Neoplasm Flashcards
This is histological findings of Opsoclonus-Myoclonus-Ataxia-Syndrome
Mild loss of purkinje and inferior olives and brainstem
Recurrence rate of PCNSL
90%
What is the main feature of optic glioma
Ocular proptosis
What is the most common glioma of Spinal cord
ependymoma
Antineuronal antibody is associated with what paraneoplastic syndrome
Indistinguishible to ALS
The following are diagnostic of Angioblastic intravascular lymphoma
(+) C-ANCA
CSF: high CHON and negative cells
Elevated LDH and ESR
What predicts longer survival in patients with oligodendroglioma
Loss of 19q
What associated virus is implicated to castleman disease
EBV and HHV 8 and 6
This condition is presents as subacute onset and steady progression over weeks characterized by symmetrical ataxia of gait dysarthria and nystagmus
Paraneoplastic cerebellar degeneration
Female to male ratio of meningioma
2:1
3 pattern of intracranial metastasis
Skull/Dura
Brain
Craniospinal Meninges
Cytotoxic edema is observed in the following setting
hypoxic-ischemic injury
What causes Acromegaly?
Overproduction of GH after puberty
Increase in protein in patient with neoplasm can be explained by
Extension of tumor in meningeal surface or ventricular wall
What distinguishes metastatic tumor from primary ones
multiple nodular deposits of tumor on imaging
Associated antibody in Paraneoplastic cerebellar degeneration
anti-Yo
Treatment of colloid cyst
Surgery
VP shunting
Aspiration of cyst
MRI findings of Limbic encephalitis
T2 hyperintensity and edema with focal necrosis
This disease is characterized by infiltration of glial cells on one or both hemisphere
Gliomatosis Cerebri
Irradiation in metastatic brain tumor is given in
2 weeks period
What is the 5 year survival after surgery in lowgrade astrocytoma
90%
Most common cause of ischemic necrosis of the pituitary
Sheehan’s syndrome
Anti-Hu antibody is associated with this paraneoplastic syndrome
Sensory Neuropathy
MRI findings of Angioblastic Intravascvular lymphoma
Multiple nodular and variegated abnormality on T2 weighted image (contrast enhancing)
What are the associated diseases of Carotid body tumor
NF-1
VHL
MRI findings of Anti-NKDA encephalitis
T2 hyperintensity on the medial temporal lobe
Tumors that arise in Pons or in 4th ventricle that may manifest as CPA
Ependymoma
Astrocytoma
Papilloma
Medulloblastoma
How many patients with astrocytoma/low-grade where seizure is the most common presentation
2/3
Most common solid tumor of childhood
Neuroblastoma
Why is Pineal Gland not included in WHO classification
Classified as Germ Cell Tumor
This is characterized by astrocytes that tends to infiltrate tracts and nuclei, symptoms depends on the location
Brainstem glioma
The following is suggestive of poor outcome in neuroblastoma
Mutation of chr. 1 and 11
MYCN amplification or overexpression
How many percent of GBM located in hemisphere
80%
What elements is used in brachytherapy
Iodine 125
How is temozolamide given
7-5m/m tapering dose in 4 weeks then 5 days every 28 days for 6 years
Associated cancer of Opsoclonus-Myoclonus-Ataxia-Syndrome
Breast cancer
Small cell lung carconmoma
What is the common feature of oliogodendroglioma and low grade gliomas
fine granules of calcium
What is the diagnostic marker for biopsy in astrocytoma
GFAP
Treatment of optic glioma may differ from location
pre chiasmastic - surgical extirpatiom
chiasmatic - partial resection then RT
What differentiate Cushing Disease and Cushing syndrome
Cushing Disease - excess secretion of pituitary ACTH
Cushing Syndrome - Excess cortisol
Risk factors for Pituitary apoplexy
anticoagulation RADIATION pituitary function tests bromocriptine treatment Head trauma
This tumor originates from non-chromaffin paranglioma cells found in the adventitia of jugular bulb
Glomus Jugulare Tumor
This disorder are low-grade malignant composed of glial cells astrocytes and neurons with various degrees of differentiation
Gangliomas
Imaging findings of Cytotoxic Edema
Decreased attenuation in CT
Hyperintensity in T2
Increased anisotropy on DWI
This tumor is characterized by ataxia of gait with signs of increased ICP with associated hepatic and pancreatic cyst
Hemangioblastoma of Cerebellum
Enlargement of tumor size can be explained by:
extensive demyelination and loss of oligodendrocytes with degree of necrosis
Infratentorial ependymoma accounts for how many percent
40%
What is the cut-off age 2nd surgery in recurrent GBM
40 years old and less
What leukemia has high predilection to infiltrate nervous system
AML > CML
Histologic findings of Germinoma
Large epithelial cells separated by network of reticular connective network tissue and contains lymphocytes
Symptoms of Adamantinoma
Children: blindness, DI, and adiposity
Adult: Weakness of legs, headache, waninglibido
Treatment of Anaplastic Ependymoma
RT and antineoplastic agents
What is the most frequent acquired genetic defect in Meningioma
NF2 gene(merlin) found in chr 22q
This accounts for poor neoplastic transformation of cerebellar stem cell at various stage
deletion of Chr 17 distal to p53
Other tumors of CPA
Neurinoma Meningioma Cholesteoma Gliomus Jugularae Tumor Neoplastic meningitis Arachnoid Cyst Epidural Plasmacytoma of petrous bone
Brainstem metastasis most often originate from what malignancy
lung cancer
MRI findings of pituitary ademoma
enhancing and only visualized if more than 3mm
What is the diagnostic marker for Pineal germinoma
B-HCG
AFP
What is the cell of origin of PCNSL
reticulum cells a histiocyte component of germinal center of the LN (B-Lymphocytes)
Neurological manifestation of Glomus Jugulare Tumors
Partial Deafness
Facial Palsy
Dysphagia
Unilateral Atrophy of tongue
This disease is characterized by loss of SC interneurons
stiffman syndrome
Associated antibody in LEMS
CRMP-5
Anti-Hu
Lhermitte Ducos Disease is associated with mutation of this gene
PTEN gene
This is characterized by rapid progression of degeneration of the spinal cord ascending sensorimotor deficit
Carcinomatous Myelopathy
What is the most common extracranial malignant tumor of infancy
Retinoblastoma
Manifestation of sphenoid wing meningioma
anosmia occulomotor palsies painful ophthalmoplegia Foster Kennedy Syndrome Uncinate Fits
Survival rate of PCNLS in immunocompetent individual
3 years
GH and TSH are secreted by this pituitary cells
Chromophobe
All tumors in sellar regions are classified as grade___
I
4 Histologic types of pineal tumors
- Germinoma
- Non-Germinoma
- Pinealoma
- Glioma
The presence of bridges between tumor cells is highly suggestive of this tumor
Adamantinoma
Adverse effect of Temozolamide
Thrombocytopenia
Leukopenia
Pneumocystis Carinii
treatment for Paraneoplastic cerebellar degeneration
Plasma exchange
IVIG
Removal of Primary tumor
What oral drug used in GBM
Temazolamide
What distinguishes GBM from anaplastic glioma
Variegated appearance
Vestibular schwanomma is associated with what disease
Von Recklinghausen disease
This neoplasm is characterized by soft jelly gray arise from primitive notochord
chordoma
How can hyperventilation alleviate increase ICP
reduced brain volume by producing respiratory alkaalosis
How many percent of pituitary tumors are prolactinoma
70%
Associated antibody with Opsoclonus-Myoclonus-Ataxia-Syndrome
Anti Ri
Treatment of Carotid body tumor
Surgical excision with or without embolization
Typical posture of patients with medulloblastoma
Head tilt the occiput is tilted back and away from the side of tumor
What is the imaging findings of vasogenic edema
Hyperintense T1
Decrease attenuation on CT
Decrease anisotropy on MRI
Characteristic feature of suprasellar arachnoid cyst where excision may result to resolution
Bobble head doll syndrome
Seesaw and pendular nystagmus
Median survival rate of patients with carcinomatous meningitis
6 months
Pathological findings in Paraneoplastic cerebellar degeneration
diffuse degenerative changes in cerebellar cortex as well as deep nuclei and tracts (posterior column and spinocerebellar tract)
Carcinomatous Myelopathy is associated. with what malignancy
Bronchogenic
Hodgkin
Presence of this histologic feature in medulloblastoma is suggestive of better prognosis
Desmoplastic
This tumor occur sporadically involving CN VIII
Vestibular schwanomma
What malignancy is associated with Stiffman syndrome
Breast cancer
location of limbic encepahalitis
Medial temporal lobe
PCNSL accounts for how many percent of all brain tumor
3%
This is an intracranial neoplasm that is derived from connective tissue elements
Sarcoma of the brain
Manner of mechanism of spread of PCNSL
systemic lymphoma with propensity to metastasis to NS
Initial symptoms of gliomatosis cerebri
frontal lobe syndrome
Depression
Subacute dementia
Pseudotumor cerebri
Common location of chordoma
a. clivus
b. sacrococcygeal regions
This tumor arise from the mucus membrane or nasopharynx near the eustachian tube
NPCa
Histology of Glomus Jugulare Tumor
Large epithelial cells arranged in alveolar pattern
The imaging of this tumor density depends on the hydration status of the patient
Colloid cyst
3 syndrome of Radiation Damage
- Acute
- Early Delayed
- Late Delayed
This disorder is characterized by widespread dissemination of tumor cells throughout the meninges and ventricles
Carcinomatous meningitis
Common site of growth medulloblastoma
cerebellar vermis
roof of 4th ventricle
Dose of mannitol
0.5-1kg/bw
This antibody is the pathogenic of NMDA subunits
NR1
3 groups of paraneoplastic neoplastic syndromes of motor neurons
- Rapidly progressive amyotrophy and fasciculation with or without reflex
- Predominantly corticospinal tract
- Indistinguishible to ALS
This results from an infarction of adenoma that outgrown its blood supply
Pituitary apoplexy
What is the most initial presentation of oligodendroglioma
Seizure (50%)
What syndrome is associated with Hemangioblastoma
Von Hippel Lindau Disease (VHL)
How many percent of PCNSL are located in cortex
60%
Differential diagnosis of Chordoma
Wegeners granulomatosis
Erdheim-Chester disease
Sarcoidosis
Chondrosarcoma
Diagnosis of NPCa depends on the following
inspection
biopsy
lymph node involvement
Treatment for carcinomatous meningitis
Symptomatic therapy for symptomatic areas followed by IV MTX into lateral ventricles
This makes up 1/3 of metastatic malignancy of CNS
Lungs
then breast then MELANOMA
This is a multifocal neoplasm of large anaplastic monoclonal lymphocytes that infiltrate the wall of BV
Angioblastic Lymphoma
Temazolamide increases median survival if without RT
14.6 years
This occurs in children with neuroblastoma
Opsoclonus-Myoclonus-Ataxia-Syndrome
These antibodies are seen in patient with brainstem encephalitis
CRMPS
anti MA1
anti MA2
Associated antibody to rapidly progressive amyotrophy and fasciculation with or without reflex
anti-Hu
What is the characteristic behavior of PCNSL
Disappearance or complex resolutionin response to corticosteroids
What should be check to children with patient with hemangioblastoma
Renal cell carcinoma
Primary tumor accounts for how many percent of intracranial neoplasm
15/100,000
what is the central feature of limbic encephalitis
amnestic component
What causes empty sella syndrome
Defect of dural diaphragm due to stable of increased ICP
Sarcoma of brain is how many percent of all intracranial neoplasm
1-3%
Oligodendroglioma is how many percent of all intracranial neoplasm
5-7%
Clinical manifestation of colloid cyst
Drop attacks
headache modified by posture - ball valve obstruction
Ependymoma is how many percent of all intracranial glioblastoma
6%
Collection of neuroepithelial cells and clusters of oligodendrocytes with multinodular architecture with MUCINOUS cyst
Desmoplastic infantile ganglion Xanthpastrocytoma
IDH 1 and 2 is associated with what outcome and behavior of tumor
better outcome and slower progression
Breast cancer goes to CNS via what pathway
systemic spread via Batson Plexus
Onset of late delayed radiation injury
3 months to years
Age onset of Glioma of brainstem
80% before 20 years old
Most common location of ependymoma in childhood
4th ventricle
Cerebellar Foramen
Downward displacement of parts of cerebellar hemisphere
Pathological findings of papilloma of choroid plexus
Cuboidal epithelium of plexus closely related to ependymoma
What is the tumor antigen involve in Papilloma of choroid plexus
SV40 virus
Mutation of this oncogene is seen in younger patient
p53
What causes papilledema
Rise in intracranial and perioptic pressure leads to impair axonal transport to optic nerve serous drainage
What is the management of PCNSL in immunocomoetent individual
MTX and cytosine arabinose
What is the treatment of Gliomatosis Cerebri
Corticosterioids
MRI findings of Brainstem glioma
T1 hypointense
T2 heterogeneously increased
Histological feature is characterized by elongated bipolar cells
Pilocytic cell
Low-grade and intermediate glioma accounts to how many percent of all gliomas
25-30%
These are cells that are primitive looking
Blastoma
How many percent patients with neoplasm has seizure
25-50%
Meningioma is derived from
arachnoidal meningothelial cells specially those forming arachnoid villi
Age predilection of gangliomas
young
Differential diagnosis of pituitary tumors
Saccular aneurysm
Meningism tuberculous of sellae
MS
Empty Sella Syndrome
This tumor is derived from enpendymal cell of vertigial ventricular structure “paraphysis”
Colloid cyst
Recurrence of Adamantinoma usually occur?
3 years
CSF picture of leukemia of NS
Lymphocytes predominance (similar to carcinomatous meningitis)
How does NS is affected by leukemia
infiltration of leptomeningeal and cranial spinal nerve roots
Associated cancer of Anti-NMDA encephalitis
teratoma
ovarian ca
small cell ca
Most common site of oligodendroglioma
Frontal and temporal
Solid tumor in children accounts for how many percent of intracranial neoplasm
22%
Mulicentricity of GBM occurs in how many percent of patient
3-6%
CSF picture of Anti-NMDA enccephalitis
(+) WBC
(+) oligoclonal bands
Mutation of NF-2 would usually occur during what age
before 21 years old
What syndrome is associated with anti NMDA
Ophelia syndrome
This ependymoma is characterized by high mitotic activity and nuclear atypia
Anaplastic ependymoma
Histologic features of Meningioma
round elongated nuclei with cytoplasmic membrane forming whorls “psammoma bodies”
Histological findings of limbic encephalitis
extensive loss of neuron with microglial proliferation and small patches of necrosis and perivascular cuffing
This syndrome is characterized by acral growrg, visceromegaly, HA andendocrine disorders (DM and hypermetabolism)
Acromegaly
What are clues of malignant meningioma
High mitotic activity
Nuclear atypia
Marked nuclear and cellular pleomorphism
Invasiveness of brain
In Ependymoma, RT would assist Surgery in
address the high rate of seeding in the ventricles
What symptoms usually results to good survival in brainstem glioma
Patient who initially presents long tract signs has increase survival
What tumor classification of medulloblastoma
PNET
What is the disadvantage of gamma knife in management of pituitary adenoma
Effects after several months
The duration of amenorrhea is directly proportional to:
Level of prolactin
Where in the neuroaxis does systemic lymphoma woukd manifest
SC or cauda equina
Why is white matter causes edema
Because of its loose structural organization which offers less resistance to fluid under pressure
Mean age for anaplastic glioma
46 years old
What is the most sensitive auditory evoked response in the presence of acoustic schwanomma
BAER
Stain used in Pineal tumors
Silver carbonate
This is a non-tumorous enlargement of sella
Empty sella syndrome
How is PCNSL diagnose
stereotactic needle biopsy
Age of onset of retinoblastoma
80% before 5 years old
Treatment for Glomus Jugulare Tumor
Radical Mastoidectomy follows irradiation
Embolization prior to surgery
Associated antibody to predominantly corticospinal tract
none
Treatment of Medulloblastoma
Maximal resection of tumor
CT and RT of the entire neuroaxis
Treatment for limbic encephalitis
Plasma Exchange
Anti VGKL
CSF findings of Carcinomatous Myelopathy
Increased CHON
(+) oligoclonal bands
4 Categories of Meningioma
Meningothelial or Syncitial
Fibroblastic
Angioplastic
Malignant Type
What is the most common pareneoplastic neurlogic syndrome
Lambert Eaton Syndrome (LEMS)
Vestibular schwannoma will occur during
5th-6th decade of life
Differential diagnosis of BS glioma
Pontine MS
Vascular malformation of pons
Brainstem encephalitis
Survival rate of PCNSL in AIDS
10-18months
This astrocytoma is characterized by enlarged cell distended with hyaline and eosinophils
Gemistocytic
What should not be given RT in oligodendroglioma
well-differentiated oligodendroglioma
Craniopharyngioma originate from what cell elements
Cell nest at the junction of infindubulum and pituitary
Rathkes Pouch
Diagnostic picture of Acromegaly
Increased GH (>0.10ng/ml) Failure of GH in respopnse to glucose and TRH
Surgical extirpation in metastatic brain disease is indicated in the following settings:
Single Parenchymatous
Growth of primary tumor and metastasis are under good control
Accessible to surgery
Not located at motor and language area
What medication causes SSS thrombosis
Phenytoin and radiation
Early CT/MRI findings of Paraneoplastic cerebellar degeneration
none
late - atrophy of BS and cerebellum
Pattern of inheritance of VHL
AD
Characterized by focal motor symptoms secondary to enlargement of tumor size
Early radiation syndrome
Pathophysiology of GBM
Hypercellularity with pleomorphism of cells and nuclear atypia
Giant cells and mitosis
Hyperplasia of endothelial cells
Necrosis & hemorrhage with thrombosis
Meningioma originates in the following structures
Dura and Arachnoid
Treatment for hemangioblastoma of cerebellum
Craniotomy and opening of cerebellar cyst and excision of hemangioblastomatpous nodule
Endovascular embolization
Pineal Glioma is derived from what structures
astroglial cell of pineal body
Age of onset of oligodendroglioma
3rd-4th decade of life
treatment for arachnoid cyst
Asymptomatic - leave alone
Symptomatic - check for subdural hemorrhage
Other name for lyphomatoid granulomatosis
Castleman disease
What are the association metastatic malignancy in infratentorial area
Pelvic and colon
How many cycles should PCV given
6 cycles
What is the radiation dose for cranial nerves encephalopathy
Radiation at 3,000 cGy in 10 divided dose for 10 days
Diagnostic for Cushing Disease
Excess plasma and urinary cortisol not suppressed by dexamethasone in small dose but can be suppressed by higher dose
What is the management of Anti-NMDA encephalitis if there is no tumor
IVIG
Subependymal giant cell astrocytoma are usually found in
Foramen of monroe
Gangliocytomas may grow in the following sites:
Adrenal gland Thoracic sympathetic Internal auditory canal SC Cerebellum
Cerebellar degeneration is associated with what malignancy
Ovarian ca
Hodgkin’s disease
This tumor is characterized by clock paralysis and atropy weakness of hands and intercostals
Foramen magnum tumor
Treatment for non-germcell pineal tumors
Radiation and Surgery
Imaging findings of oligodendroglioma
T2 hyperintensity heterogenous mass with well-defined borders
Intratumoral calcification > 1/2
Enhance with contrast
Imaging findings of GBM
Homogenous mass with center that is hypointense and non enhancing with irregular rim of enhancement surrounding the core lesion
What is the function of Erlotinib and Gefinitinib
Tyrosine kinase inhibitors that is responsive to upregulated of EGFR
What is the prognosis of GBM if with surgery and RT
12 months
What type of lymphoma has a high tendency to cause meningeal dissemination
non Hodgkin lymphoma
Imaging of Pilocytic astrocytoma
Sharply demarcated and smooth borders T1 hypointensity T2 hyperintensity enhanced nodular distal portion with cystic and calcium in cerebellar lesion
Tumor brush is defined as
tendency to calcify as their prominent vascularity
Imaging of Fibrillary Tumor
less stereotyped appearance
T1 hypointensity
T2 hyperintensity
no contrast enhancement
Vomiting and Dizziness is seen mostly seen in patient with tumor in these regions
posterior fossa
Types of Pinealoma (3)
- Pineacytoma
- atypical pineacytoma
- pineablastoma
MRI findings of gliomatosis cerebri
one or more confluent area of signal changes
Contrast enhancing is scant
Main syndrome of neuroblastoma
Polymyoclonus
Opsoclonus
Ataxia
Early stage neuroblastoma management
Observe, most of them regress spontaneously
Treatment (medulloblastoma)
Low Risk - _________
Intermediate- __________
High Risk - ____________
Treatment (medulloblastoma)
Low Risk - observe
Intermediate- CT
High Risk - Sx, RT and CT
Differential diagnosis of Tumor of Foramen Magnum
Chiari malformation
MS
Syringomyelia
Bony abnormalities at craniocervical junction
Meningioma is how many percent of all primary intracranial neoplasm
15%
What is the management of ependymoma
Surgical excision
VP shunting
irradiation
Gene that is involve in retinoblastoma
RB gene
What predicts the responsiveness of recurrent gliomas to treatment
suppression of PTEN
Imaging findings of PCNSL
dense homogenous enhancing infiltrating
non-necrotic , non-hemorrhagic periventricular masses
What is the characteristic feature of chordoma
This is the only tumor that may manifest both intracranial and extracranial mass
What is the etiology of Cushing Disease
Hyperplasia of pituitary basophilic cells or non basophilic micradenoma
This disease is characterized by lesion in photoreceptor cells and manifest with scotoma and attenuation of retinal arterioles
Paraneoplastic retinopathy
This tumor causes visual disturbances related to the borders of sella tursica
Pituitary adenoma
What is the permanent cure for meningioma
Surgical Excision
What virus is involved in Angioblastic intravascular lymphoma
EBV
This tumor grows slowly forming a mass in the cerebellum composed of granule, purkinje and glial cells
Lhermitte Ducos
How many percent of patient will have recurrence in one year in pituitary adenoma
15%
What stain can the fried egg appearance is better visualized
Silver Carbomate
When is craniotomy indicated in pituitary adenoma
extrasellar extensive of pituitary growth with transfrontal approach followed by RT
This disease is characterized by acute to subacute psychiatric manifestation in combination with hallucination, panic disorder and memory disturbance
Anti-NMDA Encephalitis
Imaging findings of Ependymoma
CT: well demarcated heterogenous hyperdense mass with uniform enhancement
MRI: HypoT1 HyperT2 with calcification
What is the characteristic feature of arachnoid cyst in infants
Extensive transillumination and macrosomia
This manifest during child bearing years where it is induced by OCP use when was stop cycle is not reestablish the cycle
Ammenorhea-Galactorrhea syndrome
What makes the meningioma highly vascularized and prominent edema
VEGF
(1) 2nd most frequency next to anti-Hu associated with what carcinoma (2)
- CRMS
2. lung carcinoma
Treatment of disseminated lymphoma of NS
RT + chemotherapy
Common location of brainstem glioma
Dorsal
Where does anti-Yo binds that promotes cerebellar degeneration
C-MYC
Diagnostic tool used in carcinomatosis meningitis
CSF analysis with cytology & flow cytometry techniques
This tumor invaginate the 3rd ventricle and blocks the foramen monroe
suprasellar arachnoid cyst
Median survival of RT alone in GBM
12.1
In astrocytoma, if treated early, the survival rate is
5.3 years
initial manifestation of sphenoid wing meningioma
Exophthalmos
Supratentorial meningioma accounts of how many percent of all meningioma based on location
90%
Extracranial metastatasis of medulloblastoma occurs where
Liver lung scalp and LN
Treatment of retinoblastoma
early recognition
radiation
surgery
Neurological symptoms of carcinomatous meningitis
Headache Backache Sciatica Cauda Equina Multiple craniopathies
Symptoms of ependymoma
Similar to medulloblastoma except protracted course and lacks cerebellar signs
This disorder is characterized by continuous muscle fiber activity
Chorea Fibrillaire
This tumor are found in 20% with tuberous sclerosis
Subependymal giant cell astrocytoma
PCV regimen includes
Procarbazine Cyclophosphamide and Vincristine
Treatment of Neuroblastoma
Depends on clinical staging
Treatment for BS glioma(Diffuse infiltrative type)
RT and VP shunting
partial resection - long term survival
This tumor manifests as painless mass at the side of neck below the angle of jaw
Carotid body tumor
What are the markers in oligodendroglioma that confer benefit
Loss of 1p
IDH1 mutation
5 years survival in medulloblastoma with treatment
80%
Reticulum cell sarcoma
CNS Lymphoma
What is a pleuripotent stem cells
this cells are capable of differentiating into neuronal or glial elements
Rb gene is associated in what loss of chromosome
Chr 10
What antiangiogenic agents can be given in patient with NF-2
Becacizumab
What causes loosening of BBB by allowing passing of blood products
Protease
Most common histological feature of astrocytoma
Fibrillary
Analogue of somatostatin shown to reduced tumor size
Octreotide 200mg/d
Outcome of GBM if no treatment
7-9 months
This is a dopamine agonist used in adjunct galactorrhea syndrome where it reduces the tumor size and improvement of visual symptoms
Bromocriptine 0.5-1.25 OD
This disorder is characterized failure of a slow bitemporal hemianopia without endocrine deficit
Meningioma of tuberculum sellae
CT/MRI findings of optic glioma
tumor and enlargement of optic foramen >7mm
The deletion of this gene is seen in 50% with astrocytoma
p53
This tumor is characterized by its systemic malignant tumor that metastasize to base of skull specifically to anterior fossa
Esthesioneuroblastoma
Antibody associated with Carcinomatous Myelopathy
Anti-Hu
treatment for germ cell pineal tumor
Surgery
Other neurological findings in paraneoplastic cerebellar degeneration
Myoclonus Opsoclonus SNHL Diplopia Vertigo
Malignant types ependymoma would present symptoms as
First symptoms to 4 weeks after diagnosis is suggestive of malignant type
What are the possible causes if the onset is sudden in metastatic brain tumor
Tumoral bleed
Non bacterial thrombotic endocarditis with cerebral embolism
PNET tumors are recognized as:
small cell glioma
undifferential embryonal origin
Treatment of Papilloma of Choroid plexus
Surgical excision
VP shunting
What is the most cellular elements affected in pituitary adenoma
Chromophobe > Acidophil > Basophil (CAB) 5:4:1
(7) Grade IV WHO Classification of tumor
GBM Giant cell glioblastoma Gliosarcoma Medulloblastoma PNET Atypical Teratoma MPNST
Give 4 viruses that are associated with primary tumor
HPV
HBV
EBV
HTLV
What condition predisposes to empty sella syndrome
Pseudotumor cerebri
Post-excision of pituitary adenoma
Hydrocephalus
Biomarkers of carcinomatous meningitis
LDH
B-Glucoronidase
B-Globulin
CEA
What drugs can be used in patients with interstitial edema
Furosemide and acetazolamide
This herniation is associated with cingulate gyrus is pushed under the falx
Subfalcine
Patient who had neurological signs and symptoms when treatment is initiated the median survival is
3.4 years
What is the management of ocular lymphoma
irradiation ONLY!
Give 4 tumors that occurs before age of 20
Medulloblastoma
Polar Spongioblastoma
Optic Nerve Glioma
Pinealoma
Pattern of growth of pituitary adenoma
Pituitary > Optic chiasm > cavernous sinus > 3rd ventricle > posterior fossa
Radiation dosage that is proven to increase survival of 5 years
6,000 cGY
This accounts for 50% of pineal tumors
Germinoma
Histological classification of astrocytoma
Fibrillary
Gemistocytic
Pilocytic
Mixed Type
Rate of growth of tumor depends on the following
Nuclear atypia
Cellularity
Mitosis
Vascular Proliferation
What chromosome does p53 is found
Chr. 17
Pathologic findings of medulloblastoma
Closely packed hyperchromatic nuclei little cytoplasm and many nuclei (PSEUDOROSETTES)
Radiographic findings of Desmoplastic infantile ganglion xanthoastrocytoma
Nodule or small cyst
hyperintense T2
Non-enhancing
What are the common locations of papilloma of choroid plexus with percentage
Lateral Ventricle 50%
4th ventricle 40%
3rd ventricle 10%
Treatment for chordoma
Surgical excision and focused radiation
What is the adverse effect of IV MTX in treating leukemia of NS
Necrotizing leukoencephalopathy
This tumor is associated with Lhermitte Ducos Disease
Gangliocytoma
Associated disorder of Chorea fibrillaire
Isaac Syndrome
Lunch cancer
Neurological symptoms of pineal tumors (6)
Increased ICP Parinauds syndrome Limb ataxia Oculomotor signs Precocious puberty Sleep not affected
Tumor in the foramen accounts how many percent of all intracranial tumor
1%
Fate of the brainstem glioma
- malignant transformation
2. spread to meninges - meningeal gliomatosis
This tumor is similar to medulloblastoma but occurs in supratentorial region
PNET
What is highly characteristic in acromegaly
Facial and bodily appearance
Age and sex predilection of medulloblastoma
4-8 years old
M>F 3:1
GBM is how many percent of all intracranial tumor
20%
How many patient with neoplasm presents with headache
25%
This tumor is high in AIDS and immunosuppressed state
PCNSL
Treatment for oligodendrocytes
Surgical excision with RT
What drug should be use to target in recurrent GBM
VEGF
Increase ICP, seizure and worsening of tumor
Acute
Medulloblastoma is derived from what stem cells
Pleuripotent stem cells
Presence of this gene is associated with poor prognosis in medulloblastoma
C-MYC
Where is the lateral of papilloma of choroid plexus where it manifests like CP angle tumor
lateral recess
Where does olfactory groove meningioma originates
arachnoidal cells along the cribriform plate
Most common location of ependymoma
4th ventricle
What is the hallmark genetic defect of vestibular schwanomma is the inheritance is AD
NF-2
Treatment for Anti-NMDA encephalitis
Removal of ovarian containing teratoma or other inciting tumor
How many years survival in “loss of 1p” in oligodendrocytes
10 years
2 Types of Ependymoma
- Ependymoma
2. Ependymoblastoma
Favored sites of recurrence
Cerebrum Cerebellum Hypothalamus Optic Nerve Optic Chiasm
treatment for early radiation syndrome
Steroids
Histologic findings of retinoblastoma
small cells with neurofibrils like neurofibroblastoma and has a tendency to form rosette
Distinct features of limbic encephalitis
confusional attack memory deficit seizure dementia hallucination
Survival rate of anaplastic tumor
3-5 years
Mean age of GBM
60 years old
Ependymoma is derived from
Ependymal cells that lines the ventricles of brain and central canal
Wha is the imaging findings of necrotizing leukoencephathy
Large areas of hypodensity
T2 Hyperintensity
What growth factor is increased meningioma
VEGFR
What is the common location of PCNSL
periventricular area
What chromosome is involve in medulloblastoma
Chr 17
Laminated calcific concretion of calcium deposits
Psammoma Bodies
What agents increase the prolactin level in normal individual
Chlorpromazine
TRH
What is the defective gene in Subependymal giant cell astrocytoma
mTOR
Paraneoplastic syndromes associated with lung cancer
Sensory neuropathy
Myasthenic syndrome
Location distribution of metastatic brain carcinoma
80% supratentorial
20% infratentorial
The imaging findings of Lhermitted Ducos Disease
Alternating lesion of dysmorphic cerebellar cells
“TIGER SKIN:
Histological findings of Carcinomatous myelopathy
Symmetrical necrosis of both gray and white matter of most cord
What is the most important prognostic factor in intracranial neoplasm
Age
MRI findings of radiation injury of the brain (Late-delayed)
Contrast enhancing lesion and avascular mass
This neoplasm is characterized by dimming of vision, constriction of fields and papilledema
Optic glioma
Familial Schwanomma is associated with mutation of these chromosome and gene
Chromosome: Chr.22
Gene: SMARCB1 gene
Growth rate of Carotid body tumor
2cm every 5 years
AB of LEMS is directed against what channel
Calcium
This marker is associated with limbic encephalitis
anti-Hu
What is the most common type of Meningioma
Syncitial
This is the most serious radiation injury where it is characterized by necrosis of white matter of the brain
Late-Delayed Process
This is a neuroectodermal cells that contains aggregate of paranglioma seen in patients residing in high altitude
Carotid Body Tumor (paraganglioma)
Imaging findings of medulloblastoma
High intensity in both T1 and T2 with heterogenous enhancement at 4th ventricle
Amplification of this gene is associated with poor outcome in patient with neuroblastoma and medulloblastoma
MYCN
p16 is associated with overexpression of
EGF
Differential diagnosis of Paraneoplastic cerebellar degeneration
CJD
Post-infectious cerebellitis
Age of onset of hemangioblastoma of cerebellum
15-50 years old
Surgical technique of schwanomma
Microsurgical suboccipital transmeatal approach
What are other receptors found in meningioma
Estrogen and Progesterone
Paraneoplastic Optic neuropathy is associated with what antibody
CRMP-5
What is the acceptable radiation dose
6,000 cGY
This tumor if covered the cerebral hemisphere may result to external hydrocephalus
Arachnoid cyst
Incidence of primary tumor
46/100,000
Histologic findings of PCNSL
highly cellular and grows around the blood vessel in angiocentric pattern
What tumor where contents may cause chemical meningitis
Cholesteoma
What is wutzelueth
inappropriate jocularity due to compression of inferior frontal lobe
Sex predilection of chordoma
M>F
What is the management of meningioma if located in Skull base and small in size
Focused radiation
Amplification of this gene is associated with tumor in older patients
EGFR
What disease should be exclude in the presence of lack of ballooning of sella
pituitary adenoma
suprasellar tumor
This tumor has a predilection to grow in juxtacortical at lateral or medial temporal lobe
Desmoplastic infantile ganglion Xanthpastrocytoma
What gene is responsible for transformation of oligodendrocytes and astrocytoma to malignant form
IDH 1 and IDH 2
Mixed oligodendroglioma and astrocytoma treatment
treated as astrocytoma
Give Temazolamide
This pineal tumors are highly cellular of small undifferentiated cells resemble to medulloblast
Pineblastoma
Factors decrease the survival in medulloblastoma
Brainstem Invasion
Spinal Subarachnoid invasion
Incomplete removal
Very Early Onset
What carcinoma is associated with limbic encephalitis
Small cell carcinoma (lung)
Hodgkin Lymphoma
What is the most vulnerable to injury in radiation
dividing cells
Associated malignancy with cerebellar degeneration
Lung cancer
Hodgkin
Lymphoma
Ovarian Tumor
What is the most common of hemangioblastoma in SC
posterior column
Most reliable diagnostic tool in radiation associated brain injury
PET-SCAN
All GBM recur within how many cm of their original site
2cm
Basophilic cells in pituitary are responsible for synthesize of what hormones
ACTH
LH
FSH
Most common types of tumor in the foramen magnum
Meningioma > schwanomma > neurofibroma and dermoid cyst
How to treat PCNSL
Corticosteroids and RT
What chromosomes appear to correlate with good survival in patient with oligodendroglioma
Deletion of 1p and 19q
Responsiveness to PCV can be determined by the presence of the gene defect
Loss of allele of Chr 1p
The form of treatment of chordoma offers survival rate of
5 years without recurrence in 80%
This is a systemic lesion with prominent nodular pulmonary, dermal and lymphnode
Lymphomatoid Granulomatosis
Other condition that has anti-Hu antibody
Sjogrens
Small Cell Ca
What is the treatment for angioblastic intravascular lymphoma
corticosteroids
Age of onset of optic glioma
before age of 15
Mean age 3.5 years
Small round nucleus and halo of unstained neoplasm
Fried egg appearance
loss of long arm of Chr.22 in meningioma is due to
Deletion of Merlin
What channel is defective in chorea fibrillaire
K channel
Pineal tumor that tends to form pineacytomatous rosettes
Pineacytoma
What is the prognosis of gliomatosis cerebri
POOR
Pathological feature of ependymoma
rosettes around the blood vessels (pseudorosettes)T
This is a tumor like formation that has its basis in maldelevelopment
Hamartroma
The direction of CSF flow in the presence of suprasellar area
upward
What gene is associated with glioma and oligodendroglioma
IDH 1 & 2
