Oncology Series

Dr. Priyanka Sachdev

• Breast tumours

• Tumours of CNS

• Thyroid Tumours

• Hemato- oncology

• Tumours of Kidney

• Liver Tumours
Breast tumours
 Normal Structure

• The breast is a modified skin appendage

• Functional in the females during lactation

• Rudimentary in the males.

 Components

1. Epithelial (10%)
2. Stromal (90%)
 Terminal duct-lobular unit (TDLU)

• The breast is divided into about 20 lobes.

• Each lobe consists of breast lobules
• Each lobule contains ductules or acini
• Ductules or acini opens into terminal ducts
• This is known as terminal ducts lobular unit (or TDLU)
• Terminal ducts drain into the nipple through lactiferous duct
• Lactiferous ducts shows a small dilatation called lactiferous sinus.
 Lining of TDLU

• The TDLU has bilayered lining:

1. Inner epithelium lining

2. Outer myoepithelial lining

 NORMAL LOBULE
BREAST ANATOMY WITH GLANDS

NORMAL DUCT
WITH STROMA EPITHELIAL
CELLS

FIBROBLASTS
 Stomal Breast Tumours

1. Fibroadenoma
2. Phyllodes tumour
 FIBROADENOMA

• Most common benign tumour

• 15 to 30 years of age

• Clinically appears as a solitary,discrete, freely mobile nodule within

the breast.
 Gross
• Small (2-4 cm diameter)
• Solitary
• Well encapsulated,spherical mass.
• The cut surface is firm, grey-white, slightly myxoid and may show
slit-like spaces formed by compressed ducts.
• Multiple fibroadenomas termed fibroadenomatosis.
Fibroadenoma (Gross) : Cut surface is showing characteristic
rubbery, glistening white, well-circumscribed mass and has a
septate appearance.
 Microscopy

• The arrangements between fibrous overgrowth and ducts may

produce two types of patterns 

1. Intracanalicular
2. Pericanalicular
 1. Intracanalicular pattern
• The stroma compresses the ducts so that they are reduced to slit-
like clefts lined by ductal epithelium
 2. Pericanalicular pattern
• Encircling masses of fibrous stroma around the patent or dilated
ducts.
 Phyllodes Tumour
(Cystosarcoma Phyllodes)

• Phyllodes = leaf-like
• Aggressive clinical behaviour.
• 30 to 70 years of age. (peak 60 years)
• Can be classified into benign, borderline and malignant
• Local recurrences are much more frequent than metastases.
 Grossly

• 10-15 cm in diameter
• Round to oval, bosselated
• Less fully encapsulated than a fibroadenoma.
• The cut surface is grey-white with cystic cavities, areas of
haemorrhages, necrosis and degenerative changes
 Microscopy
• Extremely hypercellular stroma and stromal overgrowth
accompanied by benign ductal structures  typical Leaf like
architechture

• Thus, phyllodes tumour resembles fibroadenoma except for marked

stromal overgrowth.
WHO Classification Benign PT Borderline PT Malignant PT
Stromal cellularity Modest Modest Marked
Cellular Little Moderate Marked
pleomorphism
Mitoses Few, if any Intermediate Numerous
(>10/HPF)
Margins Well circumscribed Intermediate Invasive
(Pushing)
Stromal pattern Uniform stromal Heterogenous Marked stromal
distribution stromal distribution overgrowth
Heterologous Rare Rare Not uncommon
stromal distribution

Overall average 60 20 20
distribution (%)
Fibroadenoma Phyllodes Tumor
• 20-30 yrs old • Any age
• 2-3cm • >5cm
• Firm , rubbery, painless, movable, • Firm, mobile, well circumscribed,
well-circumscribed mass nontender mass
• Epithelial elements and connective • Epithelial elements and connective
tissue stroma tissue stroma (more cellular, more
pleomorphic and mitotically more
active)
• Rapid growth but not premalignant • Tendency to grow rapidly and
aggressively
 Breast Carcinoma

• Introduction
• Clinical features
• Triple technique
• Risk factors
• Classification
• Individual tumour microscopy
• Molecular classification
• Grading
• TMN Staging
 Breast Carcinoma
• Cancer of the female breast is among the commonest of human
cancers throughout the world
• Cancer of the male breast is rare
(ratio between male : female breast cancer is 1:150).
• The incidence of breast cancer is highest in the perimenopausal
age group
 Clinical features
• Clinically, the breast cancer usually presents as a solitary,painless,
palpable lump detected by self examination.
 Triple technique

Currently, emphasis is on early diagnosis by triple technique:

1. Palpation
2. Mammography
3. Fine needle aspiration cytology (FNAC)
Triple technique
RISK FACTORS
 [Link] and racial factors

• The incidence of breast cancer is 4-6 times higher in developed

countries and low in developing countries of Asia and Africa
 2. Family history
• First-degree relatives (mother, sister,daughter) of women with breast
cancer have 2 to 6-fold higher risk of development of breast cancer.

• The risk is proportionate to a few factors:

a. Number of blood relatives with breast cancer.
b. Younger age at the time of development of breast cancer.
c. Bilateral cancers.
d. High risk cancer families having breast and ovarian carcinomas.
 3. Menstrual and obstetric history

• Total length of menstrual life is directly related to increased risk.

• Thus, there is increased risk of breast cancer development in women
who had
1. Early menarche
2. Nulliparity
3. Delayed menopause
 4. Estrogen exposure
• Menopausal hormone therapy increases the risk of breast cancer

• Reducing endogenous estrogens by oophorectomy decreases the risk

of developing breast cancer by up to 75%.

• Drugs that block estrogenic effects (e.g., tamoxifen) or block the

formation of estrogen (e.g., aromatase inhibitors) also decrease the risk
of breast cancer.
 5. Fibrocystic change

• Fibrocystic change (atypical epithelial hyperplasia) has 5-fold

higher risk of developing breast cancer subsequently.
 6. Dietary factors

i) Consumption of large amounts of animal fats, high calorie foods.

ii) Cigarette smoking.
iii) Alcohol consumption.
 7. Exercise

• Protective effect for women who are physically active.

 8. Breast density

• Women with very dense breasts on mammography have a four-

to six-fold higher risk of breast cancer compared to women with
the lowest density.
 9. Environmental toxins

• Environmental contaminants such as organochlorine pesticides

have estrogenic effects on humans.
 10. Radiation exposure
• Radiation to the chest, whether for cancer therapy, due to atomic
bomb exposure, or nuclear accidents, results in a higher rate of breast
cancer.
 11. Genetic Factors

1. BRCA 1 gene 
• Located on chromosome 17
• Breast and ovarian cancer in inherited cases

2. BRCA 2 gene 
• Located on chromosome 13
• Breast and ovarian cancer in inherited cases

3. Mutation in p53 
• Tumour suppressor gene , located on chromosome 17
 CLASSIFICATION
BREAST CANCER

Non-invasive / carcinoma In-situ Invasive carcinoma

Ductal Lobular Ductal Lobular

DCIS LCIS IDC ILC
 BREAST CANCER

Non-invasive / carcinoma In-situ Invasive carcinoma

Ductal Lobular Ductal Lobular

DCIS LCIS IDC ILC
 Non-invasive / carcinoma In-situ

1. DCIS
2. LCIS
 Ductal Carcinoma in – situ (DCIS)

4 types of patterns 

a) Solid pattern  filling and plugging of the ductal lumina with

tumour cells.
b) Comedo pattern  centrally placed necrotic debris surrounded by
neoplastic cells in the duct.
c) Papillary pattern  Intraductal papillary projections of tumour
cells which lack a fibrovascular stalk
d) Cribriform pattern  Neat punched out fenestrations in the
intraductal tumour.
 Lobular Carcinoma in – Situ (LCIS)

• Characterized by filling up of terminal ducts and ductules or

acini by rather uniform cells which are loosely cohesive and
have small, rounded nuclei with indistinct cytoplasmic margins

• Higher incidence of developing a contralateral breast cancer

 BREAST CANCER

Non-invasive / carcinoma In-situ Invasive carcinoma

Ductal Lobular Ductal Lobular

DCIS LCIS IDC ILC
 Invasive Breast Carcinoma

1. Invasive Ductal Carcinoma (IDC)

2. Invasive Lobular Carcinoma (ILC)

 Invasive Duct Carcinoma (IDC)

a) Anaplastic tumour cells forming solid nests, cords,poorly-formed

glandular structures and some intraductal foci.

b) Infiltration of tumour cells into diffuse fibrous stroma and fat.

c) Invasion into perineural spaces

d) Lymphatic and vascular invasion.

 Invasive Lobular Carcinoma (ILC)

a) A characteristic single file (Indian file) linear arrangement of

stromal infiltration by the tumour cells

b) Tumour cells  round and uniform, regular with very little

pleomorphism and infrequent mitoses.
 BREAST CANCER

Non-invasive / carcinoma In-situ Invasive carcinoma

Ductal Lobular Ductal Lobular

DCIS LCIS IDC ILC
 Paget’s Disease Of The Nipple
• Eczematoid lesion of the nipple associated with an invasive or
non-invasive ductal carcinoma of the underlying breast.

• The nipple bears a crusted, scaly and eczematoid lesion with a

palpable subareolar mass

• It is a malignant lesion
 Pathogenesis
The tumour cells from the underlying ductal carcinoma

Migrated up into the lactiferous ducts

Invaded the epidermis of nipple

Producing skin lesions

 Grossly

• The skin of the nipple and areola is crusted, fissured and

ulcerated with oozing of serosanguineous fluid from the erosions
 Histologically

• Presence of Paget’s cells singly or in small clusters in the

epidermis
• These cells are larger than the epidermal cells, spherical, having
hyperchromatic nuclei with cytoplasmic halo
 Molecular classification

• Based on gene profiling of breast cancer by microarray 

a) ER / PR Receptors
b) HER2/neu (cerbB2) Receptors
 ER / PR Receptors

• Estrogen promote the breast cancer.

• Presence or absence of hormone receptors on the tumour cells
can help in predicting the response of breast cancer to endocrine
therapy
• Accordingly, patients with high levels of ER and PR on breast
tumour cells have a slightly better prognosis (likely to respond to
anti-estrogen therapy)
 HER2/neu (cerbB2) Receptors

• HER2/neu (cerbB2) is a transmembrane protein having tyrosine

kinase activity.
• An individual having overexpression of HER2/neu by tumour cells
is likely to respond to higher dose of herceptin therapy
 ER/PR Her-2

Luminal A + -

Luminal B + +

Basal - -

Her-2 Positive - +
The picture can't be displayed.
 1. Luminal A

• ER , PR positive and HER2/neu negative.

• Slow growing and respond to hormonal treatment.

• This is the largest group (40-55%) which has characteristics of
normal luminal cells.
 ER/PR Her-2

Luminal A + -

Luminal B + +

Basal - -

Her-2 Positive - +
 2. Luminal B

• ER, PR positive, HER 2 neu positive

• More likely to have lymph node metastases

• May respond to standard chemotherapy.
 ER/PR Her-2

Luminal A + -

Luminal B + +

Basal - -

Her-2 Positive - +
 3. Basal line

• ER negative, PR negative, HER2/neu negative  Triple negative.

• Aggressive tumors
• Frequent metastasis to viscera and brain can be seen
• Poor prognosis
 ER/PR Her-2

Luminal A + -

Luminal B + +

Basal - -

Her-2 Positive - +
 4. HER2 positive

• ER , PR negative and HER 2/neu positive

• Poor prognosis
 ER/PR Her-2

Luminal A + -

Luminal B + +

Basal - -

Her-2 Positive - +
The picture can't be displayed.
 GRADING

Bloom-Richardson system

It is based on 3 features 
a) Tubule formation
b) Nuclear pleomorphism
c) Mitotic count.
Tubule formation
• Score 1 :- >75% of tumor has tubules
• Score 2 :- 10-75% of tumor has tubules
• Score 3 :- <1 0% of tumor has tubules

Nuclear size (nuclear polymorphism)

• Score 1 :- tumor nuclei similar to normal duct nuclei (2-3 x RBC)
• Score 2 :- Intermediate size nuclei
• Score 3 :- very large nuclei, usually vesicular with prominent nucleoli

Mitotic count
• Score 1 - 0-5 mitosis
• Score 2 - 6-10 mitosis
• Score 3 - >11 mitosis
 Grades

Total score

• Grade-1 (well-differentiated) 3-5

• Grade-2 (moderately differentiated) 6-7
• Grade-3 (poorly differentiated) 8-9
 Grade 1 Grade 2 Grade 3

Glandular/Tubular Differentiation: Glandular/Tubular Differentiation: Glandular/Tubular Differentiation:

>75% of tumor forms glands 10% to 75% of tumor forms glands <10% of tumor forms glands

Nuclear Pleomorphism: Nuclear Pleomorphism: Nuclear Pleomorphism:

Uniform cells with small nuclei Cells larger than normal with open Cells with vesicular nuclei,
similar in size to normal breast vesicular nuclei, visible nucleoli, prominent nucleoli, marked
epithelial cells and moderate variability in size and variation in size and shape
shape
Mitotic Count: Mitotic Count:
< 7 mitoses per 1 0 high power Mitotic Count: > 16 mitoses per 10 high power
fields 8-15 mitoses per 10 high power fields
fields
TNM Staging
Tumor Size Tumor size < 2 cm Tumor size 2-5 cm Tumor size > 5 cm Tumor extends to
skin or chest
wall

T T1 T2 T3
T4
Lymph NO N1 N2 N3
Nodes No lymph node Metastasis to Metastasis to Metastasis to
metastasis ipsilateral, ipsilateral fixed infraclavicular/

N movable, axillary
LNs
axillary, or IM
LNs
supraclavicular LN,
or to axillary and
IM LNs

Metastasis M0 M1

M
No distant Distant
Metastasis metastasis
UICC
TNM Category
stage

Early cancer
I T1, NO, M0
(operable, curable)

T1, N1, M0 Early cancer

II
T2, N01, M0 (operable, curable)

Any T, N2-3, M0 Locally advanced breast cancer

III
T3, Any N, M0 (Neoadjuvant treatment to make operable)

Metastatic
IV Any T, Any N, M1
(Not curable, Inoperable, Palliative care)
 Pattern of lymph node involvement
• The pattern of lymph node involvement follows the natural routes of
lymphatic drainage producing regional nodal metastasis
• The first node in a regional lymphatics that receives lymph flow
from the primary tumor is called sentinel lymph node.
• Sentinel lymph node is useful in breast cancer
• Term 'sentinel lymph node' was first used by Gould
 OVERVIEW
• Introduction
• Clinical features
• Triple technique
• Risk factors
• Classification
• Individual tumour microscopy
• Molecular classification
• Grading
• TMN Staging
MCQs
Q. Increased susceptibility to breast cancer is likely
to be associated with a mutation in the following
gene-

a) p53

b) BRCA-1

c) Retinoblastoma (RD)

d) H-RAS
Q. Increased susceptibility to breast cancer is likely
to be associated with a mutation in the following
gene-

a) p53

b) BRCA-1

c) Retinoblastoma (RD)

d) H-RAS
 Q. All are risk factor for breast ca except-

a) Caffeine intake

b) Early menstruation

c) Family history

d) Late menopause
 Q. All are risk factor for breast ca except-

a) Caffeine intake

b) Early menstruation

c) Family history

d) Late menopause
Q. A female patient presented with a firm mass of
2x2 cm in the upper outer quadrant of the breast.
She gives a family history of ovarian carcinoma. The
investigation that needs to be done to assess for
mutation is-

a) p53

b) BRCA-2

c) Her 2/Neu gene

d) C-myc gene
Q. A female patient presented with a firm mass of
2x2 cm in the upper outer quadrant of the breast.
She gives a family history of ovarian carcinoma. The
investigation that needs to be done to assess for
mutation is-

a) p53

b) BRCA-2

c) Her 2/Neu gene

d) C-myc gene
 Q. Most common carcinoma of breast is-

a) Intraductal carcinoma

b) Colloid carcinoma

c) Lobular carcinoma

d) Sarcoma phylloides
 Q. Most common carcinoma of breast is-

a) Intraductal carcinoma

b) Colloid carcinoma

c) Lobular carcinoma

d) Sarcoma phylloides
Q. Bilateral breast ca is-

a) Medullary ca

b) Lobular ca

c) Ductal ca

d) Paget's ca
Q. Bilateral breast ca is-

a) Medullary ca

b) Lobular ca

c) Ductal ca

d) Paget's ca
Q. In which one of the following types of carcinoma
of the breast, is a biopsy of the opposite breast
advised-

a) Inflammatory carcinoma

b) Medullary carcinoma

c) Lobular carcinoma

d) Scirrhous carcinoma
Q. In which one of the following types of carcinoma
of the breast, is a biopsy of the opposite breast
advised-

a) Inflammatory carcinoma

b) Medullary carcinoma

c) Lobular carcinoma

d) Scirrhous carcinoma
 Q. Characteristic feature of Paget's cells is -

a) Eosinophilic cytoplasm

b) Abundant clear cytoplasm

c) Glycogen mass

d) Multinucleated giant cell

 Q. Characteristic feature of Paget's cells is -

a) Eosinophilic cytoplasm

b) Abundant clear cytoplasm

c) Glycogen mass

d) Multinucleated giant cell

 Q. ER positive status in Ca Breast indicates-

a) Prognosis

b) Etiology

c) Site

d) None
 Q. ER positive status in Ca Breast indicates-

a) Prognosis

b) Etiology

c) Site

d) None
Q. True about histology in infiltrating lobular
breast carcinoma-
a) Indian file pattern

b) Pleomorphic cells in sheets

c) Cribriform pattern

d) Pin wheel pattern

Q. True about histology in infiltrating lobular
breast carcinoma-
a) Indian file pattern

b) Pleomorphic cells in sheets

c) Cribriform pattern

d) Pin wheel pattern

Q. Molecular classification of breast cancer is
based on-
a) Gene expression profiling

b) Her2/neu and ER/PR

c) Size of tumour with lymph node status.

d) On the basis of biomarkers

Q. Molecular classification of breast cancer is
based on-
a) Gene expression profiling

b) Her2/neu and ER/PR

c) Size of tumour with lymph node status.

d) On the basis of biomarkers

Q. Sentinel node biopsy in carcinoma breast is
done for-
a) Early diagnosis and recurrence

b) For stages of the carcinoma

c) Frozen section

d) Occult disease detection

Q. Sentinel node biopsy in carcinoma breast is
done for-
a) Early diagnosis and recurrence

b) For stages of the carcinoma

c) Frozen section

d) Occult disease detection

Tumours of the CNS
 Tumours of the CNS

2 types 

1. Originate in the brain or spinal cord  Primary tumours

2. May spread to the brain from another primary site of cancer

Metastatic tumours
 Metastasis to brain

• Metastasis to brain are the most common brain tumor

• Most common primary malignancy metastatizing to brain is lung

carcinoma > breast > skin (melanoma) > kidney (genitourinary)
and GIT cancers.
 Brain Tumor

Glial Neuronal Undifferentiated Meningeal

tumors tumors tumors tumors

1. Astrocytoma 1. Ganglioglioma 1. Medulloblastoma Meningioma

2. Oligodendroglioma 2. Gangliocytoma 2. Atypical teratoid/
3. Ependymoma 3. Neurocytoma rhabdoid lumor
4. Dysembryoplastic
neuroepithelial
tumor
 Important Primary brain tumours

Gliomas
Meningiomas
Medulloblastoma
 Nerve Sheath Tumours (Schwannomas)
 Pilocytic Glioblastoma Ependymoma
Oligodendroglioma
astrocytoma Multiforme

MC site

Gross

Microscopy
 Meningioma Medulloblastoma Schwannomas

MC site

Gross

Microscopy
 Gliomas

• The term glioma is used for all tumours arising from neuroglia
 Glioma types

i) Astrocytomas  From astrocytes

ii) Oligodendroglioma  From oligodendrocytes
iii) Ependymoma  From ependyma
 Astrocytomas

• Astrocytomas are the most common type of gliomas

 WHO classification

1. WHO Grade I (Pilocytic) Astrocytoma  Most common in

children and good prognosis
2. WHO Grade II (Fibrillary) Astrocytoma
3. WHO Grade III (Anaplastic) Astrocytoma
4. WHO Grade IV Astrocytoma (Glioblastoma Multiforme) Most
common in adult and Poor prognosis
 WHO Grade I Astrocytoma
Pilocytic astrocytoma
• Occur in Children

• Site  Cerebellum and brainstem

• Surgical treatment is curative in 80 to 100% of cases

• They have a good prognosis.
Gross 
• Usually well circumscribed
• Commonly cystic (myxoid or mucoid appearance)
Microscopy 

a) Rosenthal fibers are intracytoplasmic inclusions which are

compact areas of condensed mass of glial fibrillary acidic protein
(GFAP)

b) p53 mutations are associated with more aggressive

astrocytoma".
 WHO Grade IV Astrocytoma
(Glioblastoma Multiforme)
• 6th decade of life
Site  Cerebral hemispheres (temoral and frontal lobes)
Gross 
• Variegated appearance with haemorrhages and necrosis.
• Also known as butterfly tumor since it crosses midline.
Microscopy 

a) The tumour cells are poorly-differentiated round cells,

pleomorphic cells and giant cells.

b) Mitoses are frequent

c) Pseudopalisading necrosis seen  serpentine necrotic areas with

tumor cells at the edges ofnecrotic border

d) Microvascular endothelial proliferation is marked

 Oligodendroglioma

• Most common site  cerebral hemisphere white matter

(80 to 90% supratentorial)
Gross 
• Well-circumscribed, grey-white gelatinous mass with Foci of
haemorrhages and calcification
Microscopy 

a) The tumour is characterised by uniform cells

b) Tumour cells have round to oval nuclei surrounded by a clear halo

of cytoplasm  Fried Egg appearance

c) Endothelial cell hyperplasia

d) Foci of calcification
 Ependymoma

• Derived from the layer of epithelium that lines the ventricles and
the central canal of the spinal cord.
• It occurs chiefly in children and young adults (below 20 years of
age)

• Most common site 

i) In the first two decades of life  fourth ventricle
ii) In adults most common site  spinal cord (associated with
neurofibromatosis type 2)
Gross
• Ependymoma is a well-demarcated tumour
 Microscopically
• Tumour is composed of uniform epithelial (ependymal)
cells forming rosettes and perivascular pseudorosettes.

• Blepharoplasts representing basal bodies of cilia may be

demonstrated in the cytoplasm of tumour cells
 Pilocytic Glioblastoma
Oligodendroglioma Ependymoma
astrocytoma Multiforme

Cerebral Cerebral Cortex

MC site Cerebellum 4th Ventricle
hemisphere (white matter)
‒ Well
Butterfly Well
Gross circumscribed Gelatinous mass
tumor demarcated
‒ Cystic

‒ Pleomorphic
‒ Pseudopalisading ‒ Fried egg cell Rosettes ,
Microscopy Rosenthal fibres necrosis Pseudorosettes
‒ Calcification Blepharoplasts
‒ Mitosis
 Brain Tumor

Glial Neuronal Undifferentiated Meningeal

tumors tumors tumors tumors

1. Astrocytoma 1. Ganglioglioma 1. Medulloblastoma Meningioma

2. Oligodendroglioma 2. Gangliocytoma 2. Atypical teratoid/
3. Ependymoma 3. Neurocytoma rhabdoid lumor
4. Dysembryoplastic
neuroepithelial
tumor
 Meningioma
• Meningiomas arise from the cap cell layer of the arachnoid.
• Their most common sites are: lateral cerebral convexities, midline
along the falx cerebri and olfactory groove.
• Meningiomas are generally solitary.
• Increased frequency in patients with neurofibromatosis 2 and are
often multiple in these cases.
• 2nd to 6th decades of life
• Female preponderance.
• Most meningiomas are benign

• Rarely, a malignant meningioma may metastasise, mainly to

lungs
Gross 
• Well-circumscribed mass of varying size (1-10 cm in diameter).
• The overlying bone usually shows hyperostosis
 Microscopically

a) Conspicuous whorled pattern of tumour cells, often around

central capillary-sized blood vessels.

b) Some of the whorls contain psammoma bodies due to

calcification of the central core of whorls
 Brain Tumor

Glial Neuronal Undifferentiated Meningeal

tumors tumors tumors tumors

1. Astrocytoma 1. Ganglioglioma 1. Medulloblastoma Meningioma

2. Oligodendroglioma 2. Gangliocytoma 2. Atypical teratoid/
3. Ependymoma 3. Neurocytoma rhabdoid lumor
4. Dysembryoplastic
neuroepithelial
tumor
 Medulloblastoma

• Occur exclusively in the cerebellum.

• Most common primary malignant brain tumour in childhood.
• These are undifferentiated tumor because they have both
glial and neuronal features
• Dissemination through the CSF forms nodular masses at some
distance from primary tumor and this is termed "drop
metastases’”
Gross
• They are midline in children and lateral in adults.
• Protrudes into the fourth ventricle as a soft, grey-white mass or invades
the surface of the cerebellum
Microscopy 

a)Small round blue tumor cells

b)Homer-Wright pseudo-rosettes  groups of tumor cells arranged

in a circle around a fibrillary center
 Nerve Sheath Tumours

• Tumours of the peripheral nerves are commonly benign

1. Schwannoma (neurilemmoma)
2. Neurofibroma
 Schwannomas (Neurilemmomas)
• Arise from cranial and spinal nerve roots.
• Solitary nodule
• Multiple schwannomas occur in von Recklinghausen’s disease
• Association with Neurofibromatosis type 2
• Acoustic schwannoma  schwannoma of 8th nerve (Most
common)

• Invariably benign
Gross 
• Encapsulated, solid tumour
• Produces eccentric enlargement of the nerve root from where it arises
• Does not infiltrate the peripheral nerve
Microscopy 

• Two areas seen histologically 

a) Antoni A pattern  dense and compact cellular areas show

palisaded nuclei called Verocay bodies
b) Antoni B pattern  Loose acellular areas
 Meningioma Medulloblastoma Schwannomas
‒ Arise from Arachnoid
MC site ‒ Lateral Cerebral Cerebellum 8th nerve (Acoustic)
Convexities

‒ Encapsulated
‒ Eccentric
Gross ‒ Well circumscribed Grey- white mass
‒ Does not infiltrate
nerve

‒ Antoni A → Cellular
areas (Verocay
‒ Whorled pattern ‒ Home Wright
Microscopy body)
‒ Psammoma bodies Rosettes
‒ Antoni B → Loose
areas
 Pilocytic Glioblastoma
Oligodendroglioma Ependymoma
astrocytoma Multiforme

Cerebral Cerebral Cortex

MC site Cerebellum 4th Ventricle
hemisphere (white matter)
‒ Well
Butterfly Well
Gross circumscribed Gelatinous mass
tumor demarcated
‒ Cystic

‒ Pleomorphic
‒ Pseudopalisading ‒ Fried egg cell Rosettes ,
Microscopy Rosenthal fibres necrosis Pseudorosettes
‒ Calcification Blepharoplasts
‒ Mitosis
MCQs
Q. Most common site of glioblastoma
multiforme is-
a) CP angle

b) Frontal lobe

c) Brainstem

d) Occipital lobe
Q. Most common site of glioblastoma
multiforme is-
a) CP angle

b) Frontal lobe

c) Brainstem

d) Occipital lobe
Q. Which of the following brain tumors arises
from arachnoid cap cells?
a) Medulloblastoma

b) Ependymoma

c) Meningioma

d) Glioma
Q. Which of the following brain tumors arises
from arachnoid cap cells?
a) Medulloblastoma

b) Ependymoma

c) Meningioma

d) Glioma
 Q. Rosenthal fibers are seen in-

a) Pilocytic astrocytoma

b) Glioblastoma

c) Medulloblastoma

d) Ependymoma
 Q. Rosenthal fibers are seen in-

a) Pilocytic astrocytoma

b) Glioblastoma

c) Medulloblastoma

d) Ependymoma6
Q. Psammoma bodies are seen in-

a) Pilocytic astrocytoma

b) Glioblastoma

c) Medulloblastoma

d) Meningioma
Q. Psammoma bodies are seen in-

a) Pilocytic astrocytoma

b) Glioblastoma

c) Medulloblastoma

d) Meningioma
Q. Verocay body are seen in-

a) Pilocytic astrocytoma

b) Glioblastoma

c) Medulloblastoma

d) Schwannomas
Q. Verocay body are seen in-

a) Pilocytic astrocytoma

b) Glioblastoma

c) Medulloblastoma

d) Schwannomas
Q. Fried egg cell appearance and Calcification
are seen in-
a) Pilocytic astrocytoma

b) Glioblastoma

c) Oligodendrogliomas

d) Medulloblastoma
Q. Fried egg cell appearance and Calcification
are seen in-
a) Pilocytic astrocytoma

b) Glioblastoma

c) Oligodendrogliomas

d) Medulloblastoma
Q. Rosettes and Pseudorosettes are seen in-

a) Pilocytic astrocytoma

b) Glioblastoma

c) Oligodendrogliomas

d) Ependymoma
Q. Rosettes and Pseudorosettes are seen in-

a) Pilocytic astrocytoma

b) Glioblastoma

c) Oligodendrogliomas

d) Ependymoma
 Q. Home Wright Rosettes are seen in-

a) Pilocytic astrocytoma

b) Glioblastoma

c) Medulloblastoma

d) Ependymoma
 Q. Home Wright Rosettes are seen in-

a) Pilocytic astrocytoma

b) Glioblastoma

c) Medulloblastoma

d) Ependymoma
Q. All of the following are neuronal tumors,
except-
a) Gangliocytoma

b) Ganglioglioma

c) Neurocytoma

d) Ependymoma
Q. All of the following are neuronal tumors,
except-
a) Gangliocytoma

b) Ganglioglioma

c) Neurocytoma

d) Ependymoma
 Q. Rosenthal fibers are-

a) Intranclear inclusions

b) Intracytoplasmic inclusions

c) Present extracellularly

d) Part of cell membrane

 Q. Rosenthal fibers are-

a) Intranclear inclusions

b) Intracytoplasmic inclusions

c) Present extracellularly

d) Part of cell membrane

 Q. Most common glial tumor-

a) Ependymomas

b) Astrocytoma

c) Meningioma

d) Neurofibroma
 Q. Most common glial tumor-

a) Ependymomas

b) Astrocytoma

c) Meningioma

d) Neurofibroma
Q. Rosenthal fibers in astrocytoma are
composed of-
a) Heat shock proteins

b) Fibrillar proteins

c) GFAP

d) Globulins
Q. Rosenthal fibers in astrocytoma are
composed of-
a) Heat shock proteins

b) Fibrillar proteins

c) GFAP

d) Globulins
Q. True about pilocytic astrocytoma are all
except-
a) Long survival

b) Total surgical resection possible

c) Can involve posterior fossa

d) Median age at presentation is more than 80 years

Q. True about pilocytic astrocytoma are all
except-
a) Long survival

b) Total surgical resection possible

c) Can involve posterior fossa

d) Median age at presentation is more than 80 years

Q. Most common cerebellar tumor in children-

a) Astrocytoma

b) Medulloblastoma

c) Ependymoma

d) PNET
Q. Most common cerebellar tumor in children-

a) Astrocytoma

b) Medulloblastoma

c) Ependymoma

d) PNET
Q. Most common tumor in lateral hemisphere
of brain-
a) Astrocytoma

b) Meningioma

c) Ependymoma

d) Medulloblastoma
Q. Most common tumor in lateral hemisphere
of brain-
a) Astrocytoma

b) Meningioma

c) Ependymoma

d) Medulloblastoma
Q. Which of the following carcinomas most
frequently metastasizes to brain?
a) Small cell carcinoma lung

b) Prostate cancer

c) Rectal carcinoma

d) Endometrial cancer
Q. Which of the following carcinomas most
frequently metastasizes to brain?
a) Small cell carcinoma lung

b) Prostate cancer

c) Rectal carcinoma

d) Endometrial cancer
 Q. Most common site for medulloblastoma is-

a) Cerebellum

b) Pituitary

c) Cerebrum

d) Pineal gland
 Q. Most common site for medulloblastoma is-

a) Cerebellum

b) Pituitary

c) Cerebrum

d) Pineal gland