Common Intracranial Neoplasms Flashcards
primary tumors in childhood
cerebellar astrocytoma
medulloblastoma
ependymoma
brain tumors in adults
metastatic glioma multiforme (most malignant glioma and primary cns tumor) meningioma
best prognosis of all primary brain tumors
pilocytic astrocytoma
focal neurologic deficits or dysfunctions in inc icp
seizures (most common initial manifestation of primary and metastatic neoplasms)
grading of astrocytic tumors
table 4, page 3
who grading of gliomas
table 4, page 3
what is de novo/primary gbm
- initially already grade 4
- amplified egfr and mdm3, loss of pten
what is secondary gbm
- malignant transformation from low grade glioma
- better prognosis but still aggressive
gross findings in gbm
heterogenous mass with foci of necrosis and hemorrhage
histopathology of gbm
pseudopalisadiing cells around areas of necrosis
treatment of gbm
- surgical debulking, max safe resection
- stereotactic biopsy
- radiotherapy
- chemo: temozolomide
tumor markers for astrocytoma and oligoddendroglioma
idh mutant + atrx loss = diffuse astrocytoma
idh mutant + 1p/19q codeletion = oligodendroglioma
histology of oligodendroglioma
fried egg appearance
t/f oligodendroglioma doesnt respond to chemo
false
types of grade 1 astrocytoma
pilocytic astrocytoma
pleomorphix xanthoastrocytoma
subependymal giant cell astrocytoma
features of pilocytic astrocytoma
gross: cerebellum
mri: t1 hypo, t2 hyper, with mural nodule which enhances in contrast study
histology: brightly eosinophilic, corkscrew shaped rosenthal fibers
treatment for pilocytic astrocytoma
primary: surgery
incomplete resection: radiotherapy
excellent prognosis
associated condition with sega
tuberous sclerosis
very slow growing tumors near foramen of monroe
treatment for sega
surgery
everolimus (mtor inhibitor) to reduce size and ameliorate seizures
age of onset of ependymoma
first decade of 4th decade
features of ependymoma
gross: cauliflower growth in 4th ventricle
histo: true rosettes with central lumens, circular arrangements around blood vessels and pseudorosettes
imaging: hydrocephalus
tx for ependymoma
surgical resection and radiotherapy
suboptimal response to chemo
common site and age of onset of medulloblastoma
site: cerebelalr vermis, neuroepithelial roof of 4th ventricle
age: 4-8 yo, males
syndromes that have medulloblastoma
gorlin syndrome, turcot syndrome, li fraumeni syndrome, rubinstein taybi syndrome, fanconi’s anemia
features of medulloblastoma
histo: homer wright rosettes (cells around central neuropil)
imaging: hyperintense in t1 and t2, hydrocephalus
tx for medulloblastoma
maximal tumor resection
chemo and craniospinal radio
reduced survival in brainstem invasion, spinal subarachnoid metastasis, early age of onset
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
degree of involvement for vestibular schwannoma
8 > 7 > 5 > gait ataxia > limb ataxia
cerebellopontine angle
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
tx for vestibular schwannoma
surgical excision (symptomatic)
- suboccipital-meatal for preservation
- translabyrinthine for whatever
focused radiation
most common non-glial tumor, mostly benign
meningiomas
grade 2 atypical
grade 3 anaplastic / malignant
common areas for meningiomas
frontoparietal parasagittal convexities falx cerebri tentorium cerbelli sphenoid wings olfactory groove tuberculum sellae
features of meningioma
gross: firm, gray, sharply circumscribed
imaging: dural tail, homogenous enhancement, tumor blush on angiography
who grade 1 meningioma
whorls and psammoma bodies (laminated calcific concretions)
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
who malignant maningioma
rhabdoid, anaplastic, papillary
20 mitotic figures per 10 hpf
50-80% recurrence rate
tx for meningioma
primary: surgical resection
asymptomatic = follow up
deep lesions = stereotactic surgery
large = fractionated radiation
no chemo
associated disease with hemangioblastoma
vhl disease
renal cel ca
pheochromocytoma
polycythemia (due to elaborated erythropoetic factor)
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
tx for hemangioblastoma
craniotomy, open cerebellar cyst and exision of mural hemangioblastoma nodule
multifocal and inaccessible: focused radiation and stereotactic radiosurgery
description of primary cns lymphoma
- mostly lymphocytes and lymphoblasts
- primary = only in brain
- common in immunocompromised
- periventricular localization with retinal involvement
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
tx for cns lymphomas
stereotactic needle biopsy for disgnosis
primary: methotrexate-based regimen
cranial irradiation + steroids or chemo
initial presentation of pituitary adenoma
bitemporal hemianopsia
hormone derangements
nonfunctional vs functional pit adenoma
non-f: mass effects and hypopituitarism
f: prolactinoma
features of pituitary adenomas
histo: most commonly chromophobe cells
what is pituitary apoplexy
infarction that has outgrown its blood supply
life threatening unless addionian state is treated with hydrocortisone
sellar decompression
tx for pit adenoma
bromocriptine for prolactinomas ocreotide for gh-secreting tumors pituitary apoplexy: surgery -transsphenoidal = total -stereotactic = not urgent
what is empty sella syndrome
page 10
location of craniopharyngioma
superior aspect of pituitary gland
presentation of craniopharyngioma
visual field defects: bitemporal lower quadrantanopia
peak at 10 years old and 5th to th decades
features of craniopharyngioma
well delineated cystic and solid components
with calcifications
cystic: viscous cholesterol rich fluid
adamantinomatous vs papillary crainopharyngioma
adamantinomatous: stellate reticulum, ghost cells, vet keratin, sheets with peripheral palisading
papillary: well differentiated non keratinizing sq e
tx for craniopharyngioma
surgery
radiotherapy or stereotactic radiosurgery
excellent prognosis
features of dysplastic gangliocytoma of cerebellum
mri: tiger stripe appearance
tx: surgery
features of dysembryoplastic neuroeiptheliuma tumor
mri: nodule or small cyst, cluster of several adjacent small cystic lesions
tx: resection is curative and eliminates seizures
location for colloid cysts
anterior portion of third ventricle between interventricular foramina and attached to ventricle roof
clinical manifestations of colloid cysts
ball valve obstruction (intermittent severe bifrontal-bioccipital headaches)
drop attacks
tx for colloid cysts
surgery
vetriculoperitoneal shunting of csf
cyst decompression
characteristic features of arachnoid cyst (infants and young children)
macrocrania and extensive unilateral transillumination
common location for arachnoid cyst
sylvian fissure or temporal pole
tx for arachnoid cyst
asymptomatic: leave
symptomatic: mri studies
tx: marsupialization > shunting
most common primary metastatic tumors
nsclc ca > breast > malignant melanoma > renal cell ca > gi tumors
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
patterns of intracranial metastasis
to skull and ura
to brain
diffuse spread through craniospinal meninges
tx for metastasis
corticosteroids: reduce perilesional vasogenic edema
anticonvulsants for metastatic melanoma
radiation, surgery, chemo
ave survival 6 mos
this can be the first manifestation of neoplastic illness (gi ca)
carcinomatous and lymphomatous meningitis
headache, backache, polyradiculopathies, cn palsies, confusional state
tx for carcinomatous and lymhomatous meningitis
radiation
intrathecal or intraventricular chemo
preterminal sign: encephalopathy caused by widespread tumor infiltration
best response: lymphoma, breast, sclc
paraneoplastic disorders and associated autoantibodies
table 18, page 13
