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Brain Power: First Aid Neurology > Neuro-oncology > Flashcards

Neuro-oncology Flashcards

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1
Q

What is the most common primary brain tumor?

A

Meningioma

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2
Q

Differentiate high and low grade glioma based on MRI

A

Low: Non enhancing on T1 need FLAIR or T2 to see full picture
High: Enhancing intra-axial mass lesions

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3
Q

What is the first choice steroid to relieve headache and lateralizing signs?

A

Dexamethasone

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4
Q

Where are true rosettes and pseudorosettes seen?

A

T: Flexner-Wintersteiner– Retinoblastoma
F: Homer Wright– Neuroblastoma, Medulloblastoma
Perivascular pseudorosettes also seen in ependymomas

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5
Q

Where are rosenthal fibers seen?

A

Pilocytic astrocytoma but also seen as “reactive Rosenthal fibers” in craniopharyngioma, hemangioblastoma and pineal cysts

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6
Q

What are the 2 pathologic features either of which is required to make a diffuse astrocytoma a grade 4– glioblastoma?

A

Microvascular proliferation

Necrosis

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7
Q

What low grade glioma needs more aggressive treatment because of the worse prognosis associated with it?

A

Gemistocytic low grade astrocytoma

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8
Q

What are the pathologic feature is required to make a diffuse astrocytoma a grade 3– anaplastic astrocytoma?

A

Mitosis

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9
Q

What feature makes a GBM tumor responsive to Temozolomide, a DNA alkylating agent?

A

DNA repair enzyme (MGMT– methylguanine DNA methyltransferase) methylation (inactivation)

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10
Q

What is the key pathologic description of oligodendroglial tumors?

A

Uniform “fried egg” appearance, due to perinuclear cytoplasmic clearing

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11
Q

What is the most common primary spinal cord tumor?

A

Ependymoma

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12
Q

Gangliocytoma and dysplastic gangliocytoma, hamartomatous cerebellar lesion with mature ganglion cells are associated with a mutation in which gene?

A

PTEN, Cowden syndrome

These tumors are called Lhermitte-Duclos dz

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13
Q

Central neurocytoma is located in?

A

Intraventricular –> Hydrocephalus!

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14
Q

What is the only malignant neuronal tumor?

A

Neuroblastoma

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15
Q

What is a marker of neuronal differentiation that may be utilized to identify neuronal tumors?

A

Synaptophysin

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16
Q

What 3 intracranial neoplasms have a characteristic cyst with enhancing mural nodule?

A

Pilocytic astrocytoma
Ganglioglioma
Hemangioblastoma

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17
Q

In stark contrast to neuronal/ neuroglial tumors embryonal tumors are all _______?

A

Malignant and highly aggressive

18
Q

What is the typical pathologic description of infratentorial PNET/ medulloblastoma?

A

Small blue cells with Homer Wright rosettes

19
Q

What are the 3 most common tumors in the pineal region? Which one of them is VERY sensitive to radiation?

A

Germinoma > Pineal parenchymal tumors > Astrocytoma

Germinoma sensitive to radio

20
Q

Which is malignant? Pineocytoma or Pineoblastoma?

A

Pineoblastoma! Needs aggressive multiagen chemotherapy while pineocytoma only needs resection!

21
Q

What stain can be used to identify germinomas?

A

Alkaline phosphatase

22
Q

What is the most common locations of meningiomas?

A

Cerebral convexities

23
Q

What are the 4 aggressive histologic subtypes of meningioma?

A

2CPR

Clear cell, Choroid, Papillary and Rhabdoid

24
Q

What are the ddx for dural based lesions?

A

Meningioma
Hemangiopericytoma
Dural mets

25
Q

Why is it important to differentiate meningioma from a hemangiopericytoma?

A

Hemangiopericytoma needs RT while meningioma only needs resection in most cases

26
Q

What is the characteristic pathologic description of hemangiopericytoma?

A

Staghorn pattern of typical branching vascular pattern

27
Q

What mutation leads to bilateral vestibular schwannomas?

A

NF2 gene on chromosome 22

28
Q

What pathologic features may be seen in Schwannomas?

A

Antoni A regions with dense cellular componene and Verocay bodies, organized linear palisades of nuclei

29
Q

Differentiate NF1 and NF2 based on the tumors associated with them.

Which one has Lisch nodules in the iris?

A

1: NO– Neurofibroma and Optic glioma
2: SMEG– Schwannoma, Meningioma, Ependymoma, Glioma RARELY

Lisch: 1

30
Q

What is the pathologic picture of primary malignant lymphomas?

A

Perivascular cuffing by malignant lymphocytes which are CD 20 positive B cells

31
Q

What is the treatment for primary CNS lymphoma?

A

High dose methotrexate based chemo regimen

32
Q

What endocrine symptoms are seen in large nonsecreting sellar tumors?

A

Hyperprolactinemia and hypopituitarism

33
Q

What is the most common finding in pituitary macroadenoma?

A

Bitemporal hemianopsia

34
Q

What diagnostic exams are used to identify endocrinologic derangements in pituitary microadenomas?

A

Serum prolactin >200ng/ml
Serum IGF 1
24 hour urine cortisol excretino and ACTH concentration

35
Q

What is the pathologic description of craniopharyngioma?

A

Crank-case oil fluid in a cyst arising from the Rathke’s Cleft

36
Q

What is treatment for Craniopharyngioma?

A

Sx then RT

37
Q

What are the ddx for intraventricular tumors?

A 
Meningioma
Neurocytoma
subependymal giant cell Astrocytoma
Subependymoma
Ependymoma
CHoroid plexus papilloma
MAN ChES
38
Q

What does a Choroid plexus papilloma look like on imaging?

A

Calcified enhancing intraventricular mass

39
Q

What is the most common location of an CNS hemangioblastoma?

A

Cerebellum or SC

40
Q

Name the cancer syndromes associated with the ff CNS tumors:
Cortical hamartomas
Subependymal giant cell Astrocytoma SEGA
Hemangioblastoma
Astrocytoma
Gangliocytoma of the cerebellum (Lhermitte-Duclos)
Medulloblastoma

A

Cortical hamartomas– TUBEROUS SCLEROSIS
Subependymal giant cell Astrocytoma SEGA – TUBEROUS SCLEROSIS
Hemangioblastoma– VHL
Astrocytoma– LI FRAUMENI
Gangliocytoma of the cerebellum (Lhermitte-Duclos)– COWDEN
Medulloblastoma – TURCOT

41
Q

What cancer has _____ as paraneoplastic syndrome?
Limbic encephalitis
Stiff man syndrome
Lambert eaton syndrome

A

ALL Small Cell Lung Cancer

Brain Power: First Aid Neurology (10 decks)

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