31a - Adult Brain Tumors Flashcards
Which genetic syndrome is associated with glioma and medulloblastoma?
Li Fraumeni (Ch.17 , p53 mutation)
Which genetic syndrome is associated with subependymal giant cell astrocytoma?
Tuberous Sclerosis (Ch. 9/16, TSC 1/2)
Which genetic syndrome is associated with cortical tubers and glioma?
Tuberous sclerosis (Ch.9/16, TSC 1/2)
Which genetic syndrome is associated with glioma of the optic nerve, astrocytoma and glioblastoma?
Neurofibromatosis 1 (Ch. 17, NF1)
Which genetic syndrome is associated with pituitary cancer?
MEN Type 1 (ch. 11, menin)
Which genetic syndrome is associated with meningioma, schwannoma, and ependymoma?
Neurofibromatosis 2 (ch. 22, NF2)
Which genetic syndrome is associated with hemangioblastoma?
Von Hippel Lindau (Ch. 3, VHL)
Which genetic syndrome is associated with retnioblastoma?
retinoblastoma mutations (ch. 13, RB1)
Which genetic syndrome is associated with bilateral acoustic neuroma?
NF2 (ch.22)
Which neoplasms is Li Fraumeni associated with?
glioma and medulloblastoma
Which neoplasms is Tuberous sclerosis associated with?
subependymal gian cell astrocytoma, corticol tubers, glioma
Which neoplasms is a mutation in Ch. 17, p53 gene associated with?
Li fraumeni = glioma and medulloblastoma
Which neoplasms is NF1 associated with?
CH 17 mutation. glioma of optic nerve, astrocytoma, glioblastoma
Which neoplasms is NF2 associated with?
meningioma, scwhannomma (bilateral acoustic neuroma), ependymoma
Which neoplasms is MEN type 1 associated with?
ptiutitary
Which neoplasms is von hippel lindau associated with?
hemangioblastoma (ch. 3, of VHL)
Which neoplasms is a mutation in ch. 22 asssociated with?
NF2, meningioma, schwannoma, ependymoma
Which neoplasms is a mutation in 9/16 associated with?
TSC1/2 - subependymal giant cell astrocytoma, corticol tubers, glioma
Which neoplasms is a mutation in ch 11 associated wtih?
MEN1 - menin - pituitary tumors
What is most common type of primary brain tumor?
infiltrative astrocytoma and/or Glioblastoma multiforme
Which type of MRI makes water appear white?
T2 MRI. CSF, Edema and tumors (water) appear bright. Contrast is dark
Which type of MRI makes contrast appear dark?
T2 MRI. Contrast dark, water bright
Which type of MRI will show tumors as hypointense?
T1 MRI will show hypointesnse water (CSF, tumor, edema) and bright contrast.
What is the equation for cerebral perfusion pressure?
CPP = MAP - ICP
What headache symptoms should clue you in to brain tumors?
worse on waking up but better within an hour.
Vomiting immediately after headaches.
New onset or change in character of headaches, or change in mental status
What is gold standard for diagnosing brain tumors?
MRI = gold standard
CT is better for calcification/pathology
Tissue biopsy is definitive diagnosis EXCEPT for CNS lymphoma because you can sample malignant cells on LP
Concerning brain herniations, What is contralateral hemianopsia indicative of?
Ips. PCA compression
Concerning brain herniations, what is ipsilateral dilated pupil and ptosis indicative of?
CN III compression
Concerning brain herniations, what is ipsilateral paresis indicative of?
Contralateral Crus cerebri compression (Kernohan’s notch)
What is Duret hemorrhage?
caudal displacement of brainstem, commonly causes paramedian artery rupture
What is at risk for compression in a cingulate (subfalcine) herniation?
cingulate passes under falx cerebri. Anterior cerebral artery at risk for compression.
What are symptoms of a diencephalic downward (transtentorial) herniation?
brainstem will be compressed so drowsiness, imparied vertical gaze, bilateral small pupils (horner), coma–>death.
What should CNIII palsy and both contra/ipsilateral hemiparesis make you think in terms of herniations?
classical uncal herniation. May have contralateral or ipsilateral hemiparesis depending on particular case, but always CN III palsy.
What are symptoms of upward herniations through the tentorium?
ipsilateral occulmotor nerve palsey mixed with horner’s syndrome (so midposition unreactive pupil), contralateral hemiparesis
What type of herniation could cause BP and respiratory changes, weakness and horner’s syndrome?
cerebellar tonsilar herniation
What types of neoplasms are considered gliomas?
astrocytomas, oligodendroglioma, ependymoma
GBM
What are good prognostic factors for gliomas like astrocytomas or oligodendrogliomas?
MGMT methylation (good band=good prognosis), IDH mutation, Ch. 1/19 deletion in tumor. Obvious ones like low age, low grade/stage.
Where are gliomas most commonly found?
cerebral hemispheres
Butterfly lesion on MRI = ?
butterfly glioma. they like to cross the corpus callosum.
GFAP+ astrocytes with pseudopalisading tumor cells around the area of necrosis on biopsy should make you think what?
astrocytoma
What type of MRI is best for GBM?
T2 it will pop up as hyperintense (white).
Will be negative on T1 because it is slow growing, with few vessels and not a lot of leakiness
Treatment for gliomas such as astrocytomas, or ependymomas?
chemo: temozolomide and bevacizumab.
radiation
steroids to restore BBB (fast and temporary)
anticonvulsants (only after seizures occur)
Which are secreting pituitary adenomas: macro or micro?
micro secrete (< 1cm). macro >1 cm tend to be nonsecreting so they get large and start causing compression symptoms that clue you in.
What type of receptor does GH use?
JAK/STAT
What are symptoms of pituitary microadenoma?
galactorrhea from prolactin, acromegally from GH.
What are symptoms of pituitary macroadenoma?
bitemproal hemaniopsia.
headache
diplopia and facial numbing.
What nerves travel in cavernous sinus?
5 nerves in the carvernous: 3,4,V1,V2, and 6
If lower quadrants of vision are lost, from which side is the optic tract/chiasm being compressed?
vision loss on bottom = compression from top = Rahtke pouch craniopharyngioma
What is drug treatment for GH secreting tumor?
somatostatin analogue octreotide
What is drug treatment for prolactin secreting tumor?
Dopamine agonist bromocriptine. DA inhibits prolactin secretion
EBV infection in an AIDs patient is a risk for what brain neoplasm?
CNS lymphoma. Most common CNS tumor in AIDS.
Multiple lesions in leptomeninges and deeper periventricular brain parenchyma =
CNS lymphoma
What is used for diagnosis of CNS lymphoma
B cells found in CSF
Why should you not give steroids prior to doing an LP?
it will mess with results. In CNS lymphoma it will necrose B cells.
What are meningiomas derived from?
arachnoid cap cells outside the brain (extra-axial)
What are the different types of meningiomas?
low grade (most common), atypical, and malignant
Where are meningiomas found?
convexity, parasagittal or optic sheath.
Well defined masses easily separated from neuropil
What is microscopic pathology of meningioma?
psammoma bodies
How will a meningioma appear on MRI?
dark on T1, bright on T2.
Calcifications from psammoma bodies or dural tail.
Where are acoustic neuroma’s derived from?
scwhann cells around vestibular branch of CN 8
What does Antoni A and Antoni B mean?
for acoustic neuromas. on microscopic path,
Antoni A = densely packed cells
Antoni B = loose cystic areas
What is clinical presentation of acoustic neuroma?
hearing loss, tinnitus, dizziness, ataxia
What is most common source of brain mets?
lung cancer (50%), then breast cancer in females.
Melanoma high very high probability of met to brain.
also colon and renal
Where are extradural spinal cord tumors from?
mets from breast, lung, prostate,
less importantly from renal, lymphoma, sarcoma
What are the intradural extramedullary tumors?
schwannomas, neruofibriomas and meningiomas
What are the intradural intramedullary tumors?
astrocytoma in PEDs, ependymoma in ADULTS, hemangioblastomas
