Neoplasia

Question 1

3 ways intracranial neoplasia can occur

Answer 1

• with primary neoplasia from the CNS
• secondary from extra cranial structures
• metastatic dz from elsewhere

Question 2

Forms/types of primary CNS neoplasia

Answer 2

• meningioma
• glioma
• pituitary adenoma

Question 3

Where do meningiomas arise from? Are they amenable to tx?

Answer 3

• they arise from the meninges
• amenable to tx options

Question 4

Examples of glioma. Where do they arise from? Are they amenable to tx?

Answer 4

• including astrocytoma, oligodendroglioma, choroid plexus papilloma
• tumours which arise from brain parenchyma
• poorly responsive to conventional therapies

Question 5

Where do pituitary adenomas arise from? How may they present?

Answer 5

• the pituitary
• may show hormonal sequelae (e.g. Cushing’s)

Question 6

Presentation of intracranial neoplasia

Answer 6

• usually progressive neurological compromise localising to either to forebrain, brainstem or cerebellum
• often focal signs such as unilateral signs or circling

Question 7

Diagnosis

Answer 7

• advanced imaging
• but requires histopath for confirmatory definitive diagnosis

Question 8

Tx options and their uses/aims

Answer 8

Surgery
- aimed at radical debunking not complete resection due to lack of margins
- ok for meningioma but palliative
- can be useful for pituitary based but not widely available

Radiotherapy
- ok for meningioma and pituitary but palliative

Chemotherapy
- no good accepted chemo regime to offer

Palliative
- anti-inflammatory doses of corticosteroids can be useful to reduce peritumoural oedema which may reduce CS

Anticonvulsants
- anticonvulsant (phenobarbitone) therapy may be helpful if treating secondary seizures to reduce the impact of seizures but don’t prevent progression of the tumour