277 - CNS Cancers Flashcards
What CNS tumor is most likely to present with hearing loss?
What genetic syndrome do we suspect if it is bilateral?
Vestibular schwannoma
- unilateral tumors are sporadic, but bilateral tumors are pathognomonic for NF2
- defect on chr 22 (merlin protein)
- presents w/ gradual hearing loss, tinnitus, and dizziness
- b/c of slow growth reate, vestibular system compensates and dizziness is less present
- CN7 dysfunction may be seen w/ large tumors
- sugery can be curative, low mortality, but high morbidity (hearing loss, facial paralysis)
ATRX loss is associated with which CNS tumor?
Astrocytoma
What are the histological hallmarks (2) of a meningioma?
Psammoma bodies
Whorled-appearance
What is the gold standard for diagnosing CNS malignancy?
MRI w+w/o contrast
What is the most common malignant primary brain tumor?
Glioblastoma
- Pseudopalisading necrosis and microvascular proliferation*
- Most common malignancy in the brain = metastases*
- Most common primary brain tumor = meningioma*
- Most common malignant, primary bain tumor = glioblastoma*
Which 3 cancers are most likely to metastasize to the brain?
Lung
Breast
Melanoma
What is the histological hallmark of oligodendroglioma?
Fried egg cells with chicken-wire vasculature
What makes something in the CNS contrast-enhance?
Breakdown of the blood-brain barrier
What are the distinguising histologic features of a glioblastoma?
Pseudopalisading necrosis and microvascular proliferation
How does MGMT methylation affect glioblastoma prognosis?
MGMT metylated = better prognosis
What is the treatment approach to meningioma?
Observe if asymptomatic
Resect if symptomatic
Benign tumors, usually does not cause death
What kind of tumor is most likely in this patient?
Meningioma
- Homogenously contrast-enhancing with dural tails*
- Histology will have whorls/psammoma bodies*
Which kind of brain tumor stains GFAP+ ?
Astrocytoma
Includes all grades:
- 1: pilocytic astrocytoma
- 2: Diffuse astrocytoma
- 3: Anaplastic
- 4: Glioblastoma multiforme
What tumor marker is pathognomonic for oligodendroglioma?
1p19q co-deletion
What is the role of corticosteroids in the treatment of primary CNS lymphoma?
Can be helpful, but…
- Must do a biopsy before starting corticosteriods so that it doesn’t affect biopsy results
-
Should not be used alone
- If used alone, will recur and be resistant to steroids
- Use MTX-based chemotherapy / whole brain radiation too
1p19q deletion is pathognomic for what CNS tumor?
Oligodendroglioma
What is the most common presenting symptom of primary CNS lymphoma?
Behavioral change / cognitive impariment
- Headaches
- Lateralizing signs
- Classic B symptoms are ususally absent
Describe the headache characteristics that are concerning for CNS malignancy
- Worst in the morning, disappears after rising
- Gradually increases in frequency, duration, serverity
- -> eventually becomes constant
- Worsens with things that increase ICP
Also nausea, vomiting due to increased ICP
What is the cell of origin in glioblastoma multiform?
Astrocyte
Grade 4
List 2 risk factors for meningioma
NF-2
Prior ionizing radiation
What is the most common primary brain tumor?
Meningioma
Glioblastoma = most common malignant primary brain tumor
What mutation is characteristic of lower-grade gliomas?
IDH mutation
Seizure
Common presenting symptom of CNS tumor
Which CNS malignancy is most likely to present as a single, ring-enhancing mass with surrounding edema?
Primary CNS lymphoma
What is the treatment for glioblastoma?
surgery + conventional fractioned external beam radiation therapy + daily temozolomide (chemo)
treatment is noncurative
What is the most common malignancy in the brain?
metastasis
what is the most common primary brain tumor?
meningiomas
mostly benign, and has a rare malignant variant
