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Neuroradiology > Neoplasms > Flashcards

Neoplasms Flashcards

1
Q

A 65 year-old man presented with headaches and confusion.

A

Glioblastoma multiforme (GBM) = Grade IV astrocytoma

Tumors of CNS have 4 symptoms:

  1. Progressive, focal neurological deficits
  2. Headache - worse lying down, associated with nausea/vomiting
  3. Seizures
  4. Gradual cognitive slowing and personality changes

GBM

  • Most common and most lethal type of astrocytoma
  • Always in cerebral hemispheres
  • Histology - necrosis, vascular proliferation, pleomorphic cells
  • Imaging - enhancing mass with nonenhancing necrosis
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2
Q

Tumors of anterior frontal lobe present with…

A
  • Weakness of contralateral leg
  • Personality changes - disinhibition, poor judgment, cognitive slowing
  • Urinary incontinence
  • Gaze towards lesion
  • Seizures
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3
Q

Tumors of the posterior frontal lobe present with…

A
  • Contralateral weakness
  • Expressive aphasia (left-sided lesion)
  • Neglect (right-sided lesion)
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4
Q

TUmors oft he temporal lobe present with…

A
  • Memory impairment
  • Receptive aphasia (left-sided)
  • Neglect (right-sided)
  • Contralateral superior quadrantanopsia
  • Seizures
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5
Q

Tumors of occipital lobe present with…

A
  • Contralateral homonymous hemianopsia
  • Visual hallucinations
  • Alexia without agraphia (left-sided)
  • Seizures
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6
Q

Tumors of the thalamus present with…

A
  • Contralateral sensory loss
  • Aphasia (left-sided mass)
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7
Q

A 50 year-old healthy man developed cognitive slowing.

A

Gliomatatosis cerebri - multicentric gliomas

  • Malignant glioma characterized by extensive tumor infiltration without a discrete mass or areas of necrosis
  • Indistinguishable from metastatic disease or demyelination
  • Imaging
    • Small areas of enhancement
  • Signs
    • Headache, seizure, personality change, dementia, weakness
  • Epidemiology
    • Younger than 40
  • Treatment
    • Whole-brain radiation and chemotherapy
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8
Q

39 year-old woman with right- sided weakness and left 6th nerve palsy.

A

Brainstem glioma

  • Signs
    • Headache and hydrocephalus
    • Ipsilateral CN deficits
    • Contralateral sensory and motor deficits
  • Surgery does not work!
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9
Q

A 49 year-old man presents with a seizure.

MRI:

  1. At diagnosis
  2. 2 weeks later
  3. 1 year later
A
  1. Glioma
  2. Post-surgery
  3. Post-radiation

Low-grade gliomas:

  • Grade I astrocytoma
    • Surgery is curative
  • Grade II astrocytoma
    • Surgery is often not curative
    • Radiation or chemotherapy needed

Radiation necrosis:

  • Edema = hyperintensity on FLAIR
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10
Q

A 7 year-old child developed progressive headaches and ataxia.

A

Juvenile pilocytic astrocytoma (JPA)

  • Astrocytomas are the most common type of intracranial neoplasms in children and young adults
    • 75% are JPAs

JPA

  • Benign grade I tumors typically in cerebellar hemisphere
  • Associated with neurofibromatosis type I
  • Signs
    • Headache, ataxia, increased ICP
  • Surgery is curative
  • Imaging
    • Well-circumscribed lesions
    • Large cystic component with enhancing mural nodule
  • DDx
    • Hemangioblastoma
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11
Q

A 12 year-old child presented with seizures.

A

Ganglioglioma

  • Slow-growing tumors most commonly in children and young adults
    • Glial + neural elements
    • Can become malignant
  • Common in temporal > frontal, parietal, occipital
    • Near hypothalamus and infratentorial
  • Signs
    • Seizures
  • Imaging
    • Cystic tumors with or without solid component
    • Calcifications common on CT
      • Differentiates from JPA and pleomorphic xanthrocytomas
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12
Q

A 45 year-old man developed headaches. The following lesions was seen and was stable for many years.

A

Subependymoma

  • Benign, slow growing neoplasm
  • Found in 4th ventricle - do not invade brain or cerebellum
  • Symptoms
    • If they obstruct ventricular system - increased ICP symptoms
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13
Q

A 45 year-old man developed personality changes and weakness in his legs.

A

Meningioma (of the falx)

  • Benign, slow-growing tumors
  • Most common benign neoplasm
    • 2nd most common neoplasm overall (#1 = glioma)
  • Arise from arachnoid and attach to the dura and rarely invade the brain
  • Involved in neurofibromatosis type II
  • Risk factor = prior irradiation

Treatment

  • Asymptomatic lesions can be followed
  • Surgical resection with preoperative embolization
    • 25% recur
  • Malignant meningiomas have higher recurrence rate (80%) and require radiation
  • Stereotactic radiosurgery for unresectable lesions
    • Tumors of cavernous sinus are hard to resect
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14
Q

A 36 year-old man presented with seizures and a dull headache.

A

Calcified meningioma (of sphenoid wing)

  • 25% of meningiomas are calcified on CT
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15
Q

A 5 year-old presented with with headaches and restricted upgaze.

A

Pinealcytoma

  • Pineal tumors present with:
    • Vertical gaze palsy (when the affect midbrain)
    • Circadian rhythm disturbance
    • Hydrocephalus and headache if ventricular obstruction
  • Types of tumors:
    • Pinealomas (20%)
      • Pineoblastomas = type of PNET
        • Children
        • 5-year survival = 50%
        • Subarachnoid space
        • Surgery and radiation
      • Pinealcytomas
        • Adults
        • 5-year survival = 90%
        • Surgery alone
    • Germ cell
      • Germinomas (40%)
        • ​Frequently in suprasellar region
        • M > F, Asians
        • Chemotherapy and radiation
        • Elevated hCG + AlkP
      • Teratomas
      • Embryonal carcinomas
      • Choriocarcinomas
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16
Q

A 64 year-old woman presented with a headache. On exam, she had an ataxic gait and some limitations in upwards gaze.

A

Meningioma (of tentorium cerebelli)

17
Q

A 57 year- old man presented with a seizure.

A

Meningioma

  • Enhance with contrast on MRI
  • Edema = more aggressive
  • 25% calcified on CT
  • Dural tail
    • Enhancement of meninges flanking bulk of tumor
  • Hyperostosis
    • Remodeling of bone seceondary to bone invasion
    • (Red arrows)
  • Cystic
    • Some meningiomas can be cystic
18
Q

45 year-old female presented with a seizure and was found to have a mass which recurred after several operations.

A

Meningioma (atypical)

  • Most meningiomas are WHO Grade I tumors
  • Atypical meningiomas are WHO Grade II tumors
  • Anaplastic meningiomas are WHO Grade III tumors
19
Q

A 56 year old man presented with seizures.

A

Meningioma

  • Most meningiomas uniformly enhance with contrast
  • Dural tail (red arrows)
20
Q

A 36 year-old healthy female developed left-sided weakness and numbness.

A

Primary CNS lymphoma (PCNSL)

  • Most common intracranial neoplasm in HIV+
  • Subcortical lesion
  • May spread via CSF to eyes and bones
  • Imaging
    • Hyperintense with contrast on T1WI
    • Hyperintense on DWI
  • Treatment
    • Treatment with steroids will shrink tumor and prevent enhancement
    • Chemotherapy and radiation
      • Surgery doesn’t work!
21
Q

3 separate patients with seizures and headaches.

A

Metastatic lesions

  • 20% of cancer patients will develop brain mets
    • Lung > breast > melanoma, renal cell carcinoma
  • Mostly found at gray-white junction - blood flow is slow
  • Treatment
    • Steroids reduce edema and improve symptoms
    • Whole brain radiation
22
Q

A 65 year-old female developed headaches and ataxia.

A

Metastasis

  • In children, 2/3 of tumors are infratentorial
  • In adults, 2/3 of tumors are supratentorial
    • Tumors in the cerebellum are likely metastatic!
23
Q

A 44 year-old man presented with a seizure.

A

Oligodendroglioma

  • Likely to show calcification on CT
  • Less enhancement on T1WI compared to gliomas
24
Q

A 73 year-old female presented with mild cognitive dysfunction.

A

Arachnoid cyst

  • Benign sacs filled with CSF located between arachnoid and brain
    • Congenital abnormality - failure of arachnoid membrane to fuse, allowing CSF to flow into the cleft
  • Most common in middle cranial fossa outside of temporal lobe
  • Imaging
    • Follows CSF on all sequences!
  • Treatment
    • Microneurosurgical drainage
25
Q

45 y/o M with hearing loss.

A

Vestibular schwannoma

  • Most lesions in cerebellopontine angle are either schwannomas or meningiomas
  • Arise from Schwanna cells (myelination)
    • Can arise from any CN (except CN I-II)
  • Benign, slow-growing
  • Bilateral vestibular schwannomas associated with neurofibromatosis type II
  • Treatment
    • Surgery to prevent heraing loss
      • Can cause damage to CN VII = facial paralysis
26
Q

A 56 year-old man noticed he wasunable to feel his face while shaving.

A

CN V schwannoma

  • Most common schwannoma = CN VIII
  • Second most common schwannoma = CN V
27
Q

A 37 year-old woman presented with blurry vision.

A

Pituitary adenoma

  • Benign, slow-growing trumors from anterior pituitary
    • Microadenoma < 10mm
    • Macroadenoma > 10mm
  • Most are not hormonally active
    • Mass effect on brain structures
      • Headache, CN deficits, personality changes
    • Panhypopituitarism if compression of pituitary stalk
      • Lethargy, growth failure, DI, hypogonadism, hypoadrenalism
  • MRI enhanced
  • Diagnosis
    • Prolactin, TSH, 24-hr cortisol, FSH, LH
  • Treatment
    • Surgery is curative
    • Bromocriptine for prolactinomas
    • Somatostatin analogue for GH or TSH tumors
28
Q

63 y/o F with visual disturbances, sudden severe headache.

A

Pituitary apoplexy = Sheehan’s syndrome

  • When there is acute hemorrhage
    • Can occur with bleeding adenoma
  • Signs
    • Sudden headache, visual loss, opthalmoplegia
  • Treatment
    • Steroids
    • Neuro emergency since patients can die from subarachnoid hemorrhage
      • Visual change or loss of consciousness
29
Q

A 20 year-old man developed gradual, but severe visual loss and failed to develop secondary sexual characteristics.

A

Craniopharyngioma

  • Slow-growing, cystic tumors from pituitary stalk
  • Children and young adults
  • Signs
    • Visual disturbances due to compression of chiasm
    • Endocrine dysfunction due to compression of pituitary or hypothalamus
    • Increased ICP
  • MRI
    • Cyst is bright on T2WI
    • Ring-enhancing with contrast on T1WI
    • Calcified on CT
  • Treatment
    • Surgery + postop radiation (prevent recurrence)
30
Q

A 45 year-old woman presented with a bitemporal hemianopsia.

A

Meningioma (of tuberculum sellae)

  • Signs
    • Bitemporal hemianopsia due to compression of optic chiasm
    • Endocrine dysfunction due to compression of pituitary stalk

Neuroradiology (11 decks)

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