Материал: Kaplan USMLE-1 (2013) - Anatomy

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Section IV • Neuroscience

Half of brain and spinal cord tumors are metastatic. Some differences between primary and metastatic twnors are listed in Table IV-2-2:

Table IV-2-2. Tumors ofthe CNS and PNS

Primary

Metastatic

Poorly circumscribed

Well circumscribed

Usually single

Often multiple

Location varies by specific type

Usually located at the junction

 

between gray and white matter

Abbreviations: CNS, central nervous system; PNS, peripheral nervous system

Table IV-2-3. PrimaryTumors

Tumor

Glioblastoma multiforme (grade IV astrocytoma)

Astrocytoma

(pilocytic)

Oligodendroglioma

Features

•Most common primary brain tumor

•Highly malignant

•Usually lethal in 8-12 months

Benign tumor of children and young adults Usually in posteriorfossa in children

•Slow growing

•Long survival (average 5-10 years)

Ependymoma

•

Ependymal origin

 

Can arise in IV ventricle and lead to hydrocephalus

Medulloblastoma

Highly malignant cerebellar tumor

 

• A type of primitive neuroectodermal tumor (PNEl)

Meningioma

•

Second most common primary brain tumor

 

Dural convexities; parasagittal region

Schwannoma

Third most common primary brain tumor

 

• Most frequent location: CN VIII atcerebellopontine angle

 

• Hearing loss, tinnitus, CN V + VII signs

 

• Good prognosis after surgical resection

Retinoblastoma

 

Sporadic-unilateral

 

 

Familial-bilateral; associated with osteosarcoma

Craniopharyngioma

 

Derived from oral epithelium (remnants of Rathke pouch)

 

 

Usually children and young adults

Often calcified

Symptoms due to encroachment on pituitary stalk or optic chiasm

Benign but may recur

Pathology

•Can cross the midline via the corpus callosum ("butterfly glioma")

•Areas of necrosis surrounded by rows of neoplastic cells

(pseudopalisading necrosis) Rosenthal fibers lmmunostaining with GFAP

•"Fried-egg" appearance­ perinuclear halo

Rosettes and pseudorosettes

Blue, small, round cells with pseudorosettes

Attaches to the dura, compresses underlying brain without invasion

Microscopic-psammoma bodies

•Antoni A (hypercellular) and B (hypocellular) areas

•Bilateral acoustic schwannomas­

pathognomonic for neurofibromatosis type 2

Small, round, blue cells; may have rosettes

Histology resembles adamantinoma (most common tumor oftooth)

Abbreviation: GFAP, glial fibrillary acidic protein

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Chapter 2 • Central NervousSystem

ChapterSummary

•The neural tube forms 3 primary vesicles at its cranial end:

-Forebrain (prosencephalon)

-Midbrain

-Hindbrain (rhombencephalon)

•These primary vesicles then develop into 5 secondary vesicles that form the adult derivatives of the CNS.

-The telencephalon forms the cerebral hemispheres

-The diencephalon forms 4 thalamic derivatives

-The mesencephalon forms the midbrain

-The metencephalon forms the pons and cerebellum

-The myelencephalon forms the medulla

•The remainder of the neural tube forms the spinal cord. The lumen of the neural tube will develop into the ventricular system.

•The typical neuron is the multipolar neuron. It consists of a cell body (soma), multiple dendrites, and a single axon. Axons utilize anterograde and retrograde axonal transport to move subcellular elements to and from the soma. Skeletal motor neurons, preganglionic autonomic neurons, and glial cells develop from the neural tube. Glial cells include astrocytes, oligodendrocytes, microglia, and ependymal cells.

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