Masses of Childhood: Intracranial, Orbital, Neck

Question 1

What tumors are more common in the first 3 years of life?

Answer 1

Supratentorial Tumors

Question 2

What tumors are more common aged 4-10?

Answer 2

Infratentorial Tumors

Question 3

In children older than 10, what are more common - supratentorial or infratentorial tumors

Answer 3

Trick question - both are equally as common.

Question 4

What is the 2nd most common pediatric neoplasm

Answer 4

Brain CNS tumors (2nd after leukemia) - also second most common cause of cancer deaths (25%)

Question 5

How many primary brain tumors are diagnosed in the pediatric population per year?

Answer 5

4,000

Question 6

What are most common tumor types before age 9?

Answer 6

cmbryonal/primitive neuroectodermal/medulloblastoma, pilocytic astrocytoma

Question 7

What are most common tumor types ages 10-19

Answer 7

gliomas grade I, II, III

Question 8

What is overal surival (OS) for DIPG?

Answer 8

10-15% at 5 years, mean survival 1 year

Question 9

What is OS for medulloblastoma?

Answer 9

50% at 10 years

Question 10

What is OS for low-grade gliomas even if it can’t be resected

Answer 10

90%

Question 11

What is the risk of early death for survivors of childhood CNS malignancy?

Answer 11

25% will die before age 50

Question 12

What are causes of morbidity/mortality from brain tumors?

Answer 12

• Recurrence, Progression of disease
• Subsequent neoplasm
• Cardiopulmonary disease

Question 13

What are cardinal features of brain tumors?

Answer 13

• Increased intracranial pressure (with or without hydrocephalus or macrocrania)
• Seizures
• Neurological/Endocrinological deficits
• Cognitive impairment
• Acute decompensation can occur at any time

Question 14

What are symptoms of children with CNS tumors upon presentation?

Answer 14

Depends on Age:

• Infants:
  
  • Increased head circumference, nausea, vomiting, lethargy
• Children
  
  • Same as above plus headache, decreased visual acuity, partial onset seizures, focal neurological signs such as cranial nerve palsies
• Older Children
  
  • Above plus deterioration in school
    *

Question 15

True or False: Rapid deterioration of tumors point to aggressive, maignant tumors

Answer 15

True

Question 16

True or false: Benign tumors may have a slow progression that goes unnoticed until a major deficit becomes apparent

Answer 16

True: Such as with craniopharyngioma, when lack of growth is not really noticed but when there is loss of vision it becomes noticeable.

Question 17

What are indications for neuroimaging with headaches?

Answer 17

1. Persistent HA >6 months duration not responding to medical treatment
2. HA + abnormal neurological finding
3. Persistent HA without family Hx of migraine
4. Persistent HA + episodes of confusion, disorientation, emesis
5. HA that awakens child from sleep or occur immediately on wakening (repeatedly)
6. Family Hx predisposing to CNS tumors &/or laboratory findings suggestive of CNS lesion.

Question 18

MRS: NAA evaluates what?

Answer 18

impairment of neuronal function 2.0 ppm

Question 19

MRS: Cho evaluates what?

Answer 19

membrane construction/destruction (Cho, 3.2 ppm)

Question 20

MRS: Creatine evaluates what?

Answer 20

Energy metabolism (Cr 3.0 ppm)

Question 21

MRS: Lactate demonstrates what?

Answer 21

Degree of necrosis (lac 1.33ppm)

Question 22

MRS: Lip evaluates what?

Answer 22

Degree of necrosis (Lip 0.9 ppm - broad peak).

Question 23

What is the dose of gadolinium?

Answer 23

0.1mg/kg body weight