Neoplasms: Types of tumors Flashcards
Astrocytoma is a Glioma or Non-glioma
Glioma
Oligodendroglioma is a Glioma or Non-glioma
Glioma
Ependymoma is a Glioma or Non-glioma
Glioma
Medulloblastoma is a Glioma or Non-glioma
Non-glioma
Meningioma is a Glioma or Non-glioma
Non-glioma
Pituitary adenoma is a Glioma or Non-glioma
Non-glioma
Neurinoma (Schwannoma)
is a Glioma or Non-glioma
Non-glioma
Primary CNS lymphoma is a Glioma or Non-glioma
Non-glioma
Pediatric Brain Tumors are located and name 3 types
Predominant brain tumors in children are infratentorial in location
Cerebellar astrocytoma
Medulloblastoma
Fourth Ventricular ependymoma
Which type of tumor is most prevalent
Gliomas
Glial cells can be subdivided into and give rise to
Astrocytes – Have a nutritive role for neurons
Oligodendrocytes – Produce the myelin sheath
Ependymal cells – Line the ventricles
These cells can give rise to tumors called astrocytomas, oligodendrogliomas & ependymomas, respectively
Gliomas arise from and are found
Arise from glial cells, which are the cells that support, insulate, & metabolically assist neurons
Neurons are rarely the basis for neoplastic formation
Found mostly in cerebral hemispheres in adults, & in the cerebellum in pediatrics
Low-grade Astrocytoma
are, growth rate, location, WHO grade
Benign neoplasms that are slow growing and often cystic (encapsulated - Well differentiated)
Usually located in the frontal lobe, but can be anywhere in the cerebrum
Almost always infiltrative and progressive
WHO: 1-2
Can you have surgery to remove a low grade astrocytoma
With surgery, survivability is high; without surgery the prognosis is poor due to progressive nature
Damage is usually from compression so when tumor is removed you usually recover pretty well
Cystic (encapsulated) – damage will be compressive rather than infiltrative – easier to remove surgically
However it can come back and if it comes back it is usually more aggressive —> GBM
Do Low Grade Astrocytomas cause damage
Although benign, can still be catastrophic due to
- Location
- Conversion into higher grade tumor
- ->Once this occurs, the tumor becomes more infiltrative
High Grade Astrocytomas are, growth rate, location, WHO grade
High grade astrocytomas (grade III & IV) are apt to invade the cerebral hemispheres via the corpus callosum
Very aggressive (esp Grade IV) & will eventually recur
Anaplastic Astrocytoma is a type of and WHO grade
High Grade Astrocytomas
Grade 3
What is the name of a (WHO) grade 4 high grade astrocytoma
Glioblastoma Multiforme (GBM)
Glioblastoma Multiforme
Grade
Location
Prognosis
Grade 5
Predominantly located in the deep white matter of cerebral hemispheres
50% are bilateral & occupies > 1 lobe
Highly malignant & fatal
What is the hallmark of an oligodendroglioma
Radiographic evidence of calcification
Why are oligodendrogliomas so well treated?
Because of the calcification and they are encapsulated so you can remove them and the brain will survive pretty well
Oligodendroglioma
Growth rate
Prognosis
Slow growing, solid calcified tumor
Can bleed spontaneously
-> stroke-like sx
After a long post-treatment inactive period, the probability of a more aggressive recurrence is high
Ependymoma
Location
Prognosis
Derived from the ependymal cells lining the ventricular system & the central canal of the SC
More common in the fourth ventricle
Common in children & highly metastatic via CSF
Why are ependymomas likely detected early
Because of the location it can block flow coming out and limit flow of CSF and increase ICP
Due to signs of ↑ ICP in the posterior fossa (HA, vomiting, papilledema)
Ependymoblastomas (anaplastic ependymoma) commonly affects which population and how dangerous are they
common in children & highly metastatic via CSF
Medulloblastoma Arises from Growth rate Common in Results in
Rapidly growing malignant embryonal tumor that arises from the vermis of the Cb
Metastasizes to the surface of the remaining CNS via CSF pathways, more commonly into the spine
Most common malignant 1° tumor in children
Often results in hydrocephalus, ↑ ICP, and cerebellar signs
Medulloblastoma
Typical location
Survival rate
Posterior fossa
Usually since kids are pretty resilient it has a high survival rate
Meningioma
Growth
Location
Slow growing benign lesions that occur predominantly along the dural folds and cerebral convexities
May occur in the SC as well
May infiltrate the dura, dural sinuses and bone, but not the brain parenchyma
What is the good thing about Meningiomas and what does this mean for the prognosis ?
They affect the meninges and not the brain
Prognosis is better because in order to remove it you do not have to go that deep into the parenchyma, these are usually pretty superficial
Better prognosis bc it is pretty superficial however close to the skull but that can lead to hyperostosis thickening of the skull
What do you have to worry about with meningiomas
They can lead to hyperostosis which is a thickening of the skull because the meninges metastasized into the skull
What is hyperostosis and what cancer can cause this
It’s an osteoblastic response leading to a thickening of the skull
seen with meningiomas
clinical signs and meningiomas
They can become quite large before clinical signs and symptoms are evident
Pituitary Adenoma is and results in
Benign epithelial tumor derived from the anterior pituitary gland
Frequently encroaches on the optic chiasm
Result in hyposecretion or hypersecretion of pituitary hormones
Pituitary Hormones
Anterior Pituitary Gland – GH, TSH, ACTH, FSH, LH, Prolactin
Posterior Pituitary Gland – vasopressin (ADH) & oxytocin
Associated syndromes due to a pituitary adenoma
Galactorrhea – excess prolactin (20 prolactinoma) - abnormal milk discharge
Amenorrhea – excess prolactin (20 prolactinoma)-(absents of menstrual cycle )
Gigantism – excess GH
Acromegaly – excess GH - bones thicken because growth plates are fused
Cushing’s disease – excess ACTH
Hypopituitarism can lead to
Fatigue, weakness and hypogonadism
A 2nd presentation consists of suppression of 2° sex characteristics and hypothyroidism
A 3rd presentation consists of HA with visual loss
Neurinomas are and originate from
Slow growing, encapsulated, benign tumors that originate from Schwann cells (Technically outside of the CNS)
Neurinomas develop in
The vestibular portion of CN VIII (affects CN 7)
-Acoustic neuroma or vestibular schwannomas
-Typically located in the IAC, may extend into cerebellopontine angle
Clinical presentation of neurinomas
Clinical presentation is sensorineural hearing loss, tinnitus & vertigo
Late features include dysphagia & facial muscle weakness
Neurinoma treatment
Cure is achieved through surgical excision, although it may result in hearing loss.
The earlier the surgery, the greater likelihood of hearing preservation.
Primary CNS lymphoma
Who is as risk and how fast
Aggressive Non-Hodgkin’s Lymphoma usually found in the immunosuppressed (ie. AIDS patients)
Primary CNS lymphoma leads to what type of changes/deficits
Leads to behavior/cognitive changes in 2/3 patients
50% has HP, aphasia, & visual field deficits
15-20% present with seizures
Diagnosis of Brain Tumors
MRI * CT * PET scan Angiography Biopsy Craniotomy (open) Stereotactic needle biopsy
Medical & Surgical Management of brain tumors
Traditional surgery
Chemotherapy
Radiation Therapy
Stereotactic Radiosurgery
Stereotactic biopsy/surgery
Small needle inserted into skull
Direction of needle guided by MRI/CT
Cells “suctioned out” through needle
Craniotomy
Resection of skull overlying tumor
Removal of tumor
Replacement of bone flap
What do they do if the is an increase in CSF?
They put in a shunt to drain
VP Shunt Placement
To bypass blockage of CSF
To relieve pressure
Indications for radiation
Inoperable tumors
Partial resection
Methods of radiation
External Beam RT
Brachytherapy (GBM)
Whole Brain RT
External Beam RT
It goes straight in and they try to aim at one specific point
Brachytherapy is done by
They stick radioactive sources by the tumor because they do not want to get as close and the radiation helps reduce the size of the tumors. Done for different areas of the brain
Chemotherapy can be done to enhance RT effects by
Ommaya Reservoir
Chemotherapy wafers
(Wafers are soaked with a chemotherapy drug (BCNU) and are implanted in the space where the tumor was. The wafers destroy the remaining tumor cells)
Medications for brain tumors
Dexamethasone
- Steroid
- ↓ cerebral edema
- Helps relieve headaches
- Alleviate symptoms 24-48 hours
- Maximum effect days 4-5
- Gradually tapered
Anticonvulsants
-For patients with focal changes to prevent seizure activity
