Module 7:CNS: Brain Tumors Flashcards
This card deck will focus on the last topic of brain tumors. First are primary brain tumors, what are intrinsic vs extrinsic and supratentorial vs infratentorial?
Intrinsic: gliomas (astrocytic, oligodendroglial)
Extrinsic: meningiomas, schwannomas
Supratentorial in adults
Infratentorial in children
Secondary brain tumors are considered metastases, which is the most common brain tumor. What are the most common sources of these mets?
- Small cell lung cancer
2. Breast ( her 2 positive and triple negative)
What will the CT scan show for mets to the brain?
Multiple ring enhancing lesions in the cerebral hemisphere
Lymphoma is another common metastases to the brain, from what?
Esp in immunocompromised /HIV patients
–associated with multiple sexual partners
The first primary brain tumor to discuss is Glioblastoma Multiformes, what is the pathogenesis?
Most aggressive malignant tumor in the brain
- -origin = glial cells/astrocytes
- -high grade astrocytoma (Space occupying lesion) That spreads from one hemisphere (White matter) to the next through the corpus callosum
What is seen on gross and histology for a Glioblastoma Multiformes?
Butterfly appearance on gross
Located in the cerebral hemisphere (cross over at the corpus callosum)
Very hemorrhagic and necrotic
Histology: central area of necrosis surrounded by pseudo-pallacading of the malignant cells
What is the presentation for a Glioblastoma Multiformes?
Found in adults (40-60 yr olds)
–supratentorial
Sudden Onset
Recurrent headaches (Worse in the AM and while straining), seizures, papilledema, contralateral hemiparesis and projectile vomiting
What is the tumor marker for Glioblastoma Multiformes?
GFAP tumor marker (glial fibrillary acidic protein)
What is a poor prognosis for Glioblastoma Multiformes?
Infiltrate
Unresectable
Resistant to treatment
What is a better prognosis for Glioblastoma Multiformes?
Younger -EGFR \+IDH-1 \+p53 \+MGMT methylation
What is the overall prognosis for patients with Glioblastoma Multiformes?
High grade astrocytoma (so patient dont live very long maybe a year)
The next brain tumor is an Oligodendroglioma, what kind of tumor is that?
Well differentiated glioma in 3rd and 4th decade
–indolent course and often calcified
What is the etiology for Oligodendroglioma?
Loss of heterozygosity for ch 1 & 19
What is the prognosis for Oligodendroglioma?
Good prognosis b/c chemosensitive
–better prognosis if 1p and/or 19q deletions
The next brain tumor is a Meningioma, what is the etiology?
Benign tumor with Benign Behaviors (slow growing and well circumscribed)
- mostly sporadic and in older patients over 40
- -if familial: associated with neurofibromatosis II NF2 (also associated with this is vestibuloschwannoma + meningioma)
- -common in black women
What is the pathogenesis for a Meningioma?
Dome shaped tumor of the meningothelial cells of the arachnoid attached to the underside of the dura
What are the signs and symptoms of a Meningoma?
Gradual onset
Headaches, Projectile vomiting and papillemdema
Seizures (irritates the cerebral cortex)
What is seen on CT and excisional biopsy (Best investigation) for a patient with a meningoma?
See calcifications on CT: psammoma bodies
Excisional Biopsy: papillary projection (Whorled pattern of cell growth) with psammoma bodies
What are the complications associated with a meningioma?
Complications: Compression of the cerebellar hemisphere — focal neuro deficits, cranial nerve problems and seizures
High degree of recurrence after removal but good prognosis
There are two types of Nerve Sheath Tumors, neurofibroma and schwannoma. What are some features of a schwannoma?
Middle aged and elderly (earlier in NF2)
Slow growing tumor that arises from Schwann Cells
Schwannoma most commonly affects, what?
CNVIII: acoustic neuroma
Spinal Sensory nerve roots
Nerve sheath tumors are cured by what?
Resection (Risk to perent nerve function)
The next brain tumor is seen in kids called a Pilocytic Astrocytoma, what are some features?
Most common primary CNS tumor in childhood
–well differentiated glioma in the cerebellum & hypothalamus (composed of compactly and loosely arranged delicate hair like astrocytes)
What is seen on CT/MRI in a patient with a pilocytic astrocytoma?
Cystic with enhancing rim and mural nodule
How is pilocytic astrocytoma cured?
Resection
The last brain tumor for this section is a Medulloblastoma, who is this seen in and what is the origin?
Seen in Children
–intratentorial
Origin: Cerebellar Vermis (can co-exist with Ewings tumor)
What is seen on presentation for patients with Medulloblastoma?
Cerebellar Signs (ataxia, slurred speech, intention tremor, nystagmus, 3Ds)
What is seen on histology for a medulloblastoma?
Excisional Biopsy (Best investigation): --homer-wright rosettes (pseudorosettes) - small round blue cells
What are the complications of a Medulloblastoma?
Malignant tumor — spreads via CSF — spreads to ventricles – hydrocephalus (obstructive or non communicating)
Drop Metastasis: tumor cells detach, enter ventricles (Can reach cauda equina — cauda equina syndrome and nerve pain)
What is the prognosis for a Medulloblastoma?
Radiosensitive
-risk of papillary thyroid cancer
Beta-Catenin positive so good prognosis
If Medulloblastoma is familial what diseases is it associated with?
Tuckers
Ghorlin
