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N P Neuro part > 030415 brain tumors > Flashcards

030415 brain tumors Flashcards

1
Q

types of primary brain tumors

A

meningiomas

gliomas: astrocytomas, glioblastoma, ependymoma, oligodendroglioma, embryonal tumors
others: pituitary, nerve sheath tumors, lymphoma, craniopharyngioma, germ cell tumors, etc

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2
Q

morbidity and mortality in low and high grade neoplasms in CNS

A

both low and high have significant morbidity and mortality (diffusely infiltrative, involvement of critical anatomic areas, inability to resect critical anatomic areas)

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3
Q

astrocytomas

A

most common glial tumor

diffuse astrocytomas (grade 2) have tendency to progress to higher grades (anaplastic astrocytoma, glioblastoma) over time

80% are glioblastomas

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4
Q

clinical features of astrocytomas

A

seizures
focal neurologic deficits (GRADUAL onset)
headaches

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5
Q

median survival for glioblastoma multiforme

A

1 yr

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6
Q

WHO grading scheme for astrocytomas

A

1: pilocytic astrocytoma (no tendency to become higher grade)
2: astrocytoma (diffuse)–CELLULARITY is moderately increased and occasional NUCLEAR ATYPIA
3: anaplastic astrocytoma–increased cellularity, distinct nuclear atypia, marked MITOTIC ACTIVITY
4: glioblastoma multiforme–pleomorphic astrocytic cells, brisk mitotic activity, prominent MICROVASCULAR PROLIFERATION AND NECROSIS

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7
Q

grade 2 astrocytoma-gross morphoogy

A

flattened gyri, ill-defined

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8
Q

necrosis w pseudopalisading

A

distinct for grade 4 astrocytoma

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9
Q

pilocytic astrocytoma occurs where

A

most commonly cerebellum

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10
Q

imaging of pilocytic astrocytoma

A

well demarcated

cystic tumor w/ enhancing mural nodule

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11
Q

histology of pilocytic astrocytoma

A

densely fibrillary (pilocytic/hair like) areas alternating w microcystic component

Rosenthal fibers (eosinophilic astrocyte processes)

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12
Q

oligodendroglioma occurs in whom

A

adults

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13
Q

imaging of oligodendroglioma

A

well defined hypodense mass, may see CALCIFICATION

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14
Q

prognosis for oligodendroglioma

A

5-10 yrs for grade II

better than for astrocytomas

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15
Q

allelic loss of chromosome 1p and 19q are predictors of prolonged survival and susceptiblity to chemo

A

anaplastic oligodendrogliomas

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16
Q

histology of oligodendroglioma

A

calcifications

round nuclei, “FRIED EGG” cells

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17
Q

ependymoma occurs in whom

A

usually children

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18
Q

prognosis for ependymoma

A

4 yrs

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19
Q

histology of ependymoma

A 
true rosettes (mini ventricle)
perivascular pseudorosettes
20
Q

choroid plexus papilloma occurs in whom

A

kids

21
Q

where does choroid plexus papilloma occur

A

4th ventricle, lateral ventricle, 3rd ventricle, cerebellopontine angle

22
Q

prognosis for choroid plexus papilloma

A

very good w surgical resection if papilloma

if carcinoma, poor prognosis

23
Q

colloid cyst

A

benign
usually attached to roof of 3rd ventricle
can obstruct foramen of Munro intermittently
positional headache

24
Q

ganglioglioma occurs in whom

A

young (under 30)

25
Q

where does ganglioma occur

A

typically supratentorial and in temporal lobe

26
Q

how is ganglioglioma like or unlike pilocytic astrocytoma

A

it also has cyst w mural nodule, but it’s in cerebrum

27
Q

medulloblastoma

A

embryonal neuroepithelial neoplasm of POSTERIOR FOSSA, of primitive neuroectoderm

28
Q

characteristic feature of medulloblastoma

A

tendency to spread through CSF pathways

29
Q

tx for medulloblastoma

A

surgical resection followed by radiation (usually cranio-spinal)

30
Q

histology for medulloblastoma

A

small blue cells, highly cellular

Homer Wright rosettes

31
Q

primary CNS lymphoma

A

occur btwn 40-60
poor prognosis-most die within a year
periventricular lesions

32
Q

meningioma

A

extra parenchymal tumor of CNS

women more than men

33
Q

imaging of meningioma

A

DURAL BASED

WELL DEFINED

34
Q

meningioma-associations

A

progesterone receptors

NF2, radiotherapy

35
Q

outlook for meningioma

A

if grade I, excellent 5 yr survival

36
Q

histology for meningioma

A

sheets of tumor cells w indistinct borders
whorls
Psammoma bodies

37
Q

where are schwannomas located usually

A

peripheral nerves in head and neck and flexor surfaces or extremities

schwannomas-intracranial tumors most often in cerebellopontine angle and attached to 8th nerve (symptoms of hearing loss, tinnitis, facial numbness)

38
Q

neurofibroma

A

benign tumor composed of Schwann cells, fibroblasts, perineural cells

assoc w NF1

cutaneous form and peripheral nerve form

39
Q

familial tumor syndromes assoc w increased risk of nervous system tumors-four types

A

NF1, NF2, Von Hippel LIndau dis, tuberous sclerosis
each has cutneaous or eye abnormalities
most linked to loss of tumor suppressor genes

40
Q

NF1

A

much more common than NF2

neurofibromas, cafe au lait spots, Lisch nodules, optic glioma, oseeous lesions, axillary freckling, family hx

associated tumors: MOST IMPORTANT-NEUROFIBROMAS THAT UNDERGO TRANSFORMATION TO MALIGNANT PERIPHERAL NERVE SHEATH TUMORS

41
Q

NF2

A

criteria include: BILATERAL VESTIBULAR SCHWANNOMAS (most common manifestation), first degree relative w NF2, lens opacity, cerebral calcifications

other associations: meningiomas, schwannomas, gliomas, neurofibromas

42
Q

Von Hippel Lindau dis

A

hemangioblastomas of CNS and retina (CEREBELLAR HEMANGIOBLASTOMAS)

renal cell carcinoma, pheo, visceral cysts, retinal angiomas

43
Q

tuberous sclerosis

A

clinical: SEIZURES, autism, cognitive dysfxn

CORTICAL HAMARTOMAS (TUBERS-neuronal and glial properties), subependymal giant cell astrocytomas, etc

44
Q

paraneoplastic syndrome

A

clinical syndrome produced by remote effect of systemic malignancy

hypothesized that some visceral cancers express certain neural antigens. immune system recognizes these antigens as foreign and attacks own CNS/PNS

45
Q

Lambert Eaton myasthenic syndrome

A

paraneoplastic neurologic syndrome

muscle weakness esp in legs that improves w testing on exam

46
Q

metastatic tumor in brain–what to tx w?

A

radiation therapy

N P Neuro part (18 decks)

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