279 - CNS Cancers Flashcards

1
Q

What CNS tumor is most likely to present with hearing loss?

What genetic syndrome do we suspect if it is bilateral?

A

Vestibular schwannoma

Bilateral: NF-2 mutation (chromosome 22)

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2
Q

ATRX loss is associated with which CNS tumor?

A

Astrocytoma

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3
Q

What are the histological hallmarks (2) of a meningioma?

A

Psammoma bodies

Whorled-appearance

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4
Q

What is the gold standard for diagnosing CNS malignancy?

A

MRI with contrast

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5
Q

What is the most common malignant primary brain tumor?

A

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*
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6
Q

Which 3 cancers are most likely to metastasize to the brain?

A

Lung

Breast

Melanoma

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7
Q

What is the histological hallmark of oligodendroglioma?

A

Fried egg cells with chicken-wire vasculature

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8
Q

What makes something in the CNS contrast-enhance?

A

Breakdown of the blood-brain barrier

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9
Q

What are the distinguising histologic features of a glioblastoma?

A

Pseudopalisading necrosis and microvascular proliferation

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10
Q

How does MGMT methylation affect glioblastoma prognosis?

A

MGMT metylated = better prognosis

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11
Q

What is the treatment approach to meningioma?

A

Observe if asymptomatic

Resect if symptomatic

Benign tumors, usually does not cause death

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12
Q

What kind of tumor is most likely in this patient?

A

Meningioma

  • Homogenously contrast-enhancing with dural tails*
  • Histology will have whorls/psammoma bodies*
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13
Q

Which kind of brain tumor stains GFAP+ ?

A

Astrocytoma

Includes all grades:

  • 1: pilocytic astrocytoma
  • 2: Diffuse astrocytoma
  • 3: Anaplastic
  • 4: Glioblastoma multiforme
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14
Q

What tumor marker is pathognomonic for oligodendroglioma?

A

1p19q co-deletion

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15
Q

What is the role of corticosteroids in the treatment of primary CNS lymphoma?

A

Can be helpful, but…

  • Must to a biopsy before starting
  • Should not be used alone
    • If used alone, will recur and be resistant to steroids
    • Use MTX-based chemotherapy / whole brain radiation too
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16
Q

1p19q deletion is pathognomic for what CNS tumor?

A

Oligodendroglioma

17
Q

What is the most ocmmon presenting symptom of primary CNS lymphoma?

A

Behavioral change / cognitive impariment

  • Headaches
  • Lateralizing signs
  • Classic B symptoms are ususally absent
18
Q

Describe the headache characteristics that are concerning for CNS malignancy

A
  • Worst in the morning, disappears after rising
  • Gradually increases in frequency, duration, serverity
    • -> constant
  • Worsens with things that increase ICP

Also nausea, vomiting due to increased ICP

19
Q

What is the cell of origin in glioblastoma multiform?

A

Astrocyte

20
Q

List 2 risk factors for meningioma

A

NFM-2

Prior ionizing radiation

21
Q

What is the most common primary brain tumor?

A

Meningioma

Glioblastoma = most common malignant primary brain tumor

22
Q

What mutation is characteristic of lower-grade gliomas?

A

IDH mutation

23
Q
A

Seizure

Common presenting symptom of CNS tumor

24
Q

Which CNS malignancy is most likely to present as a single, ring-enhancing mass with surrounding edema?

A

Primary CNS lymphoma