Chapter 24

CNS
Sr. No. TOPIC Page No.
1 Normal brain 2

2 Subarachnoid haemorrhage 6

3 CSF findings in health and various types of meningitis 8

4 Pyogenic meningitis 9

5 Tuberculous meningitis 10

6 Classification of CNS tumors 11

7 Astrocytoma 12

8 Oligodendroglioma 15

9 Ependymoma (WHO grade II) 17

10 Meningioma 18

11 Medulloblastoma 19

12 Important questions 21

Second Edition (2020):

Notes:
WHO fascicles for brain tumors
Robbins & Cotran, Pathologic Basis of Diseases, South Asia Edition, 2014
MCQs:
Praveen Kr Gupta & Vandana Puri, Complete Review of Pathology & Hematology for NBE, 2019-20, 5th Edition
Harsh Mohan, Pathology Quick. Review and MCQs, 4th Edition
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 NORMAL BRAIN

Meninges: Comprise of 3 sequential connective tissue membranes, called meninges cover the brain &
spinal cord.

Gray and white matter: Morphologically all parts of CNS are made up of grey matter and white
matter.

Neurons: Neuron is the functional unit of the nervous system. It consists of cell body containing the
nucleus and several processes of varying lengths (axons and dendrites). Grey matter consists of most of
neuron cell bodies and white matter the axons.

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Neuroglial cells: Other than neurons, the CNS is composed of supporting cells, called the ‘neuroglial
cells’ (‘glial cells’). There are four types of ‘glial cells’:
1. Astrocytes,
2. Oligodendrocytes,
3. Microglia, and
4. Ependymal cells.

Astrocytes: They provide physical and morphological support (mesenchymal1) to the neurons. The cells
have dark small round, oval to elongated nuclei and lack stainable cytoplasm.

Rosenthal fibres are thick, elongated, brightly eosinophilic, irregular structures that occur within
astrocytic processes2, containing heat-shock proteins3 and ubiquitin. They are particularly seen in long
standing gliosis.

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Reactive astrocytes (gemistocytes): They have enlarged nuclei, often eccentric and a mass of
eosinophilic cytoplasm.

Oligodendrocytes: They maintain the myelin in the CNS. The cells have round nuclei and distinct clear
cytoplasm.

Microglia: They possess phagocytic4 properties. Cells have elongated vesicular nuclei.

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Ependymal cells: They line the ventricles of the brain and the central canal of the spinal cord. They
form a single layer of ciliated cuboidal-to-columnar cells.

1. Which is a mesenchymal cell?

A. Microglia
B. Astrocytoma
C. Oligodendroglioma
D. Ependymal cells

2. Rosenthal fibers are:

A. Intranuclear inclusions
B. Intracytoplasmic inclusions
C. Present extracellularly
D. Part of cell membrane

3. Rosenthal fibers in astrocytoma are composed of:

A. Heat shock proteins
B. Fibrillar proteins
C. GFAP
D. Globulins

4. Phagocytosis in brain is caused by:

A. Astrocytes
B. Microglia
C. Oligodendrocytes
D. Ependymal cells

KEYS: 1. B, 2. B, 3. A, 4. B

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 SUBARACHNOID HEMORRHAGE (SAH)

Causes of SAH:
1. The most frequent cause of clinically significant subarachnoid hemorrhage is rupture of a
saccular (berry) aneurysm.
2. Extension of traumatic hematoma
3. Rupture of a hypertensive intracerebral hemorrhage into the ventricular system
4. Vascular malformation
5. Hematologic disturbances
6. Tumors

Types of intracranial aneurysm:

1. Saccular aneurysm (most common)
2. atherosclerotic (fusiform; mostly of the basilar artery)
3. mycotic
4. traumatic
5. dissecting
The last three more often cause cerebral infarction than subarachnoid hemorrhage.

SACCULAR (BERRY) ANEURYSM

Incidence: 2% of population

Site:
- 90% are near major arterial branch points in the anterior circulation.
- 20-30% cases have multiple aneurysms.

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Pathogenesis:
- Sporadic (majority)
- Genetic (few)
- Increased incidence is seen in
1. Autosomal dominant polycystic kidney disease
2. Ehlers-Danlos syndrome type IV
3. Neurofibromatosis type 1 [NF1]
4. Marfan syndrome
5. Fibromuscular dysplasia of extracranial arteries
6. Coarctation of the aorta

Risk factors:
1. cigarette smoking
2. hypertension

Clinical Features:
Rupture of an aneurysm and SAH is most frequent in the fifth decade and in females.
In 1/3rd cases, rupture is associated with acute increases in intracranial pressure, such as straining at stool
or sexual orgasm.
C/c:
- sudden, excruciating headache
- rapidly losing consciousness
- 25% and 50% of patients die with the first rupture, others gain consciousness in minutes
- repeat bleeding is common in survivors

Morphology:
An unruptured saccular aneurysm is a thin-walled outpouching, usually at an arterial branch point along
the circle of Willis or a major vessel just beyond.
- Measurement: few millimeters to 2 or 3 cm in diameter
- External appearance: bright red, shiny and a thin, translucent wall
- Neck of aneurysm: may be wide or narrow
- Arterial wall adjacent to the neck: intimal thickening and gradual attenuation of the media as it
approaches the neck
- Aneurysm sac: intimal elastic lamina and muscular wall are absent, while adventitia is
continuous with that of the parent artery. The intima is thickened and hyalinized. Atheromatous
plaques, calcification, or thrombotic occlusion may be seen in the wall or lumen.
- Rupture usually occurs at the apex of the sac with extravasation of blood into the subarachnoid
space, the substance of the brain, or both. Adjacent brain and meninges: may show brownish
discoloration due to prior hemorrhage.

VASCULAR MALFORMATIONS
Vascular malformations of the brain are classified into four principal groups:
1. arteriovenous malformations
2. cavernous malformations
3. capillary telangiectasias
4. venous angiomas
Of these, the first two are associated with risk of hemorrhage.

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Arteriovenous malformations (AVM):
- involve vessels in the subarachnoid space extending into brain parenchyma or may occur
exclusively within the brain. The most common site is the territory of the middle cerebral artery,
particularly its posterior branches.
- Males are affected twice as frequently as females, and the lesion is often recognized clinically
between the ages of
- Age of presentation: 10 and 30 years
- S/s: of seizure disorder, an intracerebral hemorrhage, or a subarachnoid hemorrhage.

Cavernous malformations consist of greatly distended, loosely organized vascular channels with thin,
collagenized walls most often in the cerebellum, pons, and subcortical regions.

1. Subarachnoid hemorrhage results most often from the following:

A. Hypertension
B. Aneurysm
C. Vascular malformation
D. Bleeding diathesis

KEYS: 1. B

CSF FINDINGS IN HEALTH AND VARIOUS TYPES OF MENINGITIS

CSF findings in health and various types of meningitis

Feature Normal Acute Acute Chronic
pyogenic lymphocytic (tuberculosis
(bacterial (viral meningitis)
meningitis) meningitis)
1 Naked eye Clear and Cloudy or Clear or slightly Clear of slightly
appearance colourless frankly turbid turbid, forms
purulent fibrin coagulum
on standing
(cobweb)
2 CSF 60-150 mm Elevated Elevated (above Elevated (above
pressure water (above 180 250 mm water) 300 mm water)
mm water)
3 Cells 0-4 1000-100,000 10-100 100-1000
lymphocytes/ neutrophils/m Mononuclears/m Mononuclears/m
ml l l l
4 Proteins 15-45 mg/dl Raised Raised Raised
5 Glucose 50-80 mg/dl Reduced Normal Reduced
(usually<40mg/ (usually less

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 dl) than 45 mg/dl)
6 Bacteriology Sterile Causative Sterile Tubercle bacilli
organisms present
present

1. Glucose content of CSF is unaltered in the following type of meningitis:

A. Acute pyogenic meningitis
B. Acute viral meningitis
C. Cryptococcal meningitis
D. Tuberculous meningitis

2. The appearance of cobweb formation in CSF indicates:

A. Pyogenic meningitis
B. Viral meningitis
C. Tuberculous meningitis
D. Fungal meningitis

KEYS: 1. B, 2. C

PYOGENIC MENINGITIS

Definition: Meningitis is an inflammatory process of the leptomeninges and CSF within the
subarachnoid space, while meningoencephalitis combines this with inflammation of the brain
parenchyma.

Classification:
Meningitis

Infectious Non-bacterial (chemical)

Acute Chronic Irritant in subarachnoid space

Pyogenic Aseptic Tuberculous

(Bacterial) (Viral) Spirochetal
Cryptococcal

Causative organism:
- Neonates: E. coli, group B streptococci
- Infants: Haemophilus influenzae; however the incidence is markedly reduced due to vaccination
- Adolescents and in young adults: Neisseria meningitidis
- Elderly: Streptococcus pneumoniae and Listeria monocytogenes

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Clinical features:
- Fever
- Signs of meningeal irritation and neurologic impairment: headache, photophobia, irritability,
clouding of consciousness, and neck stiffness
- The Waterhouse-Friderichsen syndrome results from meningitis-associated septicemia with
hemorrhagic infarction of the adrenal glands and cutaneous petechiae. It is more common with
meningococcal and pneumococcal meningitis.

CSF findings:

Sr. Feature Normal Pyogenic meningitis

1 Naked eye appearance Clear and colourless Cloudy or frankly purulent
2 CSF pressure 60-150 mm water Elevated (above 180 mm water)
3 Cells 0-4 lymphocytes/ml 1000-100,000 neutrophils/ml
4 Proteins 15-45 mg/dl Raised
5 Glucose 50-80 mg/dl Reduced
(usually <40 mg/dl)
6 Bacteriology Sterile Causative organisms present

Morphology:
- Meningeal vessels are engorged
- Neutrophils are exudate is evident within the leptomeninges over the surface of the brain.
- In less severe cases, inflammation is seen around leptomeningeal blood vessels.
- Location of the exudate varies according to the organism:
o in H. influenzae meningitis, it is usually basal
o in pneumococcal meningitis, it is often densest over the cerebral convexities near the
sagittal sinus
- Fulminant meningitis may extend to ventricles, causing ventriculitis or substance of brain (focal
cerebritis).
- Phlebitis may lead to venous thrombus and hemorrhagic infarct of underlying brain.
- Healing may lead to leptomeningeal fibrosis and development of hydrocephalus.
- Pneumococcal meningitis leads to chronic adhesive arachnoiditis.

TUBERCULOUS MENINGITIS

Tuberculosis of the meninges/brain may be part of systemic disease or an isolated infection.

Clinical features: headache, malaise, mental confusion, and vomiting

CSF findings:

Sr Feature Normal Chronic (tuberculosis meningitis)

1 Naked eye appearance Clear and colourless Clear of slightly turbid, forms fibrin
coagulum on standing (cobweb)
2 CSF pressure 60-150 mm water Elevated (above 300 mm water)

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 3 Cells 0-4 lymphocytes/ml 100-1000 Mononuclears/ml
4 Proteins 15-45 mg/dl Raised
5 Glucose 50-80 mg/dl Reduced (usually less than 45 mg/dl)
(usually <40mg/dl)
6 Bacteriology Sterile Tubercle bacilli present

Morphology:
Grossly:
- Subarachnoid space: shows gelatinous or fibrinous exudate, most often at the base of the brain,
obliterating the cisterns and encasing cranial nerves. There may be
- Leptomeninges: may show discrete, white granules diffusely scattered

Microscopic examination:
Subarachnoid space:
- May show presence of lymphocytes, plasma cells, and macrophages
- In florid cases, well-formed granulomas with caseous necrosis and Langhan’s giant cells may be
seen.
- Arteries may show obliterative endarteritis with inflammatory infiltrate in their walls and marked
intimal thickening.
- ZN stain: may be positive for AFB

Parenchyma (brain): may show single or multiple well-circumscribed mass (tuberculoma). Tuberculoma
comprises of central core of caseous necrosis surrounded by epithelioid cells, lymphocytes and plasma
cells.

Complications:
1. arachnoid fibrosis producing hydrocephalus
2. obliterative endarteritis producing arterial occlusion and infarction of underlying brain
3. When the process involves the spinal cord subarachnoid space, nerve roots may also be affected.

HIV-positive individuals: have increased risk of M. avium-intracellulare infection. CNS involvement is

in a setting of disseminated infection. The lesions typically contain confluent sheets of macrophages
filled with organisms, with little or no associated granulomatous reaction.

CLASSIFICATION OF CNS TUMORS

A. TUMORS OF NEUROGLIA {GLIOMA (Gliomas are the most common primary CNS tumors,
accounting for 40% of CNS tumors)}:
1. Astrocytoma
2. Oligodendroglioma
3. Ependymoma

B. TUMORS OF NEURONS:
1. Neuroblastoma
2. Ganglioneuroma

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C. TUMORS OF MENINGES:
Meningioma

D. POORLY DIFFEERENTTTIATED TUMORS: Medulloblastoma

E. OTHERS: Primary CNS lymphoma

F. METASTATIC TUMORS:
- They account for 25-50%1 of intra-cranial tumors.
- The most common primary sites are lung, breast2, skin (melanoma), kidney and GIT.
- Choriocarcinoma has high propensity for metastasis to the brain.
- Meninges is the most frequent site of involvement of metastatic deposit. Carcinoma of breast
and lung account for 41%3 and 24% cases of leptomeningeal carcinomatosis.
- Intraparenchymal metastasis is seen more commonly at the junction of gray and white matter.

1. The commonest intracranial tumor is:

A. Glioma
B. Pituitary tumor
C. Meningioma
D. Metastasis
2. Common primary sites of metastasis to the brain are:
A. Thyroid carcinoma
B. Tongue carcinoma
C. Lung carcinoma
D. Breast carcinoma
E. Ovary carcinoma

3. The most common cause of leptomeningeal metastasis is adenocarcinoma arising from:

A. Breast
B. Thyroid
C. Bone
D. Liver

KEYS: 1. D, 2. C,D, 3. A

ASTROCYTOMA

Incidence: Most common type of glioma

Pathological grades:
1. Pilocytic astrocytoma, WHO Grade I
2. Diffuse astrocytoma, WHO Grade II
3. Anaplastic astrocytoma, WHO Grade III
4. Glioblastoma multiforme, WHO Grade IV

Pilocytic astrocytoma (WHO grade I):

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Age of presentation: First two decades of life; is the most common pediatric brain tumor1

Site:
Cerebellum, optic nerve, hypothalamus, thalamus and basal ganglia, cerebral hemispheres, brain stem.

Gross:
- Soft discrete gray tumor
- Cyst formation is common

Microscopy:
- Tumor shows astrocytes having elongated, bland nuclei and long hair-like processes
- Microcystic areas are seen
- Another histologic feature is presence of brightly eosinophilic, corkscrew-shaped Rosenthal
fibres2.

IHC: The tumor is glial fibrillary acidic protein (GFAP) positive

Tumor progression: Slowly growing masses, which at any point may stabilize or even regress.

Management:
- Surgical excision
- Post-operative radiotherapy, if surgical excision is not complete (especially in the regions of
brain stem, hypothalamus).

Diffuse astrocytoma (WHO grade II):

Age distribution: Typically affect young adults. Peak incidence: 30 and 40 years.

Site:
- Supratentorially in the frontal and temporal lobes
- Brain stem
- Spinal cord

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 Gross appearance:
- Mass lesion either in the gray- or white-matter
- Have indistinct margins; tumor merges with the surrounding tissue
- Cyst formation may be seen
- Focal calcification may be present

Microscopic appearance:
1. Diffuse fibrillary astrocytoma
2. Gemistocytic astrocytoma (gemistocytes should account for >20% of tumor cells)
3. Protoplasmic astrocytoma

Diffuse fibrillary astrocytoma:

- Cellularity moderately increased
- Occasional nuclear atypia is seen
- Abundance of cytoplasmic fibrillary background
- Mitosis, necrosis and microvascular proliferation should be ABSENT. A single mitosis can be
compatible with the diagnosis in the absence of the latter two

IHC: GFAP is consistently expressed

Management:
- Surgical excision
- Post-operative radiotherapy, if surgical excision is not complete (especially in the regions of
brain stem).

Outcome: Mean survival time after surgical intervention is 6-8 years.

Anaplastic astrocytoma (WHO grade III):

Origin: Arise from low grade astrocytomas or de novo

Age distribution: Mean age 41 years

Site: Cerebral hemispheres

Gross appearance:
Tumor mass with sometimes more clear distinction from surrounding brain structures.
Macroscopic cysts are uncommon.

Microscopic appearance:
Histopathological features:
- increased cellularity
- distinct nuclear atypia
- marked mitotic activity
- multinucleated tumour cells and abnormal mitosis are common
- necrosis and microvascular proliferation are not compatible with the diagnosis of anaplastic
astrocytoma.

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Prognosis: Interval time for progression to glioblastoma is 2 years

Glioblastoma multiforme (WHO grade IV):

Origin: Arise from low grade astrocytomas (secondary glioblastoma) but more frequently are de novo
(primary glioblastoma).

Age: Peak incidence between 45-70 years (mean, 53 yr)

Site: Subcortical white matter of cerebral hemispheres (temporal4, parietal, frontal and occipital)

Gross appearance:
Poorly delineated
Cut surface shows variable colors, grayish to yellowish (areas of necrosis), red or brown spots of
hemorrhage.
Cysts containing turbid necrotic fluid may be seen.
A very common feature is extension of tumor through corpus callosum into contralateral hemisphere;
creating a bilateral symmetrical lesion (‘butterfly glioma’).

Microscopy:
- Characterized by highly anaplastic glial cells with presence of multinucleated giant cells, and
high mitotic activity.
- Necrosis and/ vascular proliferation are essential diagnostic features.
- Necrosis: Large areas of necrosis occur in the tumor center. Viable tumor cells tend to
accumulate in the periphery5.
- Vascular proliferation: Vascular proliferation is commonly found around necrosis and in the
periphery. It appears as: ‘glomeruloid tufts’, and blood vessels lined by multilayered mitotically
active endothelial cells.

Life expectancy: <one year

OLIGODENDROGLIOMA

Introduction: WHO grading system recognizes two malignancy grades for oligodendroglial tumors:
1. WHO grade II for well-differentiated tumors
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2. WHO grade III for anaplastic oligodendroglioma

Oligodendroglioma (WHO grade II):

Age: Adult with peak incidence in 5th and 6th decades

Site: Cerebral hemispheres, commonly frontal lobe (50-65%); others: temporal, parietal, and occipital).
Arise preferentially in the white matter.

Gross:
Well-defined soft grayish-pink mass
Located in cortex and white matter
Mucoid degeneration may be seen, which leads to gelatinous appearance

Microscopy:
Moderately cellular
Tumor cells are rounded with homogeneous nuclei and have a swollen clear cytoplasm (honeycomb
appearance).
Microcalcification, mucoid or cystic degeneration may be seen.
Marked nuclear atypia and an occasional mitosis is compatible with the diagnosis.
Significant mitotic activity, necrosis and microvascular proliferation indicate progression to grade III.

IHC:
There is no IHC marker for oligodendroglial cells.
Vimentin may be expressed in oligodendrogliomas.

Predictive factors: 5-year survival rate of patients with oligodendroglioma is 83%

Anaplastic oligodendroglioma:
Gross: In addition, the tumor may demonstrate areas of necrosis

Microscopy:
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 - Increased cellularity
- Marked cytological atypia
- High mitotic activity
- Microvascular proliferation and necrosis may be present

Predictive outcome: 5-year survival rate is 23%

EPENDYMOMA (WHO GRADE II)

Age: It is a slowly growing tumour of children and young adults.

Site: Originate from the wall of cerebral ventricles or from the spinal canal.

Gross:
- Generally well-demarcated
- Protrude into the ventricular lumen

Microscopy:
- Perivascular pseudorosettes6: tumor cells arranged radially around blood vessels
- Ependymal true rosettes: columnar cells arranged around a central lumen

IHC:
- Typically, express S 100 protein, vimentin and EMA
- Prominent GFAP immunoreactivity is observed in pseudorosettes

Predictive factors:
Clinical outcome in children (below 3 years) appears to be significantly worse than in adults because of:
- more common posterior fossa location in children
- more prominent anaplastic features in this age group

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 MENINGIOMA

Introduction: They are generally slow growing benign tumors, attached to the duramater. They arise
from the cap cell layer of arachnoid matter7.

Risk factor: prior radiation therapy

Age of presentation: Most common in middle age and elderly, peak incidence in 6th and 7th decades.
Also occur in children.

Site: Occur in intracranial, orbital and intraventricular cavities; spinal canal. In the intracranial cavity,
most arise over the cerebral convexities, closely associated to falx cerebri. Spinal meningiomas are most
common in thoracic region.

Gross appearance: Well-demarcated, rubbery to firm, rounded masses with broad dural attachment,
that compress brain but can be easily separated from it.

Microscopy:
Pathological grade:
Meningothelial
Fibrous
Transitional (mixed) WHO Grade I
Psammomatous
Angiomatous…

Atypical WHO Grade II

Clear cell…

Papillary WHO Grade III

Anaplastic…

Whorling Psammoma bodies

Meningothelial (syncytial) meningioma:

- It is the classic and common variant.
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- Tumor cells form lobules that are surrounded by thin collagenous septae. Tumor cells are polygonal,
with round to oval central nuclei, abundant granular cytoplasm and poorly defined cell membranes
(syncytial).
- Whorling and psammoma bodies are less common in this variant.

Fibrous meningioma: Spindle-shaped cells resembling fibroblasts form parallel and interlacing bundles.

Transitional meningioma:
- Have features transitional between meningothelial and fibrous meningioma.
- Whorls are conspicuous and frequent.
- Psammoma bodies are frequent.

Psammomatous meningioma:
- These tumors characteristically occur in thoracic spinal region.
- Neoplastic cells have a transitional appearance with whorls; although most of the whorls are
replaced by psammoma bodies.

Atypical meningioma:
- Associated with aggressive local growth and high rate of recurrence.
- Diagnosed by mitotic index ³4/ 10 hpf or at least three atypical features (increased cellularity,
high N:C ratio, prominent nucleoli, patternless growth, or necrosis).

Anaplastic meningioma:
- Highly aggressive tumor
- Histologically a high-grade sarcoma with some evidence of meningothelial origin
- MI ³20/ 10 hpf

MEDULLOBLASTOMA (WHO GRADE IV)

Age of presentation: It is the second most common pediatric brain tumor, after pilocytic astrocytoma
and most common malignant brain tumor in children. It may be seen in adults also.

Site: Exclusively in cerebellum8; midline cerebellum in children and lateral location in adult.

Morphology:
Grossly: tumor is well circumscribed, gray, friable. It may extend to the surface involving the
leptomeninges.

Microscopically: tumor is densely cellular with sheets of anaplastic cells. Individual cell is small, with
scant cytoplasm and hyperchromatic nuclei. Mitosis are abundant.

Prognosis:
- Highly malignant tumor but is radiosensitive9
- High propensity to disseminate through CSF10, producing tumor masses at distant sites e.g. cauda
equina. They are called ‘drop metastases’.

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1. Most common cerebellar tumor in children?
A. Astrocytoma
B. Medulloblastoma
C. Ependymoma
D. PNET

2. Rosenthal fibers are seen in:

A. Pilocytic astrocytoma
B. Medulloblastoma
C. Ependymoma
D. Gliolastoma

3. Which of the following statement(s) is/are true about pilocytic astrocytoma:

A. Slow growing
B. Eosinophilic granular bodies
C. Most commonly involve cerebellum
D. Mostly cystic in nature
E. Negative GFAP

4. Most common site for glioblastoma multiforme is:

A. CP angle
B. Temporal lobe
C. Brain stem
D. Occipital lobe

5. A 40-year-old lady is diagnosed to have brain tumor in frontal lobe. The lesion is
characterized by focal necrosis surrounded by ring-like enhancement.
A. Glioblastoma multiforme
B. Oligodendroglioma
C. Ependymoma
D. Astrocytoma

6. Perivascular pseudorosettes are classically seen in:

A. Ependymoma
B. Oligodendroglioma
C. Astrocytoma
D. Medulloblastoma

7. True about meningioma:

A. More common in men
B. 50% are malignant
C. 95% cure rate following treatment
D. Arise from arachnoid layer

8. Most common site for medulloblastoma is:

A. Cerebellum
B. Pituitary
C. Cerebrum
D. Basal ganglia
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 9. Following is true about medulloblastoma:
A. It is seen in elderly
B. It is radiosensitive tumor
C. Only treatment is surgery
D. Seen in anterior cranial fossa

10. Medulloblastoma most common metastases is to:

A. Lung
B. CNS
C. Liver
D. Bone

KEYS: 1. A, 2. A, 3. A,B,C,D, 4. B, 5. A, 6. A, 7. D, 8. A, 9. B, 10. B

IMPORTANT QUESTIONS

SHORT NOTES
1. CSF findings in pyogenic meningitis
2. CSF findings in tuberculous meningitis
3. Astrocytoma
4. Meningioma
5. Subarachnoid hemorrhage

SHORT ANSWERS
1. Classification of brain tumor
2. Histological types of meningioma

The End
Please refer text for further reading.
Mistakes are regretted.

Dr. Neena Doshi

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