Neuro, Melanoma, and Sarcoma Flashcards
CNS tumors which need LP for staging (4)
Primary CNS Lymphoma
Medulloblastoma
CNS Germ Cell Tumors
Ependymoma
Grade I Gliomas associated Mutations:
Pilocytic Astrocytoma ->
SEGA ->
Pilocytic Astrocytoma -> BRAF/KIAA fusion
SEGA ->TSC gene mutations, respond well to MTORi
1p19q codeletion is a hallmark of what type of brain tumor?
Good or bad prognosis?
Oligodendrogliomas (grade II) and Anaplastic Oligodendrogliomas (grade III)
GOOD
IDH mutation is usually in what glioma subtype?
Effect on Prognosis?
Diffuse Astrocytoma (Grade II) Anaplastic Astrocytome (Grade III)
GOOD
Disease defining mutation in diffuse midline dlioma or diffuse infiltrative pontine glioma
H3F3A K27M mutation
Best prognosis in GBM
MGMT methylated
IDH mutant
GBM treatment in the elderly
How do you give RT?
Do you give TMZ?
RT > Palliative care
Hypofractionated RT is equivalent to standard RT
TMZ alone may be alternative for MGMT methylated tumor
Poor PS, MGMT unmethylated-> Hospice
Fried Egg appearing
IDH Mutant with 1p/19q codeletion
Diagnosis?
Treatment?
Oligodendroglioma
PCV+RT after surgery
IDH WT Astrocytoma-> Treatment?
Surgery -> GBM treatment
Melanoma thickness separating T1, T2, and T3
T1= <1mm thickness T2= 1-2 mm T3= 2-4 mm
N1a vs. N1b melanoma staging
What is N1c?
N1a= 1 clinically occult node (detected on SLN) N1b= 1 clinically detected node N1c= Satellite or in-transit lesion
Surgical margin needed based on thickness
In Situ ->
< 2 mm ->
> 2 mm ->
In Situ-> 0.5 cm
<2 mm-> 1 cm
>2 mm-> 2 cm
When is SLN needed in melanoma?
> 1 mm depth (T2)
<1 mm depth but high risk features (ulceration, elevated mitotic rate, signs of regression)
Who needs Complete Lymph Node Dissection in melanoma these days?
macroscopic/clinically detected disease in LNs
Who gets adjuvant treatment in Melanoma?
Patients Grade III or greater (LN disease >1 mm)
No Ipi/Nivo as adjuvant
When do you see c-KIT mutations in melanoma?
Acral or Mucosal Melanoma
Melanoma with chronic sun damage
Which triplet is approved in BRAF mutated Melanoma
Vemurafinib+Cobinimetinib+Atezo
Which sarcoma is associated with chronic Lymphedema
Angiosarcoma
Most Common Primary bone sarcoma
Osteosarcoma
Most important PROGNOSTIC factor in osteosarcoma
Grade
Most important PREDICTIVE factor for Osteosarcoma
Response to preop chemotherapy (>90% necrosis)
What primary bone tumor has “sunburst appearance” at metaphyseal end of long bone?
Conventional osteosarcoma
Which osteosarcoma lacks intramedullary involvement and is associated with good prognosis with surgery alone?
PAROSTEAL osteosarcoma
Which bone sarcoma has onion skin or moth eaten appearance with large soft tissue component?
Ewing’s Sarcoma
