Neuropathology Practice Questions

Q: A metastatic carcinoma in the brain of an adult most often originates from which primary cancer?

Lung. **Explanation:** Brain metastases are the most common intracranial tumors in adults, occurring far more frequently than primary brain malignancies. [1] **1. Why Lung Cancer is Correct:** The **Lung** is the most common primary site for brain metastasis in both men and women, accounting for approximately **40–50%** of all cases. [1] This is due to the lung's rich vascular network and the ability of tumor cells to enter the systemic arterial circulation directly, bypassing the pulmonary filtration system. Small cell lung carcinoma (SCLC) has the highest propensity to spread to the brain, though non-small cell lung cancer (NSCLC) is more common overall. **2. Why Other Options are Incorrect:** * **Stomach & Oral Cavity:** These cancers rarely metastasize to the brain. Gastrointestinal malignancies typically spread via the portal system to the liver. * **Ovary:** Ovarian cancer primarily spreads via local seeding (peritoneal cavity) and rarely involves the central nervous system. **3. High-Yield Clinical Pearls for NEET-PG:** * **Frequency Order:** The most common primary sources for brain metastasis are: **Lung > Breast > Melanoma > Renal Cell Carcinoma (RCC) > Colon.** [1] * **Melanoma:** While lung cancer is the most common *source*, Melanoma has the highest *likelihood* (percentage-wise) of spreading to the brain if the patient has advanced disease. * **Location:** Metastases usually occur at the **grey-white matter junction** (where blood vessels narrow, trapping tumor emboli) and are often **multiple** and well-circumscribed. * **Children:** In contrast to adults, the most common source of brain metastasis in children is **Neuroblastoma.** * **Choriocarcinoma:** A high-yield fact is that Choriocarcinoma, though rare, has a very high tendency for hemorrhagic brain metastasis. [1] **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1317-1318.

Q: Which of the following tumors are also called as "Ghost cell tumors"?

Primary CNS lymphoma. **Explanation:** **Primary CNS Lymphoma (PCNSL)** is referred to as a **"Ghost Cell Tumor"** primarily due to its characteristic response to corticosteroid therapy. When patients with PCNSL are treated with steroids (like dexamethasone) prior to a biopsy, the tumor cells undergo rapid apoptosis and shrinkage. On histopathology, this results in a "disappearing" effect or the presence of necrotic debris and faint cellular outlines, making the tumor difficult to diagnose—hence the name "Ghost Cell Tumor." **Analysis of Options:** * **A. Medulloblastoma:** A highly malignant primitive neuroectodermal tumor (PNET) of the cerebellum, characterized by **Homer-Wright rosettes** and small blue round cells. * **B. Acoustic Neuroma (Schwannoma):** Characterized by **Antoni A** (dense) and **Antoni B** (loose) patterns with **Verocay bodies**. It does not disappear with steroids. * **D. Glioblastoma (GBM):** The most common malignant primary brain tumor, characterized by **pseudopalisading necrosis** and microvascular proliferation. **High-Yield Facts for NEET-PG:** * **Association:** Strongly associated with **HIV/AIDS** (CD4 count <50 cells/µL) and **EBV infection** [1]. * **Histology:** Most are **Diffuse Large B-Cell Lymphomas (DLBCL)**. They show a characteristic **"perivascular cuffing"** pattern (cells circling blood vessels) [1]. * **Clinical Pearl:** Always avoid giving steroids before a suspected CNS lymphoma biopsy to prevent the "Ghost Cell" phenomenon, which can lead to a false-negative pathology report. * **Marker:** CD20 positive. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1315-1316.

Q: All of the following are true about the microscopic appearance of pilocytic astrocytoma, EXCEPT:

Decrease in the number of blood vessels. ### Explanation **Pilocytic Astrocytoma (WHO Grade 1)** is the most common primary brain tumor in children, typically occurring in the cerebellum. **Why Option D is the Correct Answer:** Contrary to the option, Pilocytic Astrocytoma is characterized by **prominent vascularity**. It often exhibits **vascular endothelial proliferation** (glomeruloid bodies). While in other gliomas (like Glioblastoma) this indicates high-grade malignancy, in Pilocytic Astrocytoma, it is a benign feature and does not imply a poor prognosis. Therefore, a "decrease" in blood vessels is incorrect. **Analysis of Incorrect Options:** * **A. Bipolar cells:** These are the hallmark "piloid" (hair-like) cells. They are elongated cells with thin, hair-like bipolar processes, giving the tumor its name. * **B. Rosenthal fibers:** These are thick, elongated, eosinophilic, "corkscrew" shaped structures found within astrocytic processes. They represent degenerated intermediate filaments (ubiquitin and αB-crystallin). * **C. Eosinophilic granular bodies (EGBs):** These are small, proteinaceous droplets found in the tumor. Their presence is a classic marker of slow-growing, low-grade tumors. **NEET-PG High-Yield Pearls:** * **Biphasic Pattern:** Microscopic examination shows a mix of dense (Rosenthal fibers) and loose/microcystic (EGBs) areas. * **Genetics:** Strongly associated with **BRAF gene** alterations (KIAA1549-BRAF fusion). * **Imaging:** Classically presents as a **cystic lesion with an enhancing mural nodule** in the cerebellum. * **Prognosis:** Excellent; usually curable by surgical resection.

Question 1

What are the similar features between cerebral abscess and cerebral infarct?

Accepted Answer

Liquefactive necrosis

Answer

Coagulative necrosis

Answer

Heals by collagen formation

Answer

Always develop from emboli from other sites

Question 2

A metastatic carcinoma in the brain of an adult most often originates from which primary cancer?

Accepted Answer

Lung

Answer

Stomach

Answer

Ovary

Answer

Oral cavity

Question 3

Neuronophagia is seen in which of the following conditions?

Accepted Answer

Poliomyelitis

Answer

Amoebic encephalitis

Answer

Tuberculer meningoencephalitis

Answer

Cerebral malaria

Question 4

Which of the following tumors are also called as "Ghost cell tumors"?

Accepted Answer

Primary CNS lymphoma

Answer

Medulloblastoma

Answer

Acoustic neuroma

Answer

Glioblastoma

Question 5

A 50-year-old woman undergoes neurosurgery for resection of a well-circumscribed intracranial neoplasm attached to the dura. The tumor compressed the underlying brain parenchyma without infiltration. Which of the following is the most likely diagnosis?

Accepted Answer

Meningioma

Answer

Arteriovenous malformation

Answer

Glioblastoma multiforme

Answer

Medulloblastoma

Question 6

All of the following are true about the microscopic appearance of pilocytic astrocytoma, EXCEPT:

Accepted Answer

Decrease in the number of blood vessels

Answer

Bipolar cells

Answer

Rosenthal fibers

Answer

Eosinophilic granular bodies

Question 7

Intranuclear inclusions in oligodendrocytes are seen in which of the following conditions?

Accepted Answer

Progressive multifocal leukoencephalopathy

Answer

Creutzfeldt Jakob disease

Answer

Polio

Answer

Japanese encephalitis

Question 8

Which of the following is NOT true about pilocytic astrocytoma?

Accepted Answer

Median age at presentation is more than 80 years.

Answer

Associated with long survival.

Answer

Total surgical resection is often possible.

Answer

Commonly involves the posterior fossa.

Question 9

All of the following are true about meningiomas EXCEPT:

Accepted Answer

They are attached to the pia mater.

Answer

Meningiomas are predominantly benign tumors of adults.

Answer

They arise from the meningothelial cell of the arachnoid.

Answer

They occur in association with eighth nerve schwannomas.

Question 10

Which of the following is considered a low-grade Central Nervous System tumor?

Accepted Answer

Meningioma

Answer

Diffuse astrocytoma

Answer

Anaplastic astrocytoma

Answer

Glioblastoma multiforme

Neuropathology — MCQs

Neuropathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?