BMB 2 - CNS Neoplasms; Paraneoplastic & Autoimmune Encephalitis Flashcards
Metastatic malignancies to the brain are ____x more likely than primary malignancies.
Metastatic malignancies to the brain are 10 x more likely than primary malignancies.
20% of metastases to the adult brain come from what organ system?
The lungs
What are the four most common origin sites for metastases ending up in the adult brain?
Lung > melanoma > breast > renal cell carcinomas
(>> colorectal)
What are the three most common origin sites for metastases ending up in the pediatric brain?
Sarcomas
Neuroblastomas
Germ cell tumors
What are the most common origin sites for hemorrhagic metastases ending up in the adult brain?
Melanoma,
renal,
thyroid,
choriocarcinoma
What is the most common type of primary brain cancer?
Diffusely infiltrating gliomas
(e.g. glioblastoma multiforme)
Name some of the various S/Sy sometimes seen in patients with primary brain tumors?
Weakness and numbness
Aphasia
Seizures
Ataxia and gait impairment
Headaches
Brainstem symptoms
Blindness
Primary brain tumors are generally more associated with epilepsy in ________er patient populations and due to the less common, _______-grade gliomas.
Primary brain tumors are generally more associated with epilepsy in younger patient populations and due to the less common, high-grade gliomas.
Why are high-grade gliomas more likely to result in epilepsy than low-grade?
Due to an IDH 1/2 mutation which results in production of 2-hydroxyglutarate, which is both cytotoxic and stimulatory
(i.e. they produce glutamate, which is excitatory)
Brain metastases do not typically cause seizures; they are only more likely to cause them in what circumstances?
Unless (1) the cortex is involved or (2) the metastases are hemorrhagic
Brain metastases are widely associated with _________ edema and ____toxicity.
Brain metastases are widely associated with vasogenic edema and cytotoxicity.
True/False.
MRI is the main imaging technique used in identifying brain metastases.
True.
How do brain metastases typically present on MRI?
Multiple, well-circumscribed lesions at the gray-white junction
The large majority (80%) of brain metastases are in what location?
Options: cerebrum, cerebellum, or brainstem
Cerebrum
What would be your first step in working up the source of a patient’s brain metastases?
CT scan of the chest/abdomen/pelvis
What are the three options for radiation of brain metastases?
- Whole brain radiation
- Hippocampal-avoidant radiation
- Stereotactic radiosurgery
What term refers to the condition in which a solid tumor (typically lung, melanoma, or breast tumors) diffusely spreads to the leptomeninges?
Leptomeningeal carcinomatosis
A patient with untreated leptomeningeal carcinomatosis can expect to live how long?
And with treated leptomeningeal carcinomatosis?
4 weeks
4 months
(rapidly fatal)
Give the four names for the four grades of astrocytoma:
Grade 1 — Pilocytic
Grade 2 — Diffuse
Grade 3 — Anaplastic
Grade 4 — Glioblastoma
Glioblastoma multiforme is actually a very aggressive form of __________oma.
Glioblastoma multiforme is actually a very aggressive form of astrocytoma.
Are glioblastomas benign or malignant?
Malignant
What are the features of oligodendroglioma growth and IDH genetics?
Slow-growing with calcification;
1p/19q codeletion
Which primary brain tumor is typically found in either the spinal cord, brainstem, or thalamus and involves histone mutations?
Diffuse midline glioma
(associated with K27M and G34R mutations)
Which primary brain tumor is associated with HIV and EBV?
Primary CNS lymphoma
