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Brant - 5th Edition > Chapter 5 - Central Nervous System Neoplasm and Tumor-like Masses > Flashcards

Chapter 5 - Central Nervous System Neoplasm and Tumor-like Masses Flashcards

1
Q

Clinical presentations of CNS neolplasm. (3)

A
  1. Headaches
  2. Seizures
  3. Focal neurological deficits
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2
Q

Study of choice for the evaluation of a patient with intracranial neoplasm.

A

Contrast- enhanced brain MRI

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3
Q

Basic sequences of MRI for evaluation of intracranial neoplasm (4)

A
  1. DWI
  2. T2WI (with FLAIR)
  3. T2*-weighted imaging (GRE or SWI)
  4. Pre/postcontrast T1WI

Advance options:

  1. Perfusion-weighted imaging
  2. MR spectroscopy
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4
Q

Restricted diffusion in DWI may be seen in what cases? (3)

A
  1. Acute stroke
  2. Hypercellar tumors (lymphoma)
  3. Highly viscous fluids
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5
Q

This measures cerebral blood volume (CBV) as a noninvasive marker of tumor vascularity, which usually increases with tumor grade

A

MR perfusion

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6
Q

This measures chemical shift of nonwater molecules in a region of interest (single or multi voxel) as a noninvasive marker of tumor metabolism.

A

MR spectroscopy

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7
Q

The chemical or frequency shift (in MRS) is measured how?

A

It is measures in parts per million (ppm), calibrated relative to tetramethysilane (TMS)

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8
Q

In a normal brain, what are the main metabolites and their respective peaks? (3)

A
  1. Choline - 3.2 ppm
  2. Creatine - 3.0 ppm
  3. N-acetylaspartate - 2.0 ppm
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9
Q

What choline/creatine ratio is suggestive of a high grade tumor?

A

Choline/creatine ratio >2

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10
Q

Uses of PET in CNS tumor

A

Distinguishing residual/recurrent tumor from radiation-induced changes in the white matter.

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11
Q

Tumors that metastasize to the brain that causes hemorrhage. (6)

A
  1. Melanoma
  2. Renal cell carcinoma
  3. Choriocarcinoma
  4. Thyroid carcinoma
  5. Breast carcinoma
  6. Bronchogenic carcinoma (lung)

(MR CT BB)

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12
Q

Calcified intracranial masses. (6)

A
  1. Craniopharyngioma
  2. Astrocytoma, aneurysm
  3. Chorid plexus tumor
  4. Oligodendroglioma (>50%)
  5. Meningioma
  6. Ependymoma

(CA COME)

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13
Q

Vascularized granulation tissue develops within how many hours following surgery and enhances after administration of contrast.

A

48 to 72 hours

The ideal time to obtain a post-operative contrast-enhanced study (usually MR)

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14
Q

These tumors account for the majority of all gliomas

A

Astrocytoma

approximately 75%

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15
Q

Astrocytomas and gliomas are divided into two major groups based on growth pattern.

A
  1. Circumscribed

2. Diffuse

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16
Q

These gliomas demonstrate more well-defined margins on micrscopic examination and tend to be more amendable to a surgical cure.

A

Circumscribed gliomas

  • Lower grade and younger age
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17
Q

These gliomas demonstrate more ill-defined margins on microscopic examination, regardless of the macroscopic appearance on cross-sectional imaging.

A

Diffuse or infiltrative

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18
Q

Most common pediatric CNS tumor

A

Pilocytic astrocytoma

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19
Q

Most common location of pilocytic astrocytoma

A
  1. Cerebellum (60%)

followed by the:

  1. Optic pathways/ hypothalamus (30%)
  2. Brainstem
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20
Q

Most common age group of pilocytic astrocytoma

A

Children (<20 years old)

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21
Q

True or fase

Pilocytic astrocytoma is associated with neurofibromatosis type 1

A

True

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22
Q

A circumscribed astrocytoma that is less common and more aggressive variant of pilocytic astrocytoma

A

Pilomyxoid astrocytoma

Most commonly occures in the suprasellar region

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23
Q

A circumscribed astrocytoma that is slow-growing tumor located at the foramen of Monro and is associated with tuberous sclerosis

A

Subependymal giant cell astrocytoma

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24
Q

A circumscribed astrocytoma that is peripherally located cerebral tumor that often involves the cortex/ meninges.

A

Pleomorphic xanthoastrocytoma

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25
Q

Imaging pattern of circumscribed astrocytoma

A
  1. Circumscribed enhancing mass,

2. which may be accompanied by internal or adjacent fluid-filled cysts.

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26
Q

Classic appearance of a pilocytic astrocytoma in a child

A

Nonenhancing cyst with enhancing mural nodule in the cerebellum

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27
Q

This is a low-grade astrocytic tumor with low-level proliferative activity.

A

Diffuse astrocytoma

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28
Q

Astrocytic tumor with increased cellularity, mitotic activity, or nuclear atypia

A

Anaplastic Astocytoma

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29
Q

WHO genetically divides diffuse gliomas into: (2)

A
  1. Isocitrate dehydrogenase (IDH) mutant

2. Isocitrate dehydrogenase (IDH) wildtype

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30
Q

Which has better prognosis:

A. Isocitrate dehydrogenase (IDH) mutant

B. Isocitrate dehydrogenase (IDH) wildtype

A

A. Isocitrate dehydrogenase (IDH) mutant

Majory of diffuse and anaplastic astrocytoma are IDH- mutant

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31
Q

Imaging pattern of diffuse and anaplastic astrocytoma (4)

A
  1. Expansile parenchymal lesion
  2. Hypodense on CT
  3. Hyperintense on T2W
  4. Without significant enhancement (intact blood-brain barrier)
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32
Q

It may not be possible to distinguish diffuse from anaplastic astrocytoma before biopsy.

What are the possible clues to include the latter?

A
  1. Older age (>40 years old)
  2. Imaging markers:
    - increased cellularity (decreased diffusion)
    - mitotic activity (increased choline)
    - tumor vascularity (increased perfusion)
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33
Q

This is a Grade IV or malignant astrocytoma and is overall the most common primary intra-axial tumor of the CNS.

A

Glioblastoma multiforme

It accounts for over hald of gliomas (55%)

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34
Q

Vast majority of glioblastoma are:

a. IDH-mutant
b. IDH-wildtype

A

b. IDH-wildtype
(90%), also known as primary glioblastomas

IDH-mutant (<10%) - also known as secondary glioblastomas - younger adults - less aggressive

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35
Q

Imaging pattern of glioblastoma (3)

A
  1. Heterogenously enhancing parenchymal mass with surrounding vasogenic edema.
  2. May include calcification or hemorrhage
  3. Can present as a single enhancing mass, multifocal enhancing masses, or a combination of both enhancing and nonenhancing tumor
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36
Q

Differential diagnosis for ring enhancing lesions (7)

A
  1. Metastasis
  2. Abscess
  3. Glioma (especially glioblastoma)
  4. Infarct (subacute or healing phase)
  5. Contusion/ hematoma (subacute)
  6. Demyelinating disease
  7. Radiation necrosis

(MAGIC DR)

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37
Q

Diffuse or infiltrative glioma (commonly glioblastoma) crosses the corpus callosum to involve both cerebral hemispheres

A

Butterfly glioma

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38
Q

In adults - this refers to either a diffuse infiltrative glioma, similar to supratentorial diffuse gliomas but in a less common location, or focal tectal glioma, which is a low-grade tumor in the midbrain that causes obstructive hydrocephalus

A

Brainstem glioma

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39
Q

In young children - this refers to a diffuse infiltrative glioma with highly aggressive behavior, despite absent or minimal enhancement.

A

Brainstem glioma or diffuse intrinsic pontine glioma

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40
Q

This describes widespread infiltrative growth of a diffuse glioma, more commonly astrocytoma than oligodendroglioma, to involve at least three lobes of the brain.

A

Gliomatosis cereberi

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41
Q

Less common and account for only 6% of all gliomas.

Demonstrate diffuse growth pattern, just like their astrocytic counterparts, with neoplastic cells infiltrating beyong the macroscopic margins of the tumor.

A

Oligodendrogliomas

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42
Q

Imaging pattern of oligodendroglioma (9)

A
  1. Expansile infiltrative parenchymal elsions
  2. Hypodense on CT
  3. Hyperintense on T2
  4. Most commonly located in the frontal lobes
  5. Extend peripherally to involve cortex
  6. More likely to exhibit calcification on CT
  7. Poorly defined margin - heterogeneous signal on MRI
  8. Vascular - Variable enhancement
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43
Q

It may not be possible to distinguish oligodendroglioma from anaplastic oligodendroglioma.

What possible clues to include the latter?

A
  1. Older age (>40 years old)
  2. Imaging markers:
    - increased cellularity (decreased diffusion)
    - mitotic activity (increased choline)
    - tumor vascularity (increased perfusion)
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44
Q

These arise from the ependymal cells lining the ventricular system and the central canal of the spinal cord, therefore often present as a fourth ventricular mass in children, less commonly as an intramedullary mass in adults.

A

Ependymomas

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45
Q

Imaging pattern of ependymoma (6)

A
  1. Heterogeneous enhancing mass within the fourth ventricle in a child (most common)
  2. Capable of paraventricular or transependymal invasion into the brain parenchyma
  3. Heterogenous on CT
  4. Intratumoral calcification
  5. Cystic change
  6. Hemorrhage
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46
Q

Less common sites of ependymoma

A
  1. Cerebellopontine angles
  2. Cerebral hemispheres
  3. Lateral-third ventricles
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47
Q

Immediately underneath the ependymal lining of the ventricular system lies a thin subependyma glial plate. What tumor arise from this region?

A

Subependymoma

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48
Q

Most common locations of subependymoma (3)

A
  1. Inferior fourth ventricle
  2. lateral-third ventricles
  3. spinal cord
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49
Q

Difference of subependymoma from ependymoma

A
  1. Older adults (>40 years old)

2. Hypovascular - show less enhancement on post contrast imaging

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50
Q

Choroid plexus tumors occur on what age group?

A

Children (<20 years old)

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51
Q

Spectrum of choroid plexus tumor (3)

A
  1. Choroid plexus papilloma
  2. Atypical choroid plexus papilloma
  3. Choroid plexus carcinoma
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52
Q

Imaging pattern of choroid plexus tumor (2)

A
  1. Intensely enhancing masses with lobulated margins

2. Usually centered at the atrium or trigone of the lateral ventricle (arising from the choriod plexus glomus)

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53
Q

These tumors are characterized by varying degrees of neuronal differentiation (neurocytes and ganglion cells), often with glial component too.

A

Neuronal and mixed neuronal-glial tumors.

  • Generally present in children or young adults (age <40 years old)
  • 1% of all primary CNS tumor
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54
Q

This is a benign mixed neuroal-glial tumor with an excellent prognosis, associated with medically refrarctory partial complex seizures in children or yound adults.

A

Dysembryoplastic Neuroepithelial Tumor (DNET)

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55
Q

Typically imaging pattern of DNET

A

Nonenhancing multycystic (bubbly) mass at the cerebral cortex in a young patient, usually the temporal lobe

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56
Q

Pure neuronal tumor composed of neoplastic ganglion cells

A

Gangliocytoma

57
Q

A mixed glioneuronal tumor with neoplastic glial cells as well.

A

Ganglioglioma

58
Q

Imaging pattern of gangliocytoma and ganglioglioma

A

Partially enhancing mass at the cerebral cortex in a young patient

  • Most common neoplastic etiology for temporal lobe epilepsy
59
Q

Also known as Lhermitte-Duclos Disease

A

Dysplastic cerebellar gangliocytoma

60
Q

Classic imaging pattern of dysplastic cerebellar gangliocytoma

A

Nonenhancing mass that expands the cerebellar folia and causes “striated cerebellum” appearance on MRI.

61
Q

Dysplastic cerebellar gangliocytoma is frequently associated with what syndrome.

A

Cowden syndrome

  • an autosomal dominant phakomatosis with multiple hamartomas and mutations in the PTEN tumor suppressor gene
62
Q

Tumors that present as a heterogeneous mixed cystic-solid mass (cyst and nodule appearance) involving the cerebral cortex.

It may cause desmoplastic reaction with thickening and enhancement of the overlying meninges, analogous to PXA.

A

Desmoplastic infantile astrocytoma and ganglioma

63
Q

Glial cells form a pseudopapillary arrangement with interpapillary neuronal cells.

It presents as a cerebral mixed cystic-solid mass, with predilection for the temporal lobe, similar to ganglioglioma.

A

Papillary glioneuronal tumor (PGNT)

64
Q

The glial component resembles a pilocytic astrocytoma, while the neuronal component forms neurocystic rosettes and perivascular pseudorosettes.

It also presents as a mixed cystic-solid mass, but is most commonly located in the midline, around the fourth ventricle, or the cerebral aqueduct.

A

Rosette-Forming glioneuronal tumor

65
Q

In contrast with other neuronal tumors, which are parenchymal and often cortical in location, this is a ventricular tumor with an unclear cell of origin.

A

Central neurocytoma

66
Q

Imaging pattern of central neurocytoma

A

Prensent in young adults (20 to 40 years old)

As an enhancing mass arising from the septum pellucidum or lateral ventricular wall, near the foramen of Monro.

T2 - heterogeneous apperance (bubbly)

67
Q

These are highly malignant tumors of neuroepithelial origin, which are too poorly differentiated to be cathergorized as glial or neuronal tumors.

A

Embryonal tumors

68
Q

It is the most common CNS embryonal tumor, as well as the second most common pediatric CNS tumor (after PA).

A

Medulloblastoma

69
Q

Subtypes of medulloblastoma (4)

A
  1. Classic
  2. Desmoplastic/nodular
  3. Medulloblastoma with extensive nodularity
  4. Large cell/anaplastic
70
Q

Imaging pattern of medulloblastoma

A

Most classic appearance:

Hyperdense mass at the cerebellar vermis in a young child

71
Q

Pediatric posterior fossa tumors (4)

A
  1. Brainstem Glioma
  2. Pilocytic Astrocytoma
  3. Medulloblastoma
  4. Ependymoma

(“GAME”)

72
Q

Most common primary intra-axial posterior fossa mass of adulthood.

A

Hemangioblastoma

40 to 60 years old

73
Q

Imaging pattern of hemangioblastoma

A

Circumscribed enhancing tumors that can secrete fluid and produce internal or adjacent cysts.

74
Q

Primary differential diagnosis of hemangioblastoma

A

Hypervascular metastasis (renal cell carcinoma)

75
Q

Percentage of hemagioblastoma arising outside the posterior fossa

A

Fewer than 10%

Often in the setting of VHL, and also present as pial-based enhancing nodules, with or without cysts.

76
Q

Most common non-Hodgkin lymphoma of adults and can arise in virtually any compartment of the body, including the brain parenchyma.

A

Diffuse large B-cell lymphoma

Primary CNS Lymphoma or PCNSL

77
Q

Clinical presentation of PCNSL

A

Older adults (>40 years old) with altered mental status or focal neurologic deficits.

78
Q

Imaging pattern of PCNSL

A
  1. Homogeneously enhancing mass that abuts the CSF space and wraps around the ventricles or sulci
  2. With homogeneous hyperdensity on CT
  3. Corresponding hypointensity on T2/ADC
  4. Can infiltrate the corpus callosum
79
Q

Classic imaging patterns of PCNSL may not apply to immunocompromised patients.

Why?

A

AIDS-related or EBV-positive PCNSL tends to present with multifocal heterogeneous lesions and variable or ring-like enhancement.

80
Q

50% of brain metases are secondary to what primary cancer?

A

Lung cancer

81
Q

Common location of metastases in the intracranial or intradural compartment

A

Parenchymal (usually supratentorial)

than intraventricular, leptopmeningeal, or pachymeningeal metastases.

82
Q

Imaging pattern of metastatic tumor

A

Classic appearance:
One or multiple enhancing masses, with circumscribed margins, located peripherally near the gray-white matter junction, and surrounded by marked vasogenic edema.

83
Q

It is also known as:

  • CSF/subarachnoid dissemination of tumor
  • leptomeningeal carcinomatosis
  • carcinomatous meningitis
  • neoplastic meningitis
  • “drop” metastases when originating from a primary tumor
A

Leptomeningeal metastases

84
Q

Imaging pattern of leptomeningeal metastases

A

May appear as thin or nodular enhancement in the subarachnoid spaces, often accompanied by loss of normal CSF nulling on T2 FLAIR images, sometimes complicated by communicating hydrocephalus.

85
Q

What are other ways to increase sensitivity for leptomeningeal disease? (2)

A
  1. Delayed postgadolium images

2. Postgadolinium T2 FLAIR images

86
Q

Benign extra-axial neoplasms which arise from the vestibular nerve (CN8) - in vast majority of cases.

A

Schwannoma

  • Less commonly, may arise from the other cranial nerves (CN5), and rarely, may arise within the brain parenchyma, possibly originating from peripheral nerves that innervate vessel walls (nervi vasorum).
87
Q

Imaging pattern of schwannoma

A

Heterogeneous signal intesity, especially when large

Generally described as enhancing T2 hyperintense masses along a peripheral nerve

88
Q

It is characterized by multiple schwannomas (and meningiomas)

  • NOT neurofibromas
A

Neurofibromatosis type 2

89
Q

Bilateral vestibular schwannoma is diagnostic of what disease?

A

Neurofibromatosis type 2

90
Q

Other peripheral nerve sheath tumor (3)

A
  1. Neurofibroma
  2. Perioneurioma
  3. Malignant peripheral nerve sheath tumor
91
Q

Most common extra-axial tumors

AND

Most common primary CNS tumor (36%)

A

Meningioma

92
Q

These arise from arachnoid cap cells in the arachnoid mater, which abuts the dura mater on the inside of the skull.

A

Meningioma

93
Q

Half of the cases of meningioma present as dural-based masses along what location?

A

Cerebral convexity
or
falx cerebri (parasagittal)

94
Q

Imaging pattern of meningioma

A
  1. Classic but nonspecific appearance:
    A.) Enhancing dural-based mass which may be accompanied by
    B.) adjacent dural thickening (dural tail) and
    C.) osseous changes (hyperostosis)
  2. Avidly enhancing
  3. Angiography = radial arrangement of the vessels with an early dense tumor blush that persist well into the venous phase (mother-in-law sign)
95
Q

Cerebellopontine angle masses (4)

A
  1. Arachnoid cyst
  2. Meningioma
  3. Epidermoid cyst
  4. “Neuroma” (schwannoma)

AMEN OR SAME

96
Q

Previously known as angioblastic meningioma.

It arises from modified pericapillary smooth muscle cells (pericytes of Zimmerman).

A

Hemangiopericytoma

-peak incidence of 30 to 50 years

97
Q

Imaging finding of hemangiopericytoma

A
  1. Similar to meningioma
  2. Narrow base instead of broad base attachment
  3. Typically multilobulated rather than hemispheric
  4. Bone destruction instead of hyperostosis
  5. Flow voids
  6. MRS shows elevated myoinisitol
98
Q

Site of Origin: Ependymal lining
Age: <20
Enhancement: Strong

What ventricular tumor?

A

Ependymoma

Table 5.14

99
Q

Site of Origin: Septum pellucidum
Age: 20 - 40
Enhancement: Strong

What ventricular tumor?

A

Central neurocytoma

Table 5.14

100
Q

Site of Origin: Subependymal plate
Age: > 40
Enhancement: Weak

What ventricular tumor?

A

Subependymoma

Table 5.14

101
Q

Site of Origin: Choroid plexus epithelium
Age: < 20
Enhancement: Strong

What ventricular tumor?

A

Choroid plexus tumor

Table 5.14

102
Q

Site of Origin: Choroid plexus stroma
Age: > 40
Enhancement: Strong

What ventricular tumor?

A

Meningioma

or

Metastasis

(Table 5.14)

103
Q

Image finding of meningeal melanocyte and melanoma

A
  1. Nonspecific imaging pattern
  2. Intradural enhancing mass or masses
  3. Intrinsic T1 hyperintensity
104
Q

Classifications of pineal parenchymal tumors (3)

A
  1. ) Pineocytoma - Grade I
  2. ) Pineal parenchymal tumor of intermediate differentiation
  3. ) Pineoblastoma
105
Q

Most common type of neoplasm in the pineal region.

A

Germ cell tumor (60%)

106
Q

Subcategories of germ cell tumors (2)

A
  1. ) Germinoma (aka dysgerminoma or seminoma)

2. Nongerminomatous or nonseminomatous GCT

107
Q

Difference between germ cell tumor or pineal parenchyma tumor.

A

Germ cell tumors tend to wrap around or engulf normal pineal calcifications

Pineal parenchymal tumors tend to displace or explode them.

108
Q

Nongerminomatous germ cell tumors (5)

A
  1. Embryonal carcinoma
  2. Yolk sac tumor (also known as endodermal sinus tumor)
  3. Choriocarcinoma
  4. Teratoma
  5. Mixed germ cell tumors
109
Q

Heterogeneous enhancing mass with internal fat density or signal should prompt what disease?

A

Teratoma

110
Q

Heterogeneous midline mass in a newborn should prompt consideration of what diease?

A

Congenital teratoma

  • These tumors are thought to arise in utero (may present at any age)
111
Q

Tumor arising from the subcommissural organ - a small ependymal gland located at the posterior margin of the third ventricle, just below the posterior commissure.

A

Papillary tumor of the pineal region (PTPR)

  • Enhancing mass in adults. Can be hard to differentiate from other pineal regions tumors.
112
Q

Tumor arising from the adenohypophysis.

One of the three most common primary neoplasms.

A

Adenomas

Most common primary:

  1. meningiomas - 36%
  2. adenomas - 16%
  3. glioblastoma - 15%
113
Q

What are the size of micro- and macroadenoma.

A

Microadenoma - < 1 cm

Macroadenoma - > 1 cm

114
Q

Most common adenoma of the pituitary gland which can cause amenorrhea/ galactorrhea in women or decreased libido in men.

A

Prolatinoma

  • GH secreting adenomas are second most common
115
Q

Pituitary mass that may cause local mass effect:

  • visual loss (compression of optic nerves, chiasm, or tract superiorly)
  • hypopituitarism or hyperprolactinemia (compression of pituitary gland or stalk, respectively)
  • Lateral invasion of the cavernous sinus
A

Macroadenoma

116
Q

Imaging pattern of pituitary adenoma

A
  1. Relatively hypoenhancing lesion (lack of blood-brain barrier)
  2. Hyperdence in CT
  3. Hypointense on T2
  4. Can be heterogenous signal related to cyst, infarcts, or hemorrhages.
117
Q

An acute syndrome - when pituitary macroadenoma suddenly enlarges due to hemorrhage

A

Pituitary apoplexy

118
Q

Tumor that arise from squamous epithelial remnants of the craniopharyngeal duct, also known as Rathke pouch.

A

Craniopharyngioma

119
Q

Most common nonneuroepithelial CNS tumor of childhood.

A

Adamantinomatous craniopharyngioma

120
Q

90% rule of adamatinomatous craniopharyngioma (3)

A
  1. ) 90% show cystic change
  2. ) 90% show calcification
  3. ) 90% show solid or nodular enhancement
121
Q

A craniopharyngioma that is less common and tends to present in older adults as a solid enhancing mass

A

Papillary craniopharyngioma

122
Q

This is a nonneoplastic cyst that result from a persistent cleft in Rathke pouch that fails to involute.

A

Rathke cleft cyst

123
Q

Rathke cleft cyst can have solid or nodular enhancement.

True or false.

A

False.

Unlike the craniopharyngioma, a Rathke cleft cyst is developmental not neoplastic and has no solid enhancement

124
Q

Suprasellar masses (7)

A
  1. Sarcoidosis
  2. Adenoma, Aneurysm
  3. Teratoma/germinoma, Tuberculosis
  4. Craniopharyngioma, Rathke Cleft Cyst
  5. Hypothalamic glioma, Hamatroma, Histiocytosis
  6. Meningioma, Metastsis
  7. Optic pathway glioma
125
Q

These are thin-walled meningothelial cyst that are located in the subarachnoid space and are thought to result from a congenital duplication or splitting of the embryonic arachnoid during development.

A

Arachnoid cysts

126
Q

Rarely, secondary or acquired arachnoid cyst can also develop as chronic sequelae of prior inflammation (meningitis, hemorrhage).

True or false.

A

True

127
Q

Image finding of arachnoid cyst

A

It follows CSF density or signal on CT and MRI.

50% are seen in middle cranial fossa
-other sites: cerebral convexities, basal cisterns, and posterior fossa.

128
Q

This is a large retrocerebellar CSF space

A

Mega cisterna magna

129
Q

During closure of the embryonic neural tube, which is formed from neuroectoderm, the abnormal inclusion of surface or external ectoderm can produce cysts with lining that resemble normal skin epithelium.

A

Epidermoid and dermoid cysts

130
Q

Imaging pattern of epidermoid cyst

A
  1. More lateral (CPA)
  2. lobulated cyst
  3. CSF density on CT
  4. CSF signal on T1 and T2W images
  5. Hyperintense on DWI (unlike arachnoid cyst)
  6. Rare - hyperdense on CT and hyperintense on MR = white epidermoid
131
Q

Imaging pattern of dermoid cyst

A
  1. Fat density on CT and MRI
  2. No demonstrable solid or nodular enhancment
  3. May rupture into the subarachnoid space - producing aseptic or chemical meningitis, with multipe fatty-type droplets (sebum) on imaging
132
Q

These are endodermal inclusion cysts, whose lining resembles bronchial or respiratory epithelium, hence filled with mucin and are highly proteinaceous.

A

Colloid cysts

133
Q

Location of colloid cyst

A

At the anterosuperior roof of the third ventricle near the foramen of Monro, where the can cause acute hydrocephalus and sudden death.

134
Q

Clinical presentation of colloid cyst

A
  1. Paroxysmal headaches
  2. Neurologic deficits
    (exacerbated by tilting the head forward - Brun phenomenon - due to ball-valve action of the cyst.
135
Q

Image pattern of colloid cyst (2)

A
  1. Round hyperdence lesion at the anterior third ventricle near the foramen of Monro on noncontrast CT
  2. Variable signal intensity on T1/T2
136
Q

These are nonneoplastic masses of true adipose tissue that result from maldifferentiation of the embryonic meninx primitiva into fat rather than normal subarachnoid space.

A

Intracranial lipoma

137
Q

Most common locations of intracranial lipoma (3)

A
  1. Interhemispheric fissure
    (possible associated with callosal dysgenesis)
  2. Suprasellar cistern
  3. Quadrigeminal cistern
138
Q

Presentaion of hamartoma of the tuber cinereum

A
  1. Gelastic seizure (laughing fits.)

2. Precocious puberty

Brant - 5th Edition (8 decks)

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