CNS Neoplasm Flashcards

1
Q

Where do you most often find pediatric neoplasm vs adult neoplasm?

A

pediatric - 3:1 infratenorial (almost all primary)

adult - 3:1 supratentorial (75% primary)

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2
Q

What are key clinical presentations of increased intracranial pressure?

A

vomiting ESPECIALLY with waking in the morning

blurred vision (check for papilledema)

headache

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3
Q

how to tumors spread in CNS?

A

primary and metastatic tumors may spread WITHIN the CNS via CSF but primary CNS tumors never spread OUTSIDE the CNS

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4
Q

what is a paraneoplastic syndrome?

A

most commonly caused by small cell carcinoma of lung… so a tumor in a different location creates effects in the CNS or PNS (ie autoantibodies formed from the tumor that cross react with nervous system)

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5
Q

What are the 3 most common pediatric neuro neoplasms?

A

pilocytic astrocytoma
medulloblastoma
ependymoma

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6
Q

Pilocytic astrocytoma

A

most often in cerebellum (causing ipsi limb ataxia and falling toward that side)

often presents in older childood…. survival usually more than 10 years

cystic lesion with mural nodule of tumor is often present – where the cyst wall is glial tissue and not neoplastic

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7
Q

Medulloblastoma

A

incompletely differentiated fetal cells make it up resulting in a poorly differentiated neoplasm

often found in cerebellum in younger children (sonic hedgehog pathway problem)

solid tumor with “seeding throughout subarachnoid space”

-often travel in closely packed sheets, mitotically very active… gloomy prognosis

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8
Q

ependymoma

A

Usually found in 4th ventricle

solid tumor that is arranged in patterns with true ependymal rosettes or perivascular pseudorosettes…

poor prognosis

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9
Q

4 most common causes of adult neuro neoplasm (gliomas)

A

1) astrocytoma
2) oligodendroglioma
3) ependymoma
4) metastasis

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10
Q

Infiltrating astrocytoma + glioblastomas (grading system)

A

accounts for 80% of adult primary brain tumors; most common in astrocytoma category

Grade II = diffuse astrocytoma - pleomorphic nuclei
grade III = anaplastic astrocytoma - plus mitotic activity
grade IV = glioblastoma (usually arise due to an amplification of epidermal growth factor receptor gene) - plus necrosis and/or vascular endothelial proliferation

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11
Q

oligodendroglioma

A

often found in cerebral hemispheres

calcification is common

central nuclei and halo of clear cytoplasm (“fried-egg appearance”)

onset between 30-50 with slow growing tumors

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12
Q

ependymoma

A

most often occur in the lateral ventricles

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13
Q

Primary brain lymphoma

A

arises from B lymphocytes in the CNS

located deep in the cerebral hemispheres

signs/symptoms = headaches, seizures

*perivascular cuffing of tumor cells and diffuse infiltration of surrounding neural tissue

Most common CNS TOOMAH in immunosuppressed

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14
Q

Germ cell tumors

A

origin = ectopic germ cells

usually in the midline, especially in pineal/suprasellar region (good prognosis actually)

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15
Q

Meningiomas

A

often found attached to dura… does NOT invade adjacent brain tissue

psammoma bodies

more often affects women

often due to loss of chromosome 22 (NF2 gene)

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16
Q

peripheral nerve sheath tumors (eg schwannoma)

A

origin = schwann cells in peripheral nerves

Most common site is the CN8 at the cerebello-pontine angle

Signs and symptoms = “acoustic neuroma” involving tinnitus, hearing loss, and vertigo.

17
Q

Tumors of Sellar Region (pituitary)

A
  • *often present with endocrine problems**
  • also present with CN3 or optic chiasm visual field deficits (ie bitemporal hemianopsia)

Pituitary adenomas are the most common… usually benign and slow growing

Craniopharyngioma - seprasellar epithelial tumor

18
Q

Metastatic Neoplasm characteristics/etiology

A

Incidence: about 50% of adult CNS tumors are metastatic..

Typically spread hematogenously from especially the breast and lung

typically well-demarcated but often cause widespread edema

prognosis = poor (usually only months)

19
Q

Neurofibromatosis type 1 (NF1)

A

autoDOM - one of the most common genetic disorders

often causes neurofibromas (benign nerve sheath tumors of the PNS) AND gliomas of the optic nerve

20
Q

Neurofibromatosis type 2 (NF2)

A

autoDOM

bilateral acoustic shwannomas and multiple meningiomas

21
Q

Tuberous Sclerosis

A

autoDOM

develop hamartomas and benign neoplasms involving the brain

22
Q

Von Hippel-Lindau Disease

A

autoDOM

hemangioblastomas occur = tumors developing in the CNS from a vascular origin (especially in cerebellum and retina)

cysts often form in other organs

higher chance of renal cell carcinoma and pheochromocytoma