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CNS Path no. 3

CNS Path no. 3. What tumour am I?. Retinoblastoma Most common eye tumour of childhood 90% cases diagnosed before 7yrs old Usually fatal once it spreads outside the orbit. Intraocular melanoma Most common primary ocular malignancy in caucasians Most arise in the posterior choroid

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CNS Path no. 3

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  1. CNS Path no. 3

  2. What tumour am I? • Retinoblastoma • Most common eye tumour of childhood • 90% cases diagnosed before 7yrs old • Usually fatal once it spreads outside the orbit • Intraocular melanoma • Most common primary ocular malignancy in caucasians • Most arise in the posterior choroid • May spread btw sclera and retina or may produce bulbous masses projecting into the vitreous cavity and pushing the retina ahead

  3. Multiple = metastatic carcinoma

  4. Meningioma • Arise from? • Arachnoid granulations

  5. Astrocytoma • What is green arrow pointing at?? • Duret haemorrhages • Astrocytomas are classified as a form of glioma. What are the other 2 forms? • Oligodendroglioma • Ependymoma

  6. WHAT causes Duret haemorrhages to occur? • Occur secondary to an increased ICP – causing transtentorialherniation. • The pathophysiology of Duret haemorrhage remains under debate: either arterial origin (stretching and laceration of pontine perforating branches of the basilar artery), versus venous origin (thrombosis and venous infarction). • Multifactorial causation seems the likely explanation.

  7. A 5y/o boy presents w/ ataxia, headaches 1/52. Sudden onset vomiting, becomes comatose.CT = 4cm mass in cereballarvermis + dilation of cerebral ventricles.LP = Small dark cells with blue nuclei.WHICH NEOPLASM IS MOST LIKELY? • Schwannoma • Ependymoma • Glioblastomamultiforme • Medulloblastoma • Mets • don’t seed to CSF • Arise in ventricles • Seeds to CSF but not seen in kids • CORRECT! • Uncommon in children Medulloblastoma fits with CF’s, location, and cytological findings. Cells seed into the CSF Common tumour of young children.

  8. Incidental CT finding: 5cm well circumscribed mass beneath dura, compressing underlying left lateral parietal lobe. After resection – histology shows it is composed of elongated cells with pale, oblong nuceli and pink cytoplasm.WHICH NEOPLASM IS MOST LIKELY ? • Meningioma • Tuberculoma • Medulloblastoma • Schwannoma • Ependymoma • CORRECT! • Unlikely • Childhood and posterior fossa • Wrong location • Arises in ventricles • Meningioma arise from arachnoid granulations, often attached to the dura. Most often seen in adult women. • Well circumscribed lesions.

  9. 56yo male, presents with grand mal seizure – no prior seizure Hx. MRI shows three lesion 1-3cm in diameter, located at grey-white junction of cerebral hemispheres. WHAT NEOPLASM? Metastatic carcinoma

  10. 45 yo female, presents with unilateral headaches. WHICH NEOPLASM IS MOST LIKELY? • CORRECT! • Occur within cerebral hemi’s • Arise from w/in ventricles • Unusual location, not multiple • Meningioma. • Gliomas • Ependymal • Mets

  11. 45 yo female presents with diminished hearing on left. CT = well circumscribed 4cm mass adjacent to left pons, extending into inferior cerebella hemisphere. WHICH NEOPLASM IS MOST LIKELY? • Rare in this location • Wrong location • CORRECT! • Normally found in childhood • Normally arises in ventricles • Schwannoma’s often arise from 8th cranial nerve = acoustic neuroma • Slow growing and benign. • Meningioma • Astrocytoma • Schwannoma • Medulloblastoma • Ependymoma

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