3- Benign and Malignant Brain Tumors

Question 1

What are the 3 types of primary brain neoplasms (arising from different cells within the CNS)?

Answer 1

Meningioma

Glioma

Primary CNS Lymphoma

Question 2

What is the most common benign primary brain neoplasm?

Answer 2

Meningioma, slow growing

Question 3

What is the most common malignant primary brain neoplasm?

Answer 3

Glioma

Question 4

Secondary brain neoplasms (metastasized from a primary CA at a distant site) are most likely to have come from where?

Answer 4

Lung, melanoma, breast

Question 5

What is the most common brain neoplasm is adolescents and young adults vs the most common brain neoplasm in adults > 30 yo?

Answer 5

Adolescents and young adults- primary brain neoplasm

Adults > 30 yo- secondary brain neoplasm

Question 6

Although highly dependent on size, location, and extent of tumor, what are the more common clinical presentations of a brain neoplasm?

Answer 6

HA

Seizure

Focal neuro deficits

Cognitive dysfunction

Increased ICP

Question 7

Nocturnal HA or HA worse in am/ worse with coughing, sneezing, valsalva, as well as N/V, AMS, and CN palsy may be indicitive of what, with respect to brain neoplasm clinical findings?

Answer 7

Increased ICP

Question 8

What is the imaging of choice for brain tumor dx?

Answer 8

Brain MRI w/ contrast

(+/- CT head, chest, abd, pelvis)

Question 9

What is the 2nd most common cause of CA related death in children?

Answer 9

Primary CNS tumors

Question 10

Where do meningiomas arise from and are they slow or fast growing?

Answer 10

Arises from meninges

Slow growing

Question 11

Meningiomas are typically asx and found incidentally, although if sx present with anosmia and visual deficits. What is the management besides referral?

Answer 11

Can defer tx if asx/ resect vs radiation if sx

Question 12

What type of cell is the most abundant cell type in the CNS and surround neurons to provide support and insulation?

Answer 12

Glial cells

Question 13

What are the 3 types of glial cells?

Answer 13

Astrocytes- main glial supporting cell in CNS

Oligodendrocytes- produce myelin

Ependymal cells- produce CSF

Question 14

What is the most common glioma in adults?

Answer 14

Glioblastoma Multiforme (GBM)

• most deadly/ malignant, grade IV, poor prognosis

Question 15

How are brain tumors classified?

Answer 15

Histology and molecular testing

Question 16

What are the 2 main genetic tests performed as part of molecular testing for classification of brain neoplasms?

Answer 16

IDH mutation vs wildtype

Presence of 1p/19q codeletion

Question 17

What is indicated if a pt has an IDH mutation vs IDH wildtype?

Answer 17

IDH mutation- better prognosis

IDH wildtype- worse prognosis

Question 18

Presence of 1p/19q codeletion on molecular testing indicates what?

Answer 18

Favorable response to tx

Question 19

How does the prognosis for oligodendroglioma compare to that of an astrocytoma?

Answer 19

Better prognosis compared to astrocytoma

Question 20

Ependymomas usually occur in what population?

Answer 20

Kids

Question 21

A primary CNS lymphoma is a rare form of what type of CA?

Answer 21

NHL

Question 22

Who is at an increased risk for primary CNS lymphoma?

Answer 22

HIV, organ transplant

Question 23

Should steroids play a role in the management of a primary CNS lymphoma?

Answer 23

Steroids should be held prior to bx b/c potential of making bx non-diagnostic

Question 24

What is the management for primary CNS lymphoma?

Answer 24

Methotrexate = standard initial therapy

No role for surgery other than bx

Question 25

What is included in the initial management for large/ sx brain neoplasms? (signs/ sxs of elevated ICP, impending herniation)

Answer 25

Neurosurgical referral Emergent eval/ neurosurgical attention

Question 26

What is included in the initial management for smaller/ minimal sx brain neoplasms?

Answer 26

Outpatient management

Question 27

What is included in the surgical management of a brain neoplasm?

Answer 27

Max tumor resection w/ preservation of neuro function Awake craniotomy (allows mapping of speech, visual, sensory, motor functions) Intraoperative MRI (assesses degree of resection)

Question 28

In addition to surgery, what else is included in the management for brain neoplasms?

Answer 28

Radiation, chemo, supportive care

Question 29

In addition to pain management, psychsocial sx management, anti-seizure meds, and support groups, what role might steroids play in the supportive care management of brain neoplasms?

Answer 29

Reduce IC edema and improve neuro function (except do not use with primary CNS lymphoma)