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08 Neuro > Common Intracranial Neoplasms > Flashcards

Common Intracranial Neoplasms Flashcards

1
Q

primary tumors in childhood

A

cerebellar astrocytoma
medulloblastoma
ependymoma

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2
Q

brain tumors in adults

A 
metastatic
glioma multiforme (most malignant glioma and primary cns tumor)
meningioma
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3
Q

best prognosis of all primary brain tumors

A

pilocytic astrocytoma

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4
Q

focal neurologic deficits or dysfunctions in inc icp

A

seizures (most common initial manifestation of primary and metastatic neoplasms)

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5
Q

grading of astrocytic tumors

A

table 4, page 3

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6
Q

who grading of gliomas

A

table 4, page 3

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7
Q

what is de novo/primary gbm

A
  • initially already grade 4

- amplified egfr and mdm3, loss of pten

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8
Q

what is secondary gbm

A
  • malignant transformation from low grade glioma

- better prognosis but still aggressive

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9
Q

gross findings in gbm

A

heterogenous mass with foci of necrosis and hemorrhage

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10
Q

histopathology of gbm

A

pseudopalisadiing cells around areas of necrosis

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11
Q

treatment of gbm

A
  • surgical debulking, max safe resection
  • stereotactic biopsy
  • radiotherapy
  • chemo: temozolomide
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12
Q

tumor markers for astrocytoma and oligoddendroglioma

A

idh mutant + atrx loss = diffuse astrocytoma

idh mutant + 1p/19q codeletion = oligodendroglioma

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13
Q

histology of oligodendroglioma

A

fried egg appearance

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14
Q

t/f oligodendroglioma doesnt respond to chemo

A

false

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15
Q

types of grade 1 astrocytoma

A

pilocytic astrocytoma
pleomorphix xanthoastrocytoma
subependymal giant cell astrocytoma

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16
Q

features of pilocytic astrocytoma

A

gross: cerebellum
mri: t1 hypo, t2 hyper, with mural nodule which enhances in contrast study
histology: brightly eosinophilic, corkscrew shaped rosenthal fibers

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17
Q

treatment for pilocytic astrocytoma

A

primary: surgery
incomplete resection: radiotherapy

excellent prognosis

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18
Q

associated condition with sega

A

tuberous sclerosis

very slow growing tumors near foramen of monroe

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19
Q

treatment for sega

A

surgery

everolimus (mtor inhibitor) to reduce size and ameliorate seizures

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20
Q

age of onset of ependymoma

A

first decade of 4th decade

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21
Q

features of ependymoma

A

gross: cauliflower growth in 4th ventricle
histo: true rosettes with central lumens, circular arrangements around blood vessels and pseudorosettes
imaging: hydrocephalus

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22
Q

tx for ependymoma

A

surgical resection and radiotherapy

suboptimal response to chemo

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23
Q

common site and age of onset of medulloblastoma

A

site: cerebelalr vermis, neuroepithelial roof of 4th ventricle
age: 4-8 yo, males

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24
Q

syndromes that have medulloblastoma

A

gorlin syndrome, turcot syndrome, li fraumeni syndrome, rubinstein taybi syndrome, fanconi’s anemia

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25
features of medulloblastoma
histo: homer wright rosettes (cells around central neuropil) imaging: hyperintense in t1 and t2, hydrocephalus
26
tx for medulloblastoma
maximal tumor resection chemo and craniospinal radio reduced survival in brainstem invasion, spinal subarachnoid metastasis, early age of onset
27
associated disease with vestibular schwannoma
von recklinghausen nf nf1: 8th nerve or any other cn or spinal nerve root, ADULT nf3: bilateral acoustic neuromas, BEFORE 21 YO, autosomal dominant
28
degree of involvement for vestibular schwannoma
8 > 7 > 5 > gait ataxia > limb ataxia cerebellopontine angle
29
histopathology of vestibular schwannoma
antoni a pattern: spindle-shaped cells in fascicles with dense reticulin antoni b: loose stroma with sparse reticulin verocay bodies: columns of nuclei in the palisading arrangement of antoni a MRI: ice cream cone sign
30
tx for vestibular schwannoma
surgical excision (symptomatic) - suboccipital-meatal for preservation - translabyrinthine for whatever focused radiation
31
most common non-glial tumor, mostly benign
meningiomas grade 2 atypical grade 3 anaplastic / malignant
32
common areas for meningiomas
``` frontoparietal parasagittal convexities falx cerebri tentorium cerbelli sphenoid wings olfactory groove tuberculum sellae ```
33
features of meningioma
gross: firm, gray, sharply circumscribed imaging: dural tail, homogenous enhancement, tumor blush on angiography
34
who grade 1 meningioma
whorls and psammoma bodies (laminated calcific concretions)
35
who atypical meningioma
4 mitotic figures per 10 hpf 3: increased cellularity, small cells with high n:c ratio, prominent nucleoli, sheet-like growth, necrosis, parenchymal invasion
36
who malignant maningioma
rhabdoid, anaplastic, papillary 20 mitotic figures per 10 hpf 50-80% recurrence rate
37
tx for meningioma
primary: surgical resection asymptomatic = follow up deep lesions = stereotactic surgery large = fractionated radiation no chemo
38
associated disease with hemangioblastoma
vhl disease renal cel ca pheochromocytoma polycythemia (due to elaborated erythropoetic factor)
39
features of hemangioblastomas
gross: well circumscribed nodule with large fluid cyst histo: gliosis and rosenthal fibers angiography: tumor blush, large feeding arteries, dilated draining veins
40
tx for hemangioblastoma
craniotomy, open cerebellar cyst and exision of mural hemangioblastoma nodule multifocal and inaccessible: focused radiation and stereotactic radiosurgery
41
description of primary cns lymphoma
- mostly lymphocytes and lymphoblasts - primary = only in brain - common in immunocompromised - periventricular localization with retinal involvement
42
features of cns lymphomas
gross: no necrosis histo: sheets of neoplastic cells and penetrate and destroy surrounding blood vessels MRI: resolution of contrast enhancement in response to corticosteroids
43
tx for cns lymphomas
stereotactic needle biopsy for disgnosis primary: methotrexate-based regimen cranial irradiation + steroids or chemo
44
initial presentation of pituitary adenoma
bitemporal hemianopsia | hormone derangements
45
nonfunctional vs functional pit adenoma
non-f: mass effects and hypopituitarism | f: prolactinoma
46
features of pituitary adenomas
histo: most commonly chromophobe cells
47
what is pituitary apoplexy
infarction that has outgrown its blood supply life threatening unless addionian state is treated with hydrocortisone sellar decompression
48
tx for pit adenoma
``` bromocriptine for prolactinomas ocreotide for gh-secreting tumors pituitary apoplexy: surgery -transsphenoidal = total -stereotactic = not urgent ```
49
what is empty sella syndrome
page 10
50
location of craniopharyngioma
superior aspect of pituitary gland
51
presentation of craniopharyngioma
visual field defects: bitemporal lower quadrantanopia peak at 10 years old and 5th to th decades
52
features of craniopharyngioma
well delineated cystic and solid components with calcifications cystic: viscous cholesterol rich fluid
53
adamantinomatous vs papillary crainopharyngioma
adamantinomatous: stellate reticulum, ghost cells, vet keratin, sheets with peripheral palisading papillary: well differentiated non keratinizing sq e
54
tx for craniopharyngioma
surgery radiotherapy or stereotactic radiosurgery excellent prognosis
55
features of dysplastic gangliocytoma of cerebellum
mri: tiger stripe appearance tx: surgery
56
features of dysembryoplastic neuroeiptheliuma tumor
mri: nodule or small cyst, cluster of several adjacent small cystic lesions tx: resection is curative and eliminates seizures
57
location for colloid cysts
anterior portion of third ventricle between interventricular foramina and attached to ventricle roof
58
clinical manifestations of colloid cysts
ball valve obstruction (intermittent severe bifrontal-bioccipital headaches) drop attacks
59
tx for colloid cysts
surgery vetriculoperitoneal shunting of csf cyst decompression
60
characteristic features of arachnoid cyst (infants and young children)
macrocrania and extensive unilateral transillumination
61
common location for arachnoid cyst
sylvian fissure or temporal pole
62
tx for arachnoid cyst
asymptomatic: leave symptomatic: mri studies tx: marsupialization > shunting
63
most common primary metastatic tumors
nsclc ca > breast > malignant melanoma > renal cell ca > gi tumors
64
characteristics of metastatic tumors
sc ca and melanoma: multiple metastasis kidney, breast, thyroid, lung adenoca: solitary malignant melanoma, testicular, bronchial: highest tendency to metastasize malignant mel, choriocarcinoma, nsclc, renal cell ca: most bleed
65
patterns of intracranial metastasis
to skull and ura to brain diffuse spread through craniospinal meninges
66
tx for metastasis
corticosteroids: reduce perilesional vasogenic edema anticonvulsants for metastatic melanoma radiation, surgery, chemo ave survival 6 mos
67
this can be the first manifestation of neoplastic illness (gi ca)
carcinomatous and lymphomatous meningitis | headache, backache, polyradiculopathies, cn palsies, confusional state
68
tx for carcinomatous and lymhomatous meningitis
radiation intrathecal or intraventricular chemo preterminal sign: encephalopathy caused by widespread tumor infiltration best response: lymphoma, breast, sclc
69
paraneoplastic disorders and associated autoantibodies
table 18, page 13

08 Neuro (24 decks)

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