Adult brain tumors: Pathology review

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Adult brain tumors: Pathology review



Adult brain tumors: Pathology review

USMLE® Step 1 questions

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A 54 year-old woman is brought to the emergency department due to a seizure. People in the homeless shelter who witnessed the event report that she fell to the ground and started having rhythmic jerking movement of the limbs. Her medical history is unknown. Physical examination reveals the patient to be dishevelled, confused, and barely responsive. Computed tomography of the head is obtained and shown below before (left) and after (right) the addition of contrast (shown below):  

Credit: Wikimedia Commons

Which of the following is the most likely origin of this patient's primary tumor?  


In the neurology ward, a 64-year old female, named Angela, came in complaining of morning headaches along with nausea and vomiting for the past few weeks. Her husband says that her personality has changed over the last few weeks and she seems more aggressive. Brain MRI revealed a mass in the frontal lobe.Tissue biopsy shows a pseudo-palisading pattern with necrosis in the middle and viable cells lining up in the periphery.

Now, next to Angela, there’s Jerry, a 59-year old male who’s also having morning headaches for the past few months. A brain MRI is ordered and reveals a mass on the brain surface, just under the dura mater. Tissue biopsy shows psammoma bodies.

Finally, there’s a 40-year old male, named Dan, who complains of ringing in the ears and hearing loss on one side. A brain MRI is done, and showed a mass on the cerebellopontine angle. Tissue biopsy shows a mass with biphasic appearance with alternating hypercellular and hypocellular regions. Tumor cells stain positively for S100.

Okay, Angela, Jerry, and Dan all had brain tumor. Brain tumors occur when there’s uncontrolled growth of abnormal cells within the brain. They are broadly classified into primary tumors originating from cells within the nervous system and metastatic tumors originating from cells outside the nervous system.

Now, brain tumors can occur in both children and adults. In this video, let’s focus on adult brain tumors. In adults, metastatic tumors are much more common than primary tumors, in fact, they account for more than half of the cases. In order of decreasing frequency, they metastasize from the lung, breast, melanoma from the skin, kidneys, and colon. Now, the most common primary brain tumor in adults is glioblastoma multiforme, which is a type of astrocytomas. Meningiomas and pituitary adenomas are next on the list. Less common brain tumors include oligodendrogliomas, hemangioblastomas, and Schwannomas. immunocompromised people, like organ transplant recipients or individuals with AIDS, are at high risk of primary central nervous system lymphoma caused by the Epstein-Barr virus.


Adult brain tumors are tumors that occur in adults. The most common type of adult brain tumor is glioma, which arises from the glial cells that support the nerve cells in the brain. Other types of adult brain tumors include meningiomas (tumors that arise from the meninges, which are the membranes surrounding the brain and spinal cord), schwannomas (tumors that arise from Schwann cells, which support the nerve fibers), and astrocytomas (tumors that arise from star-shaped cells called astrocytes).


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  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Hazzard's Geriatric Medicine and Gerontology, 7E" McGraw-Hill Education / Medical (2016)
  4. "Current Diagnosis and Treatment Surgery 14/E" McGraw-Hill Education / Medical (2015)
  5. "Clinical Genomics: Practical Applications for Adult Patient Care" McGraw Hill Professional (2013)
  6. "The MD Anderson Manual of Medical Oncology, Third Edition" McGraw-Hill Education / Medical (2016)
  7. "World Cancer Report 2014" B.W. Stewart and C.P. Wild (2014)
  8. "World Cancer Report 2014" B.W. Stewart and C.P. Wild (2014)
  9. "von Hippel–Lindau-associated malignancies: Mechanisms and therapeutic opportunities" Drug Discovery Today: Disease Mechanisms (2005)

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