Intracranial tumors Flashcards
most common glioma
glioblastoma
most common tumor in pediatric population
medulloblastoma
extra-axial means…
outside the brain (ex: from the dura)
intra-axial means…
in the brain substance
examples of extra-axial tumors
- dural lesions: meningiomas, METS
- Cranial nerve tumors: schwanommas, neurofibromas, MNST
- sellar/parasellar: pituitary tumors
examples of intra-axial tumors
- glioma
- ependymoma
- neuronal tumor
WHO classification of tumors
- more appropriate for classification of GLIAL TUMORS
- degree of malignancy INCREASES with grade
Low grade: I and II
Anaplastic: III
High grade: IV
types of gliomas
- astrocytoma
- oligodendroglioma
astrocytomas (types/grades)
I: pilocytic astrocytoma
II: low grade astrocytoma
III: anaplastic astrocytoma
IV: high grade astrocytoma / GBM
pilocytic astrocytoma
- grade I
- BENIGN
- slow growing
- common in pediatrics
- well defined, cystic mass in cerebellum
- increased ICP due to obstruction of CSF in 4th ventricle (secondary hydrocephalus)
- presentation: headache, nasuea, vomiting, cerebellar signs
Tx: surgical excision
Prognosis: excellent
pilocytic astrocytoma - histology
- small oval nuclei with long cytoplasmic processes (horse hair)
- biphasic pattern: cellular and myoxoid areas
- rosenthal fibers
- NO mitotic figures present
low grade/diffuse astrocytoma
- MALIGNANT
- will evolve to higher grades if not removed
- poorly circumscribed
- invades adjacent brain structures
- no enhancement on MRI
- presentation: seizures, headache, neurological deficit
Tx: excision, radiation
Prognosis: excellent
low grade/diffuse astrocytoma - histology
- hypercellular
- mitotic figures not present or rare
- irregular nuclei
anaplastic astrocytoma
- malignant tumor
- diffuse infiltrating mass
- MRI: iso- or hypo dense on T1, may/not enhance
- presentation: seizures, headache, neurological deficit
glioblastoma multiforme
- high grade tumor (IV)
- diffuse infiltrating mass with cystic NECROTIC CENTER
- MRI: cystic, necrotic, rim enhancing mass
- presentation: seizures, headache, neurological deficit
Tx: surgical debulking, adjuvant radiation/chemo
Prognosis: dismal
GBM - histology
- central cystic necrosis
- rim enhancement after injection of contrast
- densely cellular
- nuclear pleomorphysm
- vascular endothelial proliferation
oligodendroglioma
- slow growing
- MRI: non-enhancing, often calcified
- presentation: headaches, seizures
Tx: excision/debulking, adjuvant radiation/chemo
Prognosis: good; better if 1P,19Q chromosome deleted
oligodendroglioma - histology
- fried egg appearance
- fairly homogenous
ependymoma
- low grade (II)
- intra ventricular mass
- or in spinal cord
- presentation: hydrocephalus, nausea/vomiting, motor/sensory spinal cord deficits
Tx: excision, radiation is curative
Prognosis: good
ependymoma - histology
- cellular
- ovoid monomorphic nuclei
- rosettes
neuronal tumors
- uncommon
- occur in temporal lobe
- associated with chronic seizure disorder
Tx: observation OR surgical excision
meningiomas
- slow growing
- benign
- from dura
- symptoms based on location
- MRI: enhancing mass with dural tail
Tx: excision (curative)
meningiomas - histology
-whirl pattern
-
hemangioblastoma
- benign
- highly vascular
- sporadic or genetic (Von hippel syndrome: AD, chromosome 3)
- VHL associated with hemangiomas of retina, brainstem, spinal cord, renal, liver
sellar tumors
- pituitary adenoma is most common
- subtypes: functional and non functional (secreter vs non secreter)
- functional tumors: prolactinoma, acromegly (GH), Cushings Disease (ACTH)
- slow growing
- benign
- endocrine dysfunction, visual loss
Tx: surgical excision, or medical management
sellar tumors - histology
-sheets of monotonous cells
cranial nerve tumors
- benign tumor of schwann cell most common
- slow growing
- MRI: enhancing mass in CPA extending to IAC
- presentation: hearing loss, tinnitus, vertigo, facial numbness, weakness, ataxia
Tx: surgery, radiation, observation
