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CNS Tumors Flashcards

1
Q

MC brain tumors

A

mets from distant neoplasms

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2
Q

difference in location of brain tumors between adults and children

A

adults - supratentorial

children - infratentorial

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3
Q

ionizing radiation in therapeutic doses has been assoc. with which brain tumors?

A

meningiomas
astrocytomas
sarcomas

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4
Q

most common sx. of brain tumor

A

headaches
seizures (focal or generalized)
mental status changes - memory loss, lack of concentration, changes in personality, apathy

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5
Q

clinical presentation of brain tumor in children

A 
decreased appetite and weight loss
reduced school performance
dizziness
ataxia (gait)
neck pain
bulbar weakness
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6
Q

what can a ring-enhancing lesion on MRI mean?

A

mass lesion –> disruption of BBB by infiltrating neoplasm

BUT can also be seen in infections, subacute infarction, abscess, MS plaque, AVM, radiation necrosis

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7
Q

what test can be used to detect changes in brain tissue that are assoc. with the type and grade of tumor?

A

MR spectroscopy

- looks at peak of N-acetyl aspartate assoc. with neuronal loss

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8
Q

what are the 4 gliomas

A

astrocytoma
oligodendroglioma
ependymoma
choroid plexus papilloma

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9
Q

MC tumor in adults between 40-60 years old

A

glioblastoma multiforme (grade IV astrocytoma)

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10
Q

pathology seen in glioblastoma multiforme

A

highly malignant tumors with anaplasia, high cellularity, round/pleomorphic cells, nuclear atypia, vascular proliferation and necrosis

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11
Q

how do you differentiate between grade III and grade IV astrocytoma

A

grade IV has neovascularization and necrosis; they can also be mutlfocal and infiltrate brain widely

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12
Q

grade IV astrocytoma (GBM) on neuroimaging

A

solitary brain lesion (in deep white matter, BG or thalamus) with contrast enhancement, surrounding edema –> butterfly pattern

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13
Q

tx. regiment for GBM

A

surgical resection
radiation w/ concurrent temozolomide (cytotoxic alkylating agent) - continue this for 6 months
- consider nitrosurea drugs for combination therapy

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14
Q

how do you tx local recurrences of GBM

A

stereotactic radiosurgery and hmAb bevacizumab (sequesters VEGF)

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15
Q

what are the origins of low grade astrocytomas (I and II)

A

astrocytes (glial cells)

ependymal cells

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16
Q

in children, where do low grade astrocytomas occur

A

cerebellum

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17
Q

typical presentation of slow growing tumors

A

seizures

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18
Q

study of choice to dx glioma

A

MRI with contrast

- most lesions are bright on T2 and FLAIR

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19
Q

tx. for low grade gliomas (Astrocytoma I and II)

A

close observation with serial neuroimaging
surgery if total resection is possible
consider radiation/chemo

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20
Q

genetic signature of oligodendroglioma

A

codeletion of Xm arms 1p and 19q

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21
Q

common location of oligodendroglioma

A

frontal lobes, basal ganglia, thalamus

- usually have very SLOW growth

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22
Q

pathology features of oligodendroglioma

A

calcification

- perinuclear halos with swollen cytoplasm under microscopic

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23
Q

oligodendroglioma on neuroimaging

A

low intensity on T1, high intensity on T2
vasogenic edema uncommon
contrast enhancement = poor prognostic sign

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24
Q

tx of oligodendroglioma

A

total resection if possible
local radiation
PCV chemotherapy

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25
PCV chemotherapy
procarbazine lomustine vincristine - temozolomide used increasingly
26
which tumor arises in spinal canal as intramedullary tumor in adults?
ependymoma
27
in children, where are ependymomas located
intracranially in 4th ventricle
28
histological hallmark of ependymomas
perivascular pseudorosettes - halo of cells surrounding central vascular lumen
29
tx of ependymoma
surgery to decrease tumor burden followed by radiation and chemotherapy; recurrence rates are high so close follow up with MRI
30
origin of meningioma
meningothelial (mesodermal) cells of dura mater
31
common locations of meningioma
cerebral convexities, falx cerebri and sphenoid wing
32
histology of meningioma
sheets of plump, uniform meningothelial cells with tendency to form whorls; P4 receptors found
33
meningioma on MRI
isointense on T1 and T2 with intense contrast enhancement | calcifications seen on CT scan
34
hyperostosis
osteoblastic reaction seen in CT/plain Xrays may indicate meningioma invasion of bone
35
tx of meningioma
surgical removal (preceded with endovascular embolization)
36
origin of medulloblastoma
primarily at medullary velum of 4th ventricle; primitive neuroectodermal tumor
37
presentation of medulloblastoma
rapidly growing tumor that infiltrates surrounding tissue and extends toward 4th ventricle producing hydrocephalus and may spread via CSF intracranially and to spinal cord
38
medulloblastoma on MRI
heterogenous contrast enhancing midline tumor compressing the 4th ventricle
39
tx medulloblastoma
surgery plus radiation and chemo, steroids for vasogenic edema
40
prognosis of medulloblastoma
poor prognosis in children with mets or subtotal resection; good prognosis with radical resection and radiation dose above 50 Gy to entire neuraxis
41
acoustic schwannomas are MC among...
women
42
common location of schwannomas
vestibular CN VIII in cerebellopontine angle, involving the facial and trigeminal nerves
43
histology of schwannoma
sheets of uniform spindle cells, forming palisades called Verocay bodies
44
tx of acoustic schwannoma
if sx, stereotactic radiosurgery (gamma knife) esp. if does not compress brain stem or is < 3 cm
45
ganglioglioma
seen in children and young adults, mixture of neurons and glial cells --> usually in cerebral hemisphere with slow growth and long duration of sx
46
ganglioglioma on MRI
increased T2 signal with characteristic swollen gyri
47
tx of ganglioglioma
surgery
48
Tx of choice for Primary CNS lymphoma
high dose systemic MTX-based chemotherapy (along with cytarabine, temozolomide, rituximab) w/ wo radiation - dramatic response to steroids, but tumor recurs within months
49
MC distant neoplasms with mets to brain
``` lung skin - melanoma kidney - renal cell ca breast colon ```
50
where are mets usually localized to
gray-white junction and tend to be solitary but multiple are not unusual
51
tx of brain mets
single lesions - resected followed by radiation
52
drop metastases
intradural extramedullary spinal mets that arise from intracranial lesions (MCC is ependymomas or medulloblastomas)
53
what test should be avoided with medulloblastoma
LP - unless CT shows no obstructive lesion to prevent cerebellar tonsillar herniation
54
Nf2 associated tumors
bilateral vestibular schwannoma meningiomas intramedullary ependymomas
55
brain mets that bleed easily
melanoma renal cell carcinoma choriocarcinoma
56
low dose radiation therapy is assoc. with what brain tumors
meningiomas | gliomas
57
children who receive radiation for primary tumors are at increased risk of?
secondary intracranial gliomas and sarcomas
58
what two things increase risk of CNS lymphoma
HIV | post-transplant immunosuppression
59
diagnostic test of choice for brain tumor evaluation
MRI with contrast
60
most effective tx for malignant gliomas
radiation
61
typical imaging characteristics of brain mets
smaller, multiple at grey-white junction at distal capillaries and assoc. with significant edema

Neurology (15 decks)

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