Neoplasms

Question 1

4 sx of CNS tumor

Answer 1

1) progresive, focal neuro deficit
2) HA worse in recumbency and associated with N/V + other sx of incr ICP
3) seizures if irritate cerebral cortex
4) gradual cognitive slowing and personality changes
def on location and rate of growth. if have sx of systemic disease like fever and wt loss, more likely to be metastatic than primary CNS tumor.

Question 2

anterior frontal lobe tumor

Answer 2

present with weakness (primarily with CL leg), personality changes (disinhibition, poor judgement, cog slowing, aphasia for left sided lesions), urinary incontinence due to diruption of micturition inhibition center, gaze preference, primitive reflexes (grasp, suck) seizures

Question 3

posterior frontal lobe tumor

Answer 3

present with CL weakness, expressive aphasia for left sided lesion, neglect for right, seizures

Question 4

temporal lobe tumors

Answer 4

present with memory impairment, wenches type aphasia for left sided lesions. CL superior quadratanopsia, neglect for right sided lesions, seizures

Question 5

occipital lobe tumor

Answer 5

CL homonymous hemianopsia, visual hallucination, alexia without agraphia for left sided tumor involving corpus callosum, seizures

Question 6

tumor of thalamus

Answer 6

CL sensory loss, aphasia for left sided lesions

Question 7

glioblastoma

Answer 7

an astrocytoma of cerebral hemisphere. any tumor with necrosis, vascular prolif, pleomorphic cells positive for immunostatin stain. imaging- heterogeneously enhancing masses with non enhancing area = necrosis

Question 8

gliomatosis cerebri

Answer 8

type of malignant glioma characterized by extensive tumor infiltration without discrete mass or area of necrosis. no pathognomoic clinical presentation. in ppl <40yo.
tx: whole brain radiation and chemo. - 3y lifespan
5% are multi centric which look the same as metastatic disease or demyelination

Question 9

brainstem glioma

Answer 9

HA, hydrocephalus, CN deficit IL to lesion and S/M deficit CL to lesion. no surgical resection

Question 10

CNS tumor tx

Answer 10

grade I- complete surgical resection is curative.
high grade- surgery not curative but done for histo and to relieve mass effect. when <65yo, extent of resection correlate with survival. rads- extend survival in high grade gliomas. stereotaxic radio surgery for small tumors

Question 11

radiation tx v imaging

Answer 11

wks to mo afterwards- reversible edema- hyper intensity on FLAIR. mo-y- demylination and damage to blood vessels, WM changes, mass effect and enhancement with contrast. so this looks like recurrent tumor. PET use to DD recurrent tumor and physio recovery from radiotherapy

Question 12

juvenile pilocystic astrocytoma(JPA)

Answer 12

benign who grade I tumor. usually in cerebellar hemisphere but can be anywhere. present with sx of incr ICP, HA, ataxia. often a feature of neurofibromatosis type I when grow on optic pathway.
tx: surgical resection,
image- well circumscribed, large cystic component with enhancing mural nodule. cyst is isodense to CSF on all seq
DD: hemangioblastomas

Question 13

astrocytoma

Answer 13

most common type(50%) of IC neoplasm in children and young adult. 75% are JPAs

Question 14

cerebellar tumor

Answer 14

most freq is meduloblastomas. 2nd- JPAs

Question 15

gangliogliomas

Answer 15

slow growing, children/young adult
mix of glial and neural element (if neural dom then ganglioneuroma), can undergo malig transformation
most commonly in temporal lobe, then frontal, parietal, occipital. may be found near hypothalamus and infratentorially. cystic tumor w/wo solid component.
variable degree of enhancement, calcification common on CT - DD from JPA and pleomorphic xanthrocytoma

Question 16

subependymoma

Answer 16

benign, slow growing neoplasm in 4th ventricle, do not invade brain or cerebellum. present with sx of incr ICP.

Question 17

falx meningioma

Answer 17

arise from orbital groove or plan sphenoidal. present with cog changes, frontal lobe behavioral abn, seizures, HA, parplegia. part of sphenoid bone, anterior to sella truck and above sphenoid sinus

Question 18

meningioma tx

Answer 18

surgical resection with preoperative embolization of tumor. 25% recur. malign recur at 80%-need rad.

Question 19

meningioma

Answer 19

slow growing, usually benign. 20% of primary CNS neoplasm. arise from cells of arachnoid. adherent to dura and rarely invade brain but does invade and remodel skull. in middle aged women. multi in brain and SC could be must in chromosome 22 as part of neurofibromatosis type II.
prior rad is only RF
make sx by compress nervous tissue bc extraxial. sx depend on location. highly calcified 25% of time. some cyst formation in middle or periphery. hyperostosis

Question 20

hemangiopericytoma

Answer 20

from pericytes. aggressive extra axial tumor. no calcification. tx-surgery. high recurrence

Question 21

pericytes

Answer 21

reg BBB.

Question 22

tumor of pineal area

Answer 22

1% of CNS tumor. HA, hydrocephalus if compress cerebral aqueduct, vertical gaze palsy if compress midbrain, circadium rhythm D. mostly germinomas
tx: chemo and rad.
serum marker: HCG and placental alkaline phosphatase

Question 23

pineal region neopalsm types

Answer 23

arise from pineal gland- pineolblastoma (type of PNET- mostly under 10yo), pinealcytomas. germ cell origin (germinomas, teratomas, embryonal carcinomas, choriocarcinoma)- more common in kids.

Question 24

germinoma

Answer 24

60% of germ cell tumor of pineal gland. in suprasellar region. men and asian. spread throughout sf.
chemo and radio.
serum markers- HCGna d placental alkaline phosphatase

Question 25

pineoblastoma

Answer 25

surgery and rad. 60% 5y survival rate.

Question 26

pineocytoma

Answer 26

less malign. tx with surgery alone. 5y survival rate 90%. clinically silent until affect midbrain and cause visual sx.

Question 27

meningioma from tentorium cerebelli

Answer 27

ataxia, restricted up gaze if compress dorsal midbrain. HA if compromise CSF flow

Question 28

meningioma of cerebellopontine angle

Answer 28

present with tinnitus and gradual onset of hearing loss and facial weakness. large tumors impinge on brainstem causing dysarthria, dysphagia, ataxia, weakness.

Question 29

meningioma high grade

Answer 29

atypic- grade II. anaplatic/malig- grade III. high mtitotic rate. heterogenous enhancement and sig peritumoral edema.

Question 30

low grade meningioma MRI

Answer 30

uniformly enhacne with contrast admin. edema. dural tail from meninges flanking bulk of tumor

Question 31

optic nerve sheath meningioma

Answer 31

most common intraorbital tumor. mostly unilateral, present in middle age women with diplopia, transient visual obscuration, slow visual loss. surgery in pt with rapidly progressive visual loss bc surgery causes visual loss. sterotatic radiotherapy

Question 32

primary CNS lymphoma

Answer 32

from B cells. origin unclear bc no lymphoid tissue in CNS. usually subcortical. cog decline and focal neuro deficit. spread via CSF to eyes and bone. no surgery
MRI- enahcne avidly with contrast. dark on T2 seq and bright diffusion weighted images, uniformly enhancing in immunocompetent. tx with glucocorticoid shrinks on imaging.
in immunocompent- chemo works- methotrexate and rad.

Question 33

metastatic brain ca

Answer 33

20% ca. spread via blood. most common at gray-white junction where there is slow blood flow. lung ca -50% meta to brain then breast, melanoma, renal cell carcinoma.
glucocorticoid reduce edema and improve sx. resection of up to 3 lesions is beneficial. 30% has seizure but no prophylactic anticonvulsant

Question 34

location of CNS tumor v age

Answer 34

child-2/3 infratentorial. 2/3 adult supratentorial. cerebellum most likely metastatic disease in adult