung

Breast

Prostate

GI, rare

Kidney

Melanoma

Choriocarcinoma

Bloody mets to the brain

Lung

Kidney

Melanoma

Choriocarcinoma

Astrocytoma

Oligodendroglioma

Infiltrating gliomas

Infiltrating gliomas

Astrocytoma

Oligodendroglioma

Non-infiltrating gliomas

Gangliogliomas

placental tumor

Choriocarcinoma

Black dots at gray white junction probably a hemorrhagic met

Hemorrhagic I think this one was melanoma mets

Brain mets

Bottom cerebellum loaded with mets can be silent

____ could be a presentation of metastasis to the brain

seizures

Biopsy where edema is you would see

Reactive gliosis

Brain met

adenocarcinoma mucin producing cell present

reactive brain with foamy macrophages

Brain met

cytokeratin stain

Stain for brain met

Cytokeratin

Brain met

Cerebrum with pigment in it

Melanoma met

Cerebellum met

Normal cerebellum is where the word is the rest is cancer

Focal vs infiltrative primary brain lesions

Focal

Pilocytic astrocytoma

PXA

Ependymoma

Subependymoma

SEGA

Infiltrative

Astrocytoma (II-IV)

Oligodendroglioma

Pilocytic astrocytoma

PXA

Ependymoma

Subependymoma

SEGA

Focal lesions

Astrocytoma (II-IV)

Oligodendroglioma

Infiltrative lesions

Arise from neoplastic astrocytes and oligodendrocytes within the white matter

Infiltrating gliomas

Infiltrate into the gray matter

Infiltrating gliomas

Can cross the corpus callosum and involve the other hemisphere

Infiltrating gliomas

Can release VEGF-like hormones producing leaky neovasculature

Infiltrating gliomas

In children, most common in brain stem or thalamus

Infiltrating gliomas

Infiltrating gliomas in children is most common the _______ or _______

brainstem or thalamus

Astrocytes and oligodendrocytes when they are neoplastic upregulate ______ on surface that bind to white matter tracts to tract along it

receptor

• Arise from neoplastic astrocytes and oligodendrocytes within the white matter

• Infiltrate into the gray matter

• Can cross the corpus callosum and involve the other hemisphere

• Can release VEGF-like hormones producing leaky neovasculature

• In children, most common in brain stem or thalamus

infiltrating gliomas

Infiltrating glioma

Astrocytoma or oligodendroglioma

Higher grade glioma tracking across corpus callosum to other hemisphere

Butterfly lesion is one hemisphere to the other

An important marker for labeling glial tumors

glial fibrillary acidic protein (GFAP), an intermediate filament protein

Astrocytes

GFAP stain

Glioma but make sure its not a met by staining with GFAP

Glioma stained with GFAP

WHO grade ___

Pleomorphic astrocytes

2

astrocytoma

WHO grade ___

Pleomorphic astrocytes

Mitoses

3

anaplastic astrocytoma

WHO grade __

Pleomorphic astrocytes

Mitoses

Necrosis and/or microvascular proliferation

4

Normal astrocytoma is WHO grade

2

Anaplastic astrocytoma is WHO grade

3

Glioblastoma multiforme GBM is WHO grade

4

Glioblastoma multiforme (GBM) is an ______

astrocytoma

Found in white matter of young adults, 30-40 yrs

> 10 years survival

Astrocytoma WHO grade 2

T2-bright but lacks contrast enhancement

Prognostic factors: patient age, extent of resection, neurological status at presentation

Astrocytoma, WHO grade II

Astrocytoma, WHO grade II

Diffuse enhancement gray and white matter

• Found in white matter of young adults, 30-40 yrs

• T2-bright but lacks contrast enhancement

• Prognostic factors: patient age, extent of resection, neurological status at presentation

• May remain stable for many years or undergo anaplastic transformation

• > 10 years survival

Astrocytoma, WHO grade II

Diffuse Astrocytoma, WHO Grade II

Infiltrating pleomorphic glial cells with increased cellularity

light in color edematous astrocytes

Infiltrating pleomorphic glial cells with increased cellularity

Diffuse Astrocytoma, WHO Grade II

Diffuse Astrocytoma, WHO Grade II

Neoplastic vs normal white matter

Astrocytoma WHO grade 2

• Presents 10 years later than Grade II

• Often enhance in focal or patchy pattern

• 2-4 year survival

Anaplastic Astrocytoma, WHO grade III

Often enhance in focal or patchy pattern WHO grade __

Anaplastic Astrocytoma, WHO grade III

Anaplastic Astrocytoma, WHO grade III

Anaplastic Astrocytoma, WHO grade III

Anaplastic Astrocytoma, Grade III

Mitotic figure and pleomorphic astrocytes

Hypercellular, pleomorphic, mitotic figure so 3

Anaplastic Astrocytoma, Grade III

Mitotic figure and pleomorphic astrocytes

What is different between grade 3 and 4 astrocytoma?

Grade 4 GBM has necrosis and/or microvascular proliferation

• Peak incidence 50-60 years

• Neoplasm occupies both hemispheres through the corpus callosum

• Irregular ring enhancing

• Average 1 year survival

GBM

astrocytoma who grade 4

Irregular ring enhancing

GBM

GBM

ring enhancing T1

crosses corpus callosum

necrosis in the middle

(This pattern could be GBM, abccess with correct picture of infection ,or primary CNS lymphoma, but most likely GBM)

Butterfly lesion

GBM

astrocytoma grade 4

Lots of hemorrhaging, weak blood vessels, and necrosis growing fast

GBM

pleomorphic astrocytes

mitotic activity

vascular proliferation here

GBM

necrosis

pleomorphic astrocytes

mitotic activity

GBM

know this picture!

Palisading neoplastic cells surrounding necrosis

Palisading neoplastic cells surrounding necrosis

GBM grade 4 astrocytoma

Geographic pattern, a perimeter of neoplastic glial cells surrounding necrosis

GBM

Characteristic loss of chromosomes 1p,19q

Oligodendroglioma

10-15% of all gliomas

Oligodendroglioma

Predilection for cortex

Gyriform calcification, higher grade lesions may enhance

Oligodendroglioma

Tend to like to stay in 1 of the gyri

Can have calcifications

Oligodendroglioma

Oligodendroglioma

1 gyri

Perinuclear halos or fried egg appearance

Delicate capillaries

Calcification

Oligodendroglioma

Chicken wire vasculature

Oligodendroglioma

• Perinuclear halos or fried egg appearance

• Delicate capillaries

• Calcification

• Perineuronal satellitosis

• Subpial accumulation

Oligodendroglioma

Oligodendroglioma

Perinuclear halos or fried egg appearance

Delicate capillaries (chicken wire)

Calcification

1p, 19q loss

Oligodendroglioma

Neoplasms That Infiltrate the Corpus Callosum

GBM

Primary CNS lymphoma

Primary CNS lymphoma in elder individual

Diffuse large B-cell lymphoma, enhancing (without necrosis) MRI

Primary CNS lymphoma in HIV patient

Diffuse large B-cell lymphoma, LMPEBV +, ring enhancing MRI with necrosis

HIV

Primary CNS lymphoma

HIV primary CNS lymphoma _____ +

LMPEBV

Epstein barre virus

GBM vs primary CNS lymphoma biopsy to figure it out

Primary CNS lymphoma is a __ cell lymphoma

B

Primary CNS lymphoma

Blood vessel lots of lymphocytes popping out forming a halo

B cell membrane stain

CD20

Primary CNS lymphoma stain?

CD20

Primary CNS lymphoma

CD20 B cell stain

Sea of blue cells lymphocytes

Primary CNS lymphoma

Primary CNS lymphoma has a _____ prognosis

good

Periventricular Neoplasms

Ependymomas

Central neurocytomas

Colloid cyst

Ependymomas

Central neurocytomas

Colloid cyst

Periventricular Neoplasms

Ependymoma is a _______ neoplasm

periventricular

Central neurocytoma is a _______ neoplasm

periventricular

Colloid cyst is a _______ neoplasm

periventricular

Common (10-20 % of brain tumors)

ages 30-40

(Anterior) Pituitary Adenomas

Gigantism in children and acromegaly in adults from increased ____

(Anterior) Pituitary Adenomas

GH

Cushing’s disease increased _____ triggering the adrenal gland to increase production of steroid hormones

(Anterior) Pituitary Adenomas

ACTH

Hyperthyroidism from too much ___

TSH

(Anterior) Pituitary Adenomas

(Anterior) Pituitary Adenomas