Neuro: Neoplasms

Question 1

MC tumor in CNS?

Answer 1

-metastases from distant neoplasms (1/2 come from lungs)

Question 2

Primary brain tumors

Answer 2

originate from CNS tissues and meninges

Question 3

70% of primary tumors are located?

Answer 3

supratentorial

Question 4

MC kind of tumors in adults?

Answer 4

MC: gliomas

second MC: meningiomas

**both are supratentorial

Question 5

1/3 of PBT are_____

Answer 5

malignant

Question 6

MC cancers of childhood?

Answer 6

PBTs

Question 7

in children, 70% of tumors are located?

Answer 7

infratentorial

Question 8

MC tumor in kids?

Answer 8

Medulloblastoma

*intatentorial

Question 9

MC cell origin for neoplasms?

Answer 9

glial cell

Question 10

Name the four different Gliomas:

Answer 10

1. Astrocytoma
2. Oligodendroglioma
3. Ependymom
4. Choroid plexsus papilloma

Question 11

Astrocytoma

• derived from
• what is the role of the cell it originates from?
• MC occur in what age?
• location in brain?
• CM?

Answer 11

derived from astrocytes
star shaped cells that support endothelial cells of BBB and help repair brain post injury

• MC occur in PT 2-20 YO
• can appear in any part of brain

CM:

• focal symptoms dep on location of tumor
• incr ICP–HA (can often wake up PT at night), N/V, ataxia
• vision changes, weakness, cranial nerve deficits, AMS

Question 12

Types of astrocytomas (4)
*which is benign? which is most aggressive? slow grower?

*which grades are MRI enhancing and which are non-enhacing

Answer 12

1. Pilocytic Astrocytoma (grade I)—MC in children and young adults.. most benign
2. Diffuse astrocytoma (grade II or low grade)–tend to grow and invade surround tissues.. but slow growing
3. Anaplastic astrocytoma (grade III)—rare but aggressive
4. Astrocytoma grade (IV)—aka Glioblastoma)
   * most aggressive

grades I and II are non-enhancing
III and IV are enhancing

Question 13

most common PBT in adults?

Answer 13

Astrocytoma grade IV—Glioblastoma

*aggressive

Question 14

Astrocytoma grade IV---Glioblastoma 
-peak onset 
-RF 
-DX
-CM 
TX 
prognosis

Answer 14

-most common PBT in adult
-most aggressive
-peak onset: 40-60 YO
-RF: male, >50, HHV-6 (herpes)
CM: same as other tumors… HA, seizures, focal neuro deficits and AMS

DX:

• MRI with contrast—-initial test of choice
• biopsy–confirm dx

TX:

• surgical excision when possible
• radiation and chemo

prognosis is poor

Question 15

Oligodendroglioma

• arrise from?
• location of tumor?
• Peak incidence in what age group
• fast or slow growing
• CM
• Dx
• Tx

Answer 15

arrises from a type of glial cell–oligodendrocyte—role is to supp brain tissue

• can occur anywhere in brain
• slow growing
• Peak incidence: 35-45 YO

CM:
-dep on location….
MC s/s is seizures

DX:

• CT or brain MRI with contrast
• Brain biopsy/histology—will see calcifications are common—“fried egg shaped tumor”

TX

• surgical excision when poss
• rad
• chem

Question 16

histology report: calcifications or “fried egg” shaped tumor

Answer 16

oligodendroglioma

Question 17

Ependymoma

• age group?
• location in brain
• cm
• dx
• prognosis

Answer 17

CHILDREN: avg dx age is 5
MC seen in 4th ventricle or sc

CM:

• increase ICP: papilledema, CN palsies etc
• N/V HA
• infants: incr head size**, irritability, sleeplessness and vom

DX:

• CT or brain MRI with contrast
• Biopsy: shows perivascular pseudo rsettes

Prognosis: overall 10 year survival is 45-55%

Question 18

-Biopsy: shows perivascular pseudo rsettes

Answer 18

Ependymoma

***children tumor

Question 19

Meningioma

• arises?
• fast/slow growing?
• benign or malignant?
• MC in what gender
• CM
• DX
• TX
• prognosis

Answer 19

arises from meningothelial cells in dura matter

benign and slow growing

W>M

CM:

• often asympto until compression/displacement
• seizure
• HA
• weakness
• fixed dilated pupil (CNIII palsy) common

DX:
-MRI with contrast—initial test of choice
—-shows well defined lesion attached to the dura–often with calcification
Histology shows: spindle cells concentrically arranged in a whorled pattern

TX:
asymp: observe if tumor small
Sympto: surgical excision +/- radiation

Prognosis:
5 year survivial is 70-90%
*malignant transformation is RARE

Question 20

MRI: shows well defined lesion attached to the dura–often with calcification

Answer 20

Meningioma

Question 21

Histology shows: spindle cells concentrically arranged in a whorled pattern

Answer 21

meningioma