CNS tumors Flashcards
What is the rate of primary and metastatic brain tumors
50% each
What is the order of commonality of metastatic cancer sources
Lung, breast, skin (malignant melanoma), kidney, GI tract
What are locations of tumors and what tumors are most common in adults and children
Adults: Supratentorial - glioblastoma multiforme (astrocytoma), meningioma, schwannomaChildren: Infratentorial - Pilocytic astrocytoma, medulloblastoma, ependymoma
What is the most common and second most common brain primary tumor
Glioma most common (50%)Meningioma second most common (25%)
Do brain tumors metastasize?
No, but they recur within brain a lot
What are two major clinical features seen with brain tumors
1.) Increased ICP - headaches upon awakening or certain positions, NV in mornings, altered consciousness, papilledema, brain herniation2.) Focal deficits - cranial nerves, seizures, specific neurologic deficits, hyperfunctioning structure
What is the imaging test of choice for CNS neoplasms and the definitive test to diagnose
1.) MRI2.) Brain biopsy - only definitive way to determine type
For treatment of CNS neoplasms, which tumors can be surgically resected and which ones cannot
Resction - meningioma, pituitary adenoma, schwannomaNo resection - gliomas (astrocytomas and oligodendrogliomas)
What should you do next for tumors that cannot be completely resected
Radiation therapy
What is the role of chemotherapy in CNS neoplasms
Limited
Besides treating tumor, how would you treat the increased ICP
Mannitol, hyperventilation, steroids
What is a good classification of tumors based on location and malignancy
Intraparenchymal (malignant) - includes astrocytoma, oligodendroglioma, primary lymphoma, and metastatic brain tumorsExtraparenchymal (benign and resectable) - Meningioma, schwannoma
Who is most likely to get a primary lymphoma
Immunosuppressed patients (transplant or AIDS)
What is characteristically seen in patients with primary lymphoma on MRI and in the CSF
Solitary weakly ring enhancing periventricular lesion on MRI, and EBV DNA in CSF in HIV/transplant patient (Uworld)
What are the two astrocytomas seen (adults and children)
Adults - glioblastoma multiformeChild - pilocytic astrocytoma
Is glioblastoma multiforme malignant?
Yes, very
What is the characteristic pattern of glioblastoma multiforme
Always arises in cerebral hemisphere, heterogeneous, crosses corpus callosum to form butterly lesion with centralized necrosis with pseudopallidating cells outside, GFAP positive
What is the survival rate for glioblastoma multiforme
Poor, 90% die within 3 months
What is a good treatment for glioblastoma multiforme
Surgery + radiation 2 cm margin + chemotherapy (temozolomide is agent of choice)
What is oligodendroglioma
Another glioma (besides astrocytoma) that is malignant and intraparenchymal
How does oligodendroglioma look on imaging and biopsy
Imaging: Calcified tumor in white matter, usually frontal lobe, may have seizuresBiopsy: Fried egg appearance
How long do ologidendroglioma patients have?
10 to 15 years
What are primary metastatic tumors
Tumors that metastatisize to the brain, most common are lung, breast, skin (melanoma), kidney, and GI tract
What is the medical treatment for metastatic tumors
Phenytoin for seizure prophylaxisDexamethasone for cerebral edema, give with ranitidine
