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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
Q

features of medulloblastoma

A

histo: homer wright rosettes (cells around central neuropil)
imaging: hyperintense in t1 and t2, hydrocephalus

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26
Q

tx for medulloblastoma

A

maximal tumor resection
chemo and craniospinal radio

reduced survival in brainstem invasion, spinal subarachnoid metastasis, early age of onset

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27
Q

associated disease with vestibular schwannoma

A

von recklinghausen nf

nf1: 8th nerve or any other cn or spinal nerve root, ADULT
nf3: bilateral acoustic neuromas, BEFORE 21 YO, autosomal dominant

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28
Q

degree of involvement for vestibular schwannoma

A

8 > 7 > 5 > gait ataxia > limb ataxia

cerebellopontine angle

29
Q

histopathology of vestibular schwannoma

A

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
Q

tx for vestibular schwannoma

A

surgical excision (symptomatic)
- suboccipital-meatal for preservation
- translabyrinthine for whatever
focused radiation

31
Q

most common non-glial tumor, mostly benign

A

meningiomas

grade 2 atypical
grade 3 anaplastic / malignant

32
Q

common areas for meningiomas

A 
frontoparietal parasagittal convexities
falx cerebri
tentorium cerbelli
sphenoid wings
olfactory groove
tuberculum sellae
33
Q

features of meningioma

A

gross: firm, gray, sharply circumscribed
imaging: dural tail, homogenous enhancement, tumor blush on angiography

34
Q

who grade 1 meningioma

A

whorls and psammoma bodies (laminated calcific concretions)

35
Q

who atypical meningioma

A

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
Q

who malignant maningioma

A

rhabdoid, anaplastic, papillary
20 mitotic figures per 10 hpf
50-80% recurrence rate

37
Q

tx for meningioma

A

primary: surgical resection
asymptomatic = follow up
deep lesions = stereotactic surgery
large = fractionated radiation

no chemo

38
Q

associated disease with hemangioblastoma

A

vhl disease
renal cel ca
pheochromocytoma
polycythemia (due to elaborated erythropoetic factor)

39
Q

features of hemangioblastomas

A

gross: well circumscribed nodule with large fluid cyst
histo: gliosis and rosenthal fibers
angiography: tumor blush, large feeding arteries, dilated draining veins

40
Q

tx for hemangioblastoma

A

craniotomy, open cerebellar cyst and exision of mural hemangioblastoma nodule

multifocal and inaccessible: focused radiation and stereotactic radiosurgery

41
Q

description of primary cns lymphoma

A
  • mostly lymphocytes and lymphoblasts
  • primary = only in brain
  • common in immunocompromised
  • periventricular localization with retinal involvement
42
Q

features of cns lymphomas

A

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
Q

tx for cns lymphomas

A

stereotactic needle biopsy for disgnosis
primary: methotrexate-based regimen
cranial irradiation + steroids or chemo

44
Q

initial presentation of pituitary adenoma

A

bitemporal hemianopsia

hormone derangements

45
Q

nonfunctional vs functional pit adenoma

A

non-f: mass effects and hypopituitarism

f: prolactinoma

46
Q

features of pituitary adenomas

A

histo: most commonly chromophobe cells

47
Q

what is pituitary apoplexy

A

infarction that has outgrown its blood supply

life threatening unless addionian state is treated with hydrocortisone
sellar decompression

48
Q

tx for pit adenoma

A 
bromocriptine for prolactinomas
ocreotide for gh-secreting tumors
pituitary apoplexy: surgery
-transsphenoidal = total
-stereotactic = not urgent
49
Q

what is empty sella syndrome

A

page 10

50
Q

location of craniopharyngioma

A

superior aspect of pituitary gland

51
Q

presentation of craniopharyngioma

A

visual field defects: bitemporal lower quadrantanopia

peak at 10 years old and 5th to th decades

52
Q

features of craniopharyngioma

A

well delineated cystic and solid components
with calcifications
cystic: viscous cholesterol rich fluid

53
Q

adamantinomatous vs papillary crainopharyngioma

A

adamantinomatous: stellate reticulum, ghost cells, vet keratin, sheets with peripheral palisading
papillary: well differentiated non keratinizing sq e

54
Q

tx for craniopharyngioma

A

surgery
radiotherapy or stereotactic radiosurgery
excellent prognosis

55
Q

features of dysplastic gangliocytoma of cerebellum

A

mri: tiger stripe appearance
tx: surgery

56
Q

features of dysembryoplastic neuroeiptheliuma tumor

A

mri: nodule or small cyst, cluster of several adjacent small cystic lesions
tx: resection is curative and eliminates seizures

57
Q

location for colloid cysts

A

anterior portion of third ventricle between interventricular foramina and attached to ventricle roof

58
Q

clinical manifestations of colloid cysts

A

ball valve obstruction (intermittent severe bifrontal-bioccipital headaches)
drop attacks

59
Q

tx for colloid cysts

A

surgery
vetriculoperitoneal shunting of csf
cyst decompression

60
Q

characteristic features of arachnoid cyst (infants and young children)

A

macrocrania and extensive unilateral transillumination

61
Q

common location for arachnoid cyst

A

sylvian fissure or temporal pole

62
Q

tx for arachnoid cyst

A

asymptomatic: leave
symptomatic: mri studies
tx: marsupialization > shunting

63
Q

most common primary metastatic tumors

A

nsclc ca > breast > malignant melanoma > renal cell ca > gi tumors

64
Q

characteristics of metastatic tumors

A

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
Q

patterns of intracranial metastasis

A

to skull and ura
to brain
diffuse spread through craniospinal meninges

66
Q

tx for metastasis

A

corticosteroids: reduce perilesional vasogenic edema
anticonvulsants for metastatic melanoma
radiation, surgery, chemo
ave survival 6 mos

67
Q

this can be the first manifestation of neoplastic illness (gi ca)

A

carcinomatous and lymphomatous meningitis

headache, backache, polyradiculopathies, cn palsies, confusional state

68
Q

tx for carcinomatous and lymhomatous meningitis

A

radiation
intrathecal or intraventricular chemo
preterminal sign: encephalopathy caused by widespread tumor infiltration
best response: lymphoma, breast, sclc

69
Q

paraneoplastic disorders and associated autoantibodies

A

table 18, page 13

08 Neuro (24 decks)

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