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Clin Med III Exam 3 (🐈, 👵🏼, 🌭) > Brain Neoplasms (Lauren🌭) > Flashcards

Brain Neoplasms (Lauren🌭) Flashcards

1
Q

Overall, brain tumors come from ________ cells

A

glial

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2
Q

What are the 4 types of glial cells?

A

Astrocytes

Oligodendrocytes

Ependymal

Microglia

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3
Q

What do glial cells do?

A

Surround neurons and support/insulate them

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4
Q

What kind of cell does an astrocytoma come from

A

Astrocyte

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5
Q

What is the MAIN glial supporting cell in the CNS

A

Astrocyte

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6
Q

What are the 2 types of astrocytomas?

A

Diffuse- can’t be respected completely. Grades I-IV.

Circumscribed

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7
Q

The average survival for a high grade astrocytoma is ______ and for low grade astrocytoma it is ______

A

1 year for high grade

7 years for low grade

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8
Q

What are the 2 MAIN molecular markers that we use to classify astrocytomas and oligodendromas

A

IDH mutation

1p/19q codeletion

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9
Q

What’s the deal with tumors that have IDH mutation or 1p/19q codeletion?

A

They have a favorable prognosis

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10
Q

Regarding the IDH mutation and the 1p/19q codeletion:

Most astrocytomas have:

Oligodendrogliomas have:

A

Most astrocytomas have IDH mutation

Oligodendrogliomas have both

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11
Q

What are the two types of high grade gliomas?

A
  1. Anaplastic astrocytoma (Grade III)

2. Glioblastoma multiforme (Grade IV)

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12
Q

How will a High grade glioma present?

A

SHORT history of headaches, seizures, and focal neuro symptoms based on location

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13
Q

What will you see on MRI of a high grade malignant glioma?

A

Irregular mass lesions

Heterogeneous

Ring enhancing

T2W/FLAIR imaging shows signal extending beyond margins of contrast enhancement

Predilection to extend across the corpus callosum

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14
Q

Which type of brain tumor is REALLY associated with crossing the corpus calosum?

A

Glioblastoma Multoforme

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15
Q

What is a FLAIR MRI?

A

Its some kind of special MRI sequence used to look for specific abnormalities

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16
Q

What is the most common and most deadly glioma in adults?

A

Glioblastoma multiforme

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17
Q

What is the peak age of glioblastoma multiforme?

A

55

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18
Q

Youre looking at an MRI, and you are pretty sure you see a high grade glioma. What is necessary to confirm the diagnosis?

A

Biopsy or surgical resection

MR spectroscopy if you can’t get to it

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19
Q

If a patient has a glioma on their brainstem and there’s no way you are gonna be able to biopsy it or resect it, how can you confirm the diagnosis?

A

MR spectroscopy

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20
Q

What is the treatment for high grade gliomas?

A

Resect as much as you can while still PRESERVING brain function

Then do limited-field radiation with 2-3cm margin around it

Chemo during or after radiation

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21
Q

What are some of the ways we reduce the risk of damaging healthy brain tissue when we resect tumors?

A

Awake craniotomy

Diffusion tensor imaging or stimulation mapping to identify major pathways

Intraoperative MRI

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22
Q

What is the prognosis for high grade gliomas?

A

All of them recur no matter what

Median time to tumor progression after diagnosis is 6-8 months

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23
Q

What kind of high grade glioma responds best to chemo and radiation?

A

Anaplastic oligodendrogliomas with 1p/19q codeletion

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24
Q

How can we provide supportive care to patients with high grade gliomas?

A

Dexamethasone to reduce edema and increase neurological function

Pain and depression treatment

Treat seizures if they occur

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25
Q

Should we get a patient with a high grade glioma on an anti-epileptic drug prophylactically, even if they’ve never had a seizure?

A

No

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26
Q

What kind of antiepileptic drug should we put a patient with a high grade glioma on?

A

Use newer ones that have less drug interactions. Usually Keppra

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27
Q

What is the NUMBER 1 prognostic factor for high grade gliomas?

A

Age (>65 worse)

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28
Q

With standard therapy, GBM patient have a median survival of __________

A

12-15 months 😢

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29
Q

Do we distinguish between astrocytomas and oligodendrogliomas when we’re talking about low grade gliomas?

A

No becasue they share so many Clinical features

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30
Q

What do low grade gliomas tend to do to brain tissue

A

They tend to infiltrate instead of compress/destroy

(Good thing_

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31
Q

How do patient with LOW grade gliomas present?

A

Seizures*****

High grade was a short history of headaches, seizures and focal neuro symptoms

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32
Q

True or false:

Most low grade gliomas have IDH mutations

A

True

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33
Q

Low grade gliomas are (well/poorly) circumscribed lesions

A

Poorly

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34
Q

Which is more sensitive to chemotherapy:

Oligodendrogliomas or Astrocytomas

A

Oligodendrogliomas

****

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35
Q

Should we immediately give someon with a low grade glioma surgery and radiation?

A

No. There is no difference in overall survival in patients who receive early radiation.

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36
Q

Why should we delay radiation therapy as long as possible?

A

It is neurotoxic

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37
Q

What are the CLASSIC histological features of oligodendrogliomas?

A

Round nuclei with clear halos (fried egg 🍳)

With a network of branching capillaries (“chicken wire”) 🐓

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38
Q

Fried egg and chicken wire on histology

A

Oligodendrogliomas

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39
Q

The majority of oligodendrogliomas have which molecular marker?

A

1p/19q codeletion

May also have TP53

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40
Q

What will low grade astrocytomas look like on MRI?

A

Poorly demarcated hypointesne mass lesion on T1 weighted

Hyperintense lesion on T2/FLAIR

Infiltration of tumor extends beyond margins

20-40% will enhance with Gadolinium

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41
Q

We have like a billion super fancy kinds of MRIs and other imaging these days that we can use to guide treatment for brain tumors. NONE of them are a substitute for good old fashioned______________

A

Histological tumor diagnosis

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42
Q

How will a low grade oligodendrogliomas present on MRI?

A

Ill defined

NON ENHANCING

Calcifications more common in oligo than astro

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43
Q

Can we distinguish oligodendrogliomas from astrocytomas just from doing imaging?

A

NO. Need biopsy

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44
Q

What is the best thing to do for an asymptomatic young patient with a low grade glioma?

A

Delay surgery and radiation

Just watch them

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45
Q

What kind of patients SHOULD get early radiation for a low grade glioma?

A

Neurological signs/symptoms OTHER than seizures

Significant mass effect on imaging

Growth of lesion on serial scans

Not candidates for aggressive tumor resection

Have large postoperative tumor burden

> 50 yrs old at diagnosis

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46
Q

What is the prognosis for low grade astrogliomas?

A

Medan survival is 5-9 yrs

Long history of seizures with no other deficits have favorable prognosis

Age >50 /significant neuro impairment at diagnosis has a negative impact on survival

At time of tumor recurrence, the majority will have undergone a malignant transformation

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47
Q

What is the prgnosis for low grade oligodendrogliomas?

A

8-12 year survival

May take 8-12 months to see maximum response to therapy on imaging

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48
Q

If a low grade oligodendroglioma has the 1p/19q codeletion, what does that mean for the prognosis’/

A

Less aggressive

Better response to chemo

Better survival

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49
Q

Which has a longer survival:

Low grade oligodendrogliomas

Low grade astrocytomas

A

Oligodendrogliomas

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50
Q

What is the most common benign primary brain tumor

A

Meningioma

51
Q

Meningiomas arise from ______ cells

A

Arachnoid 🕷

52
Q

How do most meningiomas present?

A

Asymptomatically. Usually found incidentally on imaging

53
Q

What the fuck is a psammoma body

A

Clusters of meningiomas that form calcified whorls

➰

54
Q

What is the CLASSIC sign of meningioma

A

PSAMOMMA BODIES

55
Q

What is this:

Meningiomas circling each other, forming calcified whorls

A

Psammoma bodies

56
Q

It is super uncommon to get symptoms from a meningioma, but the people that do are usually (male/female)

A

Female

57
Q

Where would you look on a picture of a head MRI to find a meningioma/

A

You’d look at the DURA since they arise from the MENINGES.

58
Q

Meningiomas have (slow/fast) growth with a (slow/fast) progression of symptoms

A

Slow

Slow

59
Q

True or false:

Best treatment for meningiomas is chemotherapy

A

False.

They do not respond to chemo just cut them out

60
Q

What is hyperostosis?

A

Thickening of the bone

61
Q

What does it mean if there is hyperostosis in the skull adjacent to a meningioma?

A

Bone is invaded by tumor cells

62
Q

What is the treatment for meningioma?

A

Watch and wait, doing serial scans over the years

Dont treat until symptoms or tumor enlarges

Best treatment is total surgical resection

Radiation if they cant get it all or its recurrent

63
Q

What is the prognosis for meningioma?

A

Pretty freakin great

90% recurrence free survival at 5 years

65% at 15 years

64
Q

What kind of patients get primary CNS lymphoma?

A

Immunocompromised

Old

65
Q

What is primary CNS Lymphoma?

A

An aggressive extra-nodal non-Hodgkin lymphoma

66
Q

HIV patients who gets Primary CNS Lymphoma usually also have this disease:

A

EBV

67
Q

How will a patient with primary CNS Lymphoma present?

A

Altered mental status

Focal neurological deficits that profess rapidly

68
Q

What will you see on MRI of primary CNS lymphoma?

A

Multifocal lesions that are bright with homogeneous contrast enhancement in 1/2 of patients

69
Q

How would your ophthalmologist be the one to find your Primary CNS lymphoma?

A

20% of the time they infiltrate your eye and retina

70
Q

In the brain, Primary CNS Lymphoma has a predilection for which structures?

A

Deep or midline brain structures

71
Q

What is the MAIN TREATMENT for primary CNS Lymphoma?

A

CORTICOSTEROIDS
***

METHOTREXATE

STEM CELL TRANSPLANT

72
Q

Why are corticosteroids one of the BEST treatments for Primary CNS Lymphoma?

A

Reduce peritumoral edema

DIRECT oncolytic effect

73
Q

When should you NOT give steroids for Primary CNS Lymphoma?

A

Prior to biopsy since it will make the biopsy nondiagnostic

****

74
Q

Should we do surgery for Primary CNS Lymphoma

A

No

75
Q

Is whole-brain radiation effective for Primary CNS Lymphona?

Should you use it?

A

Very effective

Should not use due to neurotoxicity

76
Q

If you have to do whole brain radiation AND methotrexate for Primary CNS Lymphoma, what order should you do it in to reduce the risk for neurotoxicity?

A

Methotrexate first

Then do radiation

77
Q

What is the prognosis for Primary CNS Lymphoma?

A

Median survival 3-4 years

More than half will relapse even with a high response to methotrexate treatment

78
Q

What is the most common solid tumor in children

A

Brain tumor

79
Q

What is the most common embryonal brain tumor of childhood

A

Medulloblastoma

80
Q

Where do medulloblastomas usually arise?

A

Cerebellum vermis

4th ventricle

81
Q

What is the first line treatment for medulloblastoma

A

Surgery

82
Q

Most adult brain tumors are (above/below) the tentorium

A

Above

83
Q

Most pediatric brain tumors are (above/below) the tentorium

A

Below

Ex: Medulloblastoma is in the cerebellar vermis and 4th ventricle

84
Q

What are the symptoms of medulloblastoma?

A

Headaches

Vomiting in the morning

Gait ataxia

Lethargy

Possible signs of increased ICP

Invasion into brainstem causes cranial nerve palsies and long-tract findings (spasticity, hyperreflexia)

85
Q

What kind of tumor is most likely to metastasize outside the CNS

A

Medulloblastoma

86
Q

Why do most children with medulloblastoma need a CSF shunt?

A

Because the tumor blocks the 4th ventricle

87
Q

Why do we defer radiation as long as possible for children with medulloblastoma?

A

Becasue theyre still developing and its really bad for kids

88
Q

Where is a medulloblastoma most likely to recur?

A

Posterior fossa

89
Q

What is the prognosis for medulloblastoma?

A

If they have resection, chemo and radiation, they have a 5 yr survival over 65%

Large cell and anaplastic tumors have worse outcome

Due to the treatment, the child will have cognitive deficits, behavioral disorders, growth failure, hormone problems, and will need to be in special education 👩🏻‍🏫

90
Q

Where do ependymomas come from?

A

Ependymal cells which line the ventricles and central canal.

Usually in the 4th ventricle

91
Q

How do most patients with ependymoma present?

A

Hydrocephalus and increased ICP

It is usually in the 4th ventricle

92
Q

Ependymomas are most common in (adults/children)

A

Children

93
Q

What is the most common type of brain tumor overall?

A

Metastatic tumors that have spread from another kind of cancer in the body

94
Q

What is the HALLMARK of a metastasis to the brain?

A

Tumor is in the gray-white matter junction in the middle cerebral artery territory

95
Q

What are the 5 most common type of tumors to metastasaize to the brain?

A
  1. Lung **
  2. Breast ***
  3. Melanoma
  4. Renal
  5. GI tumors
96
Q

If you think a patient might have a metastatic tumor in their brain, what else should you look for on exam?

A

Cachexia

Lymphedema

Asymmetric breath sounds (lung cancer)

Breast mass (breast cancer)

Skin lesions (melanoma)

97
Q

What are the symptoms or raised ICP?

A

Headache that is nocturnal or worse in the morning. Aggravated by coughing, Valsalva, or postural change

Nausea

Papilledema

Altered mental status

False localizing signs (CN VI palsy)

98
Q

What can cause pain from a brain tumor?

A

Local invasion of dura, vasculature and periosteum

Brain itself has no pain receptors

99
Q

New or old tumor:

Swelling and expansion

A

New

100
Q

New or old tumor:

Atrophy

A

Old/chronic disease

101
Q

What kind of imaging is a “virtual biopsy” that looks at metabolites to see what a tumor is all about

A

MR Spectroscopy

102
Q

Which is better to see bone involvement of a tumor: CT or MRI

A

CT

103
Q

If a patient has a tumor in the cerebral hemisphere, what is the most common presenting symptom

A

Seizure

104
Q

If a patient has a tumor in the posterior fossa, what kind of symptoms will you see

A

Ataxia

Cranial nerve signs

105
Q

If a patient has a tumor within a ventricle or near a cerebral aqueduct, what kind of symptoms will you see?

A

Signs on increased ICP

106
Q

If a patient has a tumor on their spinal cord, what kind of symptoms will you see

A

Paraparesis

Sensory loss

Urinary incontinence

107
Q

What is the first drug you can start to decrease mass effect and edema of a brain tumor

A

Dexamethasone

108
Q

Why is dexamethasone the best steroid for brain tumors

A

Low mineralocorticoid activity

Long half life

109
Q

What do you need to do to establish a tumor diagnosis and grade it?

A

Biopsy (stereotactic or an open surgery)

110
Q

Cancer is a hypercoagulable state, so what should your patient be on

A

LMWH

111
Q

Can you give someone tPA if they have a brain tumor

A

Relatively contraindicated (not absolute)

112
Q

Butterfly sign on imaging

A

Glioblastoma multiforme

113
Q

What are common sites of origin for meningiomas?

A

Sites of dural reflectoin: falx cerebri, cerebral convexity, parasagittal area etc

114
Q

90% of Prumary CNS Lymphomas are classified as ________

A

Large-cell-B-lymphoma

115
Q

Adults or children:

Medulloblastoma

A

Children

116
Q

Adults or children:

Ependymoma

A

Children

117
Q

Tumor associated with HIV+ patients and EBV

A

Primary CNS Lymphoma

118
Q

Psamomma bodies and whorl pattern

A

Meningioma

119
Q

Most deadly brain tumor

A

GBM

120
Q

1 prognostic factor for GBM

A

Age >65

121
Q

Arises from arachnoid cells

A

Meningioma

122
Q

Most found incidentally on imaging

A

Meningioma

123
Q

most common type of cancer to metastasize to brain

A

Lung

40% of non small cell lung cancer patients have brain Mets

Clin Med III Exam 3 (🐈, 👵🏼, 🌭) (3 decks)

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