Masses of Childhood: Intracranial, Orbital, Neck Flashcards
What tumors are more common in the first 3 years of life?
Supratentorial Tumors
What tumors are more common aged 4-10?
Infratentorial Tumors
In children older than 10, what are more common - supratentorial or infratentorial tumors
Trick question - both are equally as common.
What is the 2nd most common pediatric neoplasm
Brain CNS tumors (2nd after leukemia) - also second most common cause of cancer deaths (25%)
How many primary brain tumors are diagnosed in the pediatric population per year?
4,000
What are most common tumor types before age 9?
cmbryonal/primitive neuroectodermal/medulloblastoma, pilocytic astrocytoma
What are most common tumor types ages 10-19
gliomas grade I, II, III
What is overal surival (OS) for DIPG?
10-15% at 5 years, mean survival 1 year
What is OS for medulloblastoma?
50% at 10 years
What is OS for low-grade gliomas even if it can’t be resected
90%
What is the risk of early death for survivors of childhood CNS malignancy?
25% will die before age 50
What are causes of morbidity/mortality from brain tumors?
- Recurrence, Progression of disease
- Subsequent neoplasm
- Cardiopulmonary disease
What are cardinal features of brain tumors?
- Increased intracranial pressure (with or without hydrocephalus or macrocrania)
- Seizures
- Neurological/Endocrinological deficits
- Cognitive impairment
- Acute decompensation can occur at any time
What are symptoms of children with CNS tumors upon presentation?
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
*
- Above plus deterioration in school
True or False: Rapid deterioration of tumors point to aggressive, maignant tumors
True
True or false: Benign tumors may have a slow progression that goes unnoticed until a major deficit becomes apparent
True: Such as with craniopharyngioma, when lack of growth is not really noticed but when there is loss of vision it becomes noticeable.
What are indications for neuroimaging with headaches?
- Persistent HA >6 months duration not responding to medical treatment
- HA + abnormal neurological finding
- Persistent HA without family Hx of migraine
- Persistent HA + episodes of confusion, disorientation, emesis
- HA that awakens child from sleep or occur immediately on wakening (repeatedly)
- Family Hx predisposing to CNS tumors &/or laboratory findings suggestive of CNS lesion.
MRS: NAA evaluates what?
impairment of neuronal function 2.0 ppm
MRS: Cho evaluates what?
membrane construction/destruction (Cho, 3.2 ppm)
MRS: Creatine evaluates what?
Energy metabolism (Cr 3.0 ppm)
MRS: Lactate demonstrates what?
Degree of necrosis (lac 1.33ppm)
MRS: Lip evaluates what?
Degree of necrosis (Lip 0.9 ppm - broad peak).
What is the dose of gadolinium?
0.1mg/kg body weight
