Neoplasms Flashcards
4 sx of CNS tumor
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.
anterior frontal lobe tumor
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
posterior frontal lobe tumor
present with CL weakness, expressive aphasia for left sided lesion, neglect for right, seizures
temporal lobe tumors
present with memory impairment, wenches type aphasia for left sided lesions. CL superior quadratanopsia, neglect for right sided lesions, seizures
occipital lobe tumor
CL homonymous hemianopsia, visual hallucination, alexia without agraphia for left sided tumor involving corpus callosum, seizures
tumor of thalamus
CL sensory loss, aphasia for left sided lesions
glioblastoma
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
gliomatosis cerebri
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
brainstem glioma
HA, hydrocephalus, CN deficit IL to lesion and S/M deficit CL to lesion. no surgical resection
CNS tumor tx
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
radiation tx v imaging
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
juvenile pilocystic astrocytoma(JPA)
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
astrocytoma
most common type(50%) of IC neoplasm in children and young adult. 75% are JPAs
cerebellar tumor
most freq is meduloblastomas. 2nd- JPAs
gangliogliomas
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
subependymoma
benign, slow growing neoplasm in 4th ventricle, do not invade brain or cerebellum. present with sx of incr ICP.
falx meningioma
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
meningioma tx
surgical resection with preoperative embolization of tumor. 25% recur. malign recur at 80%-need rad.
meningioma
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
hemangiopericytoma
from pericytes. aggressive extra axial tumor. no calcification. tx-surgery. high recurrence
pericytes
reg BBB.
tumor of pineal area
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
pineal region neopalsm types
arise from pineal gland- pineolblastoma (type of PNET- mostly under 10yo), pinealcytomas. germ cell origin (germinomas, teratomas, embryonal carcinomas, choriocarcinoma)- more common in kids.
germinoma
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
