Gross: cerebral hemispheres, grey-white, firm or soft, background of GFAP+ filbrillary extensive

gelatinous, distorts underlying brain Diffuse (G II) network of astrocyte processes btwn nuclei,
Sx: seizure, HA, focal neuro replaces neurons
Infiltrating Molecular: classic (mutation PTEN, deletion chromo 10, More dense, mitotic figures, greater nuclear
Anaplastic (G III)
astrocytoma amplification EGFR), proneural (TP53 mutation, point pleomorphism
mutation IDH1/2), neural (more neural markers), similar to anaplastic, glomerular bodies
mesenchymal (deletion NF1) Glioblastoma (G IV) (proliferating endothelial cells bulge into
Gliomas +IDH1 = better px vascular lumen), pseudopalisading, necrosis
Cerebellum, children and young adults, very good px, resectable
Pilocytic
from progenitor cell, Morph: cystic w/ mural nodules, bipolar cells w/ hair like processes, GFAP+, rosenthal fibers (eosinophilic granular bodies)
astrocytoma (G I)
not mature cell type Molecular: rare TP53 mutation, alteration in BRAF signaling pathway
Cerebral hemispheres WM, 4-5th decade, seizures, better px than astrocytoma
Molecular: IDH1/2 mutation, EGFR amplification NOT seen like in astrocytoma
Oligodendrogliomas
Morph: gelatinous gray mass, cysts, focal hemorrhage, calcification, well circumscribed, sheets, perinuclear halos (fried egg),
anastomosing capillary network (chicken wire vascular pattern)
Ventricles in kids  hydrocephalus and spread through CSF, spinal cord in adults, px variable
Ependymoma Morph: solid/papillary, extends from ventricle floor, ependymal rosettes, perivascular pseudo-rosettes, GFAP+, round/oval nuclei
in fibrillary background
Temporal lobes, less common, young adults, seizures, BRAF mutation, cystic components
Neuronal Ganglioma
Others: dysembryoplastic neuroepithelial (childhood, good px), central neurocytoma (only neuronal elements, ventricular system)
Cerebellum, kids, drop metastasis via CSF dissemination, forms nodular masses throughout neuroaxis, poor px if untreated but
Medulloblastoma good response to radiation
Poorly Morph: well circumscribed, grey, friable, sheets small blue anaplastic cells, scant cytoplasm, mitosis, Homer-Wright rosettes
differentiated Posterior fossa, kids <5yo, highly malignant, poor px (<1 year)
Atypical/rhabdoid
(embryonal) Morph: large, rhabdoid cells mixed with small cell, extreme mitosis Molecular: chromo 22 alteration
Vascular, cerebellum, 20-40yo, secrete EPO  polycythemia, cured by resection only
Hemangioblastoma
Morph: cysts with mural nodules, low grade, circumscribed, highly vascular, strong positivity for inhibin-alpha
Primary CNS Aggressive, common in immunosuppressed and AIDS b/c of EBV, majority diffuse large C cell, silver stain w/ hooping pattern,
Other parenchymal lymphoma multifocal, rare involvement outside of brain
Germ cell Midline, pineal and supracellar region, adolescents/young adults, histo similar to gonadal germ cell, mets common
Extra-axial, attached to dura – subfrontal, parasaggital, compress brain, F>M, benign, slow growing, risk = prior radiation
Meningioma Molecular: loss long arm chromo 22q that holds NF2 (multifocal in NF2, solitary if sporadic)
Morph: rounded, encapsulated mass with dural base, benign nuclei with whorls and psamomma bodies, may grow en plaque
Metastatic Lung, breast, skim (melanoma), kidney, GIT; sharply demarcated masses at junction of GM and WM
AD, hamartomas in CNS – cortical tubers, subependymal nodules, cutaneous lesions, cysts in liver/kidney/pancreas, seizures,
Tuberous sclerosis
autism, mental retardation; mutations in TSC1 (hamartin) and TSC2 (tuberin)
Familial tumor
VHL AD, hemangioblastomas in CNS, cysts of pancrease/liver/kidney, RCC, pheochromocytoma, EPO dysregulation; VHL on chromo 3
syndromes
AD, 1 – gliomas optic nerve, pigmented iris nodules (Lisch), cutaneous hyperpigmented macules (café au lait), 2 – b/l aucoustic
NF1/2
schwannomas, multiple memingiomas, ependymomas of spinal cord
Benign, common in vestibular br CN VIII in cerebellopontine angle  tinnitus, hearing loss
Schwannoma
Morph: encapsulated, tan-grey mass, biphasic pattern of spindle cells
Peripheral
Sporadic of NF1 Morph: benign tumor w/ neoplastic Schwann cells mixed w/ perineurial like cells, fibroblasts, mast cells, CD4+
Neurofibroma
spindle cells, may be in skin or peripheral nerves, incorporates nerve of origin, may form plexiform lesions