Name (Grade) Pilocytic Astrocytoma (1/4)

Diffuse Astrocytoma (2/4)

Morphology Distinguished bc its relatively benign; cystic; wellcircumscribed; rosenthal bodies, eosinophilic granulocytic bodies; thickened blood vessels NOTE- non-infiltrative Poorly defined gray tumor; big enough to replace a whole hemisphere; always infiltrates around its margins

Molecular Genetics composed of bipolar cells that are GFAP (+); p53 mutations are RARE

Epidemiology Childhood tumor; usually in the cerebellum; also in the 3rd ventricle (optic nerve and cerebral hemispheres); Resection is possible

P53 mutations; over-expression of PDGF-A; GFAP Glial Fibrillary Acidic Protein (+)

Anaplastic Astrocytoma (3/4) DONT WASTE YOU NEURONS ON THIS ONEIT REALLY ISNT WORTH ITIMHO

More densely cellular with more mitotic figures; gemistocytic astrocytoma (bright eosinophilic cell bodies)

Glioblastoma (4/4)

Soft; firm and white; yellow because of necrosis; degeneration; and endothelial cell proliferation (wide spectrum morphology); pattern of pseudopallasating; vascular proliferation (glomeruloid body)

Oligodendroglioma (2/4)

Well-circumscribed masses; hemorrhage calcification; infiltrate in the cerebral cortex; typically in the white matter

Same as above; higher grades are associated with disruption of Rb gene (Retinoblastoma); p16 mutation; disruption of chr19q gene (possible TSG) Primary EGF-R gene mutation; increase RAS and PI3 pathways Secondary P53 mutations; amplification of MDM2 (inhibitor of p53); increase signaling through PDGF-A receptor LOH for 1p and 19q

Mean survival more than 5 years; usually progresses a higher histologic grade; radiologic studies- changes in brain, i.e. edema; most common in 4th to 6th decade of life; POOR PROGNOSIS; seizures, headaches, and other neurological deficits Same as above

Secondary is after Astrocytoma (when it appears in young people- low grade Astrocytoma) Primary deals with the older population; high grade Astrocytoma will show up really well of CT scans because of new leaky vasculature (blood shows up really well on CT)

Incur a better outcome with LOH; those that are not LOH are resistant to treatment; progress to anaplastic oligodendroglioma; overall, average survival is 5-10 years

Ependymoma (2/4)

Meningioma (usually 1/4)

Medulloblastoma

Typically occur in 4th ventricle- either solid or papillary masses; usually impossible to resect because proximal to important structures (pons, medulla) unless it is in the spine (adult); perivascular pseudorosettes; Usually attached to the dura; derived from the meningothelial cells of the arachnoid; found in external surface of the brain or the ventricular system; round, encapsulated masses; compress the brain, but are easily to take out (usually does not infiltrate); can grow en plaque (sheet); contain psammoma bodies (calcified); DO NOT SEE NECROSIS OR HEMORRHAGE; 6 different patterns: 1)syncitial 2)fibroblastic 3)transitional 4)psammomatous 5) secretory 6)microcystic (spongy) Occurs in midline of cerebellum of children; well-circumscribed, gray, and freely movable; high cellularity and sheets of anaplastic cells; commonly disseminates the CSF; presents as a nodular or mass elsewhere in the CNS; drop metastases

NF2 on chr22 (spinal cord); supertentoral lesions via chr9; NO P53 mutations!!!

If it occurs in posterior fossa, there will be hydrocephalus secondary to obstruction. CSF dissemination is common (BAD); general lesions in the posterior fossa have the worst outcome; the first 2 decades of life deal with the 4th ventricle; adults have more spinal cord-related issues Slow-growing; presents with nonlocalizing symptoms or focal findings relevant to brain compression; if present in multiple sites, may be NF2 mutation; grow more rapidly during pregnancy because of progesterone; 3:1 female to male ratio; differentiate from metastases, fibrous tumors growing on the dura

Immunoreactive to epithelial membrane antigens; keratin in the secretory patten; carcinoembryonic antigen (CEA)- (+); loss of chr22 NF2, encodes merlin

LOH from 17qpoor prognosis; MIC is possible and more aggressive

Highly malignant; dismal prognosis; very radiosensitive; 5 years survival (75%) with treatment

Schwannoma

Neurofibroma

Well-circumscribed, encapsulated, masses attached to nerve but can be separated; 2 patterns: Antoni A, Antoni Baxons are excluded; from tumors most occur at cerebullopontine angle and attach to vestibular branch of CN VIII; indura- branches of trigeminal nerve and dorsal roots; extradural- involved with large nerves with motor and sensory involvement Discreet localized massesCutaneous neurofibroma (CNS) and Solitary neurofibroma (PNS); Plexiform (shredded carrot) worst!

associated with NF2 mutation; S-100 (+)

Malignant change is rare; patients present with tinnitus and hear loss (acoustic neuroma);

NF1 and NF2 mutations

Highly variable depending on the presentation