CNS Pathology case based MCQs-2

CASE : The spinal MRI of a 22-year old male with neurofibromatosis type-2 showed a hyperintense lesion. The lesion was resected and histopathologic section is shown in image.

Question 1: What is the diagnosis?

A. Medulloblastoma
B. Ependymoma
C. Retinoblastoma
D. Central neurocytoma

Question 2: Which of the following statements is true regarding this tumor?

A. They are predominantly supratentorial
B. Posterior fossa tumors in adults have a good prognosis
C. Spinal tumors have a bad prognosis
D. IDH 1 and 2 mutations are present in 100% cases.

Question 3: Identify the variant of the tumor shown in the image below.

A. Tancytic
B. Myxopapillary
C. Subependymoma
D. Anaplastic

Question 4: Which of the following statements is true regarding tancytic ependymoma?

A. GFAP negative
B. Abundant rosettes
C. Can be confused with pilocytic astrocytoma
D. WHO Grade 1

Question 5: Identify the FALSE statement regarding the variant of ependymoma shown below

Image credit-

A. WHO Grade 1
B. Arises from filum terminale
C. Aggressive clinical course
D. Mucin stains positive

Question 6: TRUE statement regarding recent molecular classification (WHO CNS 2021 5th edition ) of ependymoma is

A. Spinal ependymomas with MYCN have a good prognosis
B. ZFTA Fusion- favorable prognosis
C. YAP Fusion- poor prognosis
D. Spinal ependymomas with NF 2 mutation- favorable prognosis

ANSWER- Question 1

Correct answer is B- Ependymoma

Ependymomas are characterized by perivascular rosettes and ependymal rosettes which have an empty central lumen

Types of rosettes
ANSWER- Question 2


🐱 Majority of of Ependymomas are infratentorial.

🐱Posterior fossa tumors in children have a poor prognosis (PF-A)- associated with loss of H3K27me, whereas Posterior fossa tumors in adults have a god prognosis (PF-B)- H3K27me is retained.

🐱 Spinal ependymomas have a good prognosis, whereas a small number of ependymomas associated with MYCN have a poor outcome.

🐱IDH 1 and 2 are associated with astroctyomas and oligodendroglomas but nor ependymomas.

ANSWER-Question 3


Diagnosis is TANCYTIC EPENDYMOMA, 🐱 Tancytes are cells with fibrillary processes which line ventricles along with ependymal cells.

Types of tancytes
ANSWER – Question 4

Correct They are GFAP positive 🐱Confused with pilocytic astrocytoma because of the prominent fibrillary projections 🐱It is a GRADE II Ependymoma 🐱 Ependymal rosettes and pseudorosettes are scanty in tanytic ependymoma, which makes diagnosis challenging.

ANSWER- Question 5

Correct answer is C
💀Diagnosis is myxopapillary ependymoma
💀It is a Grade II Tumor according to latest WHO
💀It is common in adults and arises from the filum terminale
💀It is clinically indolent ( nor aggressive)
💀Stains for Mucin is positive.

Mucin stains positive in myxopapillary ependymoma
ANSWER – Question 6

Correct answer is D

Spinal ependymomas with NF2 mutation has a good prognosis

Summary of latest molecular updates in ependymoma

Central nervous system (CNS) tumors pathology mcq pdf with answers

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Some tumors with coffee bean shaped nuclei in pathology

Tumors with coffee bean shaped nuclei
1. Papillary thyroid carcinoma
2. Granulosa cell tumor
3. Brenner tumor
4. Langerhan cell histiocytosis
5. Invasive ductal carcinoma of pancreas
6. Chondroblastoma

Click below for a list of tumors with coffee bean nuclei.