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Cheng-Ching > Neuro oncology > Flashcards

Neuro oncology Flashcards

1
Q

choroid plexus papilloma

A

enhancing in ventricle if kids, in 3rd or 4th ventricle in adults
-looks like normal choroid plexus on path
papilloma = grade 1
carcinoma. grade iii - Li-Fraumeni syndrome
-hydrocephalus Sx

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2
Q

colloid cyst

A

hyperdense on CT (protinaeous fluid)
-roof of 3rd ventricle
-ASx usually or transient LOC (obstructive hydrocephalus)

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3
Q

subependymal giant cell astrocytoma

A

tuberous sclerosis

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4
Q

central neurocytoma

A

off of broad attachment to septum pellucidum

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5
Q

SC tumors- extramedullary, intradural and extradural

A

intradural/outside SC: meningioma, nerve sheath tumors

Extradural: metastases

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6
Q

SC tumors -intramedullary

A

ependymoma - ovale/sausage shaped mass

astrocytoma - pilocytic astrocytoma, anaplastic astrocytoma, glioblastoma, H327K midline glioma

lymphoma

hemangioblastoma [(multiple (VHL-cerebellum)]
-masses blood vessels on path - cyst with mural nodule

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7
Q

Pineal tumors

A

1st -serum tumor markers - AFP, bhCP
-usually needs biopsy

Germ cell - germinoma - engulfed calcifications
-no surgery unless mature teratoma, use radiation

pineal cell tumors - peripheral calcifications (blast calcifications out of the way)
-pineocytoma/pineoblastoma (blastoma = grade IV tumors in kids)

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8
Q

grade 1 glioma

A

-pilocytic astrocytoma most common
-can enhance or having enhancing mural nodule, cyst; well circumscribed
-cerebellum

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9
Q

diffuse gliomas

A
  1. Astrocytoma
    -IDH mutant
    -p53, ATRX, p16
  2. Oligodendroglioma -diffuse infiltrating
    -IDH mutation
    -IDH/1p19q co-deletion best prognosis
    -40s-50s, 3:2 males
    -frontal lobe predominant
    Grade II - not enhancing; grade III-enhancing

-mass effect, variable enhancement

  1. GBM, IDH1 WT
    histo: -perinecrotic pseudopalisading, necrosis, endothelial hyperplasia
    -heterogenous + necrotic
    Tx: surgical resection then RT + temozolamide
    -MGMT methylated tumors-respond better to temozolamide b/c MGMT is not antagonizing to temozolamide
    -recurrent tumor - Tx-Bevacizumab - VGEF
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10
Q

diffuse midline glioma

A

grade iv
H3K27M mutant

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11
Q

CNS lymphoma

A

can be multifocal
homogenously enhancing

high dose methodexate induction then consolidation /

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12
Q

paraneoplastic disorders

A

Anti-Ri-ANNA 2 - opsoclonus myoclonus

Movement disorders:
Anti Ma
Anti DPP6
ANNA1 (Hu), CASPR2,
collapsin response mediator protein-5 (CRMP-5, also known as CV2),
LGI1 syndromes
GFAP

opsoclonus myoclonus - neuroblastoma in kids; breast, ovarian, SCLC
-Anti-Ri - breast cancer, SCLC

cerebellar degeneration - anti-Yo (anti-Purkinje cell ab) - ovarian, breast, Hodkin’s lymphoma, SCLC
-weeks-months ataxia, nystagmus, dysarthria, hearing loss
-path: loss Purkinje cells, atrophy cerebellum

anti-CRMP-5 - optic neuropathy; chorea - lung cancer

retinal degeneration - anti-recoverin/anti-CAR - SCLC, thymoma, RCC, melanoma
- disc swellings, scotomas, nocturnal vision loss

Anti-Hu-ANNA1 - subacute sensory neuropathy/neuronopathy; chorea - -SCLC

LEMS-P/Q VGCC- SCLC

Anti-Tr-lymphomas-young males

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13
Q

neuroblastoma

A

opsoclonus myoclonus
-myoclonic jerks+ataxia
Tx: ACTH

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14
Q

circumscribed gliomas

A
  1. Pilocytic astrocytoma - grade I, in cerebellum, contrast enhancing mural nodule, cystic
    -optic nerve - NF1
    Tx: surgery cures
  2. Pleomorphic Xanthoastrocytoma - grade II/III- temporal lobes, superficial, focal epilepsy
    -enhancing mural nodule, cyst
    -histo: bizarre nuclear pleomorphism, lipidized cells, eosinophilic granular bodies, intercellular reticulin deposit
    -can undergo malignancy transformation 20%
  3. Subependymal Giant Cell Astrocytoma - grade I - 3rd or lateral ventricles (ependymoma - 4th ventricle)
    -TSC only
    Histo: -calcifications
    -candle gutterings

High Grade Astrocytoma with Piloid Features

Chordoid Glioma

Atroblastoma

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15
Q

Glioneuronal, neuronal tumors

A

Gangliocytoma

Ganglioglioma

DNET

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16
Q

leptomeningeal disease

A

intrathecal chemo/ intraventricular methotrexate + RT

17
Q

Histo features

A

GBM - perinecrotic pseudopalisading, necrosis, endothelial hyperplasia, hypercellular + nuclear atypia

oligodendrogliomas - fried egg

ependymomas - sheets of cells with round nuclei; perivascular pseudorosettes, ependymal rosettes

Medulloblastoma - Homer Wright rosettes

pleomorphic xanthroastrocytoma - rosenthal fibers (also Alexander’s disease)

meningioma - meningiothelial/arachnoid cap cells - oval nuclei, psammoma bodies

SEGA-perivascular pseudorosettes

18
Q

Ependymoma

A

4th ventricle in kids
-obstruct CSF-> hydrocephalus
no seizures
-perivascular pseudorosettes

19
Q
A

Cheng-Ching (17 decks)

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