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
Translocation associated with ewing sarcoma?
t(11;22)
Which bone sarcoma is chemotherapy sensitive?
Ewing’s Sarcoma
Which bone sarcoma is chemoresistant?
Chondrosarcoma
Translocation associated with Inflammatory myofibroblastic tumor?
t(2;19)
Can respond to ALKi
Translocation associated with Dermatofibrosarcoma protuberans?
t(17;22)
Can respond to gleevec
mutation associated with synovial sarcoma
t(x;18)
Which STS’s don’t benefit from pazopanib?
Liposarcomas
Which STSs benefit from trabectedin
LIposarcoma and LMS
Which STSs benefit from tazemtostat
Epithelioid sarcomas
Which STSs benefit from eribulin
Liposarcomas
Which KIT exon mutation has most benefit with standard dose imatinib?
Exon 11
2nd line for GIST?
3rd Line for GIST?
4th Line for GIST?
2nd-> Sutent
3rd-> Regorafenib
4th-> Repretinib
Approved for use in GIST with PDGFRalpha exon 18 mutants?
Avapritinib
Which Gists should get neoadj imatinib (3)
> 10 cm
Mitotic rate >10
Tumor Rupture
