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Oncology Boards > Neuro Tumors > Flashcards

Neuro Tumors Flashcards

1
Q

The most common brain tumors in dogs are:

A

meningtiomas (45%), gliomas (40%) choroid plexus tumors (5%)

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2
Q

What gene locus is strongly associated with glioma in multiple breeds

A

CFA 26

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3
Q

Single nucleotide variants ____ ____ and ___ have been shown to be strongly associated with glioma

A

DENR, CAMKK2, P2RX7

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4
Q

What are the most common secondary brain tumors in cats?

A

LSA and pituitary

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5
Q

What is the most common clinical manifestation of intracranial neoplasia in dogs?

A

Seizures - 50% of dogs with forebrain tumors

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6
Q

What percentage of cats will present with seizures for brain tumors? Which tumor type is this more common for?

A

25%; glioma and LSA > meningioma

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7
Q

What is the most frequently reported clinical signs in cats with brain tumors?

A

Behavior change - 16-67% of cats

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8
Q

What is the most common clinical manifestation of brain tumors affecting the brainstem?

A

central vestibular signs

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9
Q

What percent of cats with meningiomas present with multiple tumors?

A

20%

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10
Q

What is the unique method that choroid plexus carcinomas can metastasize via?

A

Drop metastases - cancer cells exfoliated into the subarachnoid space or ventricular system with distant implantation of tumor foci

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11
Q

What is the rate of dogs with simultaneous and unrelated tumors in dogs with primary brain tumors?

A

3-23%

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12
Q

Meningiomas are extra or intra axial

A

extraaxial

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13
Q

What is the overall sensitivity of MR to identify canine meningiomas

A

60-100%, but specific subtype and grade can’t be determined

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14
Q

What pattern is associated with gliomas on MR?

A

“Ring enhancing” - circular ring of contrast enhancement surrounding nonenhancing abnormal tissue

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15
Q

What brain diseases can cause a ring enhancing pattern

A

GLIOMA, but also other neoplasia, vascular and inflammatory brain disease

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16
Q

What are the most common brain tumors in the intraventricular location

A

choroid plexus tumors and ependymomas

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17
Q

What is the overall safety and success rate for minimally invasive brain biopsy (MIBB)?

A

diagnostic yields ~95%, <5% risk of serious AEs

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18
Q

Most feline meningiomas are grade ____ compared to grade _____ in dogs

A

grade 1 in cats; up to 40% atypical grade II in dogs

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19
Q

Nearly 50% of canine CPTs are found in ______

A

the fourth ventricular region

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20
Q

A CSF total protein concentration greater than ____ was exclusively associated with a diagnosis of choroid plexus carcinoma (vs. papilloma)

A

80mg/dL

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21
Q

Animals that have what feature on MRI are more likely to respond favorably to treatment with steroids?

A

Peritumoral vasogenic edema

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22
Q

What percent of canine and feline meningiomas are identified incidentally?

A

6-19%

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23
Q

Dogs with supra/infra- tentorial tumors have a better prognosis with palliative care than the other

A

Supratentorial = better, MST 25 wks w/ palliative treatment vs. 4wks for infratentorial

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24
Q

What is the current preferred primary mode of therapy for feline supratentorial meningiomas?

A

cytoreductive surgery

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25
Q

Survival time for cats with cerebral meningiomas treated surgically?

A

MST 23-27mo, usually over 2 yrs (but most recur)

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26
Q

Is surgery or RT better as a primary therapy for canine meningiomas

A

Trick question - both similar, one not superior to the other

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27
Q

The MST for dogs with VEGF expression of ____ had a longer MST than for dogs with VEGF expression of ____

A

≤75% of cells or fewer = 25mo >75% of cells = 15mo

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28
Q

What spinal cord tumors are extradural

A

OSA, chondro, FSA, plasmacytoma, MM, LSA, HSA

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29
Q

What spinal cord tumors are intradural-extramedullary

A

Meningioma, PNS, nephroblastoma, HS, LSA

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30
Q

What spinal cord tumors are intramedullary

A

Astrocytoma, ependymoma, oligodendroglioma, gliomatosis cerebri, HSA, TCC, LSA

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31
Q

Extradural tumors account for ~_____% of spinal cord and frequently arise from the _______

A

50%; vertebrae

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32
Q

What is the most common spinal cord tumor diagnosed in dogs and cats?

A

Meningiomas

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33
Q

80-90% of cats diagnosed with CNS LSA were seropositive for _____ historically. Newer data suggests ~56%

A

FeLV p27 antigen

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34
Q

What breeds are predisposed to nephroblastoma

A

Young German Shep. and golden retrievers

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35
Q

What breed is overrepresented in intraspinal meningiomas?

A

Boxers

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36
Q

What % of dogs with intramedullary spinal cord tumors present with paraspinal hyperpathia

A

68%

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37
Q

Nephroblastomas almost always are found between ____ spinal cord segments because _____

A

T9 and L2 because of the embryologic origin of the metanephric blastema from which they arise

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38
Q

Approximately 80% of canine nephroblastomas will demonstrate immunoreactivity to____

A

WT-1 (human nephroblastoma gene product)

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39
Q

What is the MST for palliative treatment of vertebral and spinal cord tumors?

A

0-105 d

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40
Q

What is the MST for dogs with intraspinal meningioma treated with surgery? What can increase this?

A

6-47mo Post-op Rt - MST 45mo

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41
Q

MST of cats treated with surgery for spinal meningiomas

A

6-17mo

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42
Q

Cats have a higher proportion of benign or malignant PNSTs than dogs?

A

benign

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43
Q

What is the most frequently affected cranial nerve for PNST in dogs?

A

Trigeminal nerve

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44
Q

What is the most common spinal nerve roots affected by PNSTs in dogs?

A

Caudal cervical (C6-T2) followed by lumbar intumescence

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45
Q

What are the signs of trigeminal PNSTs?

A

Severe, unilateral masticatory mm atrophy, diminished jaw tone, decreased facial sensation, Horners

46
Q

What % of brachial plexus tumors will have a palpable mass on PE?

A

33%

47
Q

Up to 50% of PNST will display only what on MRI

A

Only nerve thickening (w/o a discrete mass)

48
Q

What are negative prognostic indicators for dogs with PNST?

A

proximity to and invasion of the vertebral canal (occurs in 45% of tumors) and incomplete margins after surgery

49
Q

What is the overall MST for dogs with paraspinal and plexus PNST?

A

6mo

50
Q

What is the prognosis for cats with PNST

A

better - only low low percent recur after surgery

51
Q

Clinical signs associated with presumed intracranial glioma treated with CCNU that had clinical signs ≥ _____days prior to diagnosis was associated with a longer surival than dogs with with signs present for shorter than this

A

16 days

52
Q

Results of safety study investigating intrathecal cytosar and methotrexate in cats and dogs? (Genoni VCO 2016)

A

n = 1 tonic/clonic seizure responsive to diaz. otherwise no AE in short term

53
Q

A systematic review of brain tumors in dogs (HU JVIM 2015) showed what about chemotherapy, RT and surgery?

A

No support for CCNU as effective tx

No difference in outcome b/w RT and surgery

54
Q

What was the MST for dogs treated symptomatically with steroids and anti-epileptics vs. support + CCNU for intracranial lesions? (Van Meervenne VCO 2014)

A

Supportive MST 60d

CCNU 93d

no difference

55
Q

What was found to be predictive of outcome for postsurgical survival time in dogs treated for intracranial glioma? What wasnt? (MacLellan JAVMA 2018)

A

Tumor grade predictive of outcome - invasive bx needed to determine

preop tumor volume via MRI neither assoc or predictive of outcome

56
Q

What was MST for low grade gliomas vs. high grade gliomas treated with surgery? (MacLellan JAVMA 2018)

A

low grade w/ small volumes = 727d

High grade 174d

57
Q

What is the difference on MRI for canine meningiomas vs. intracranial histiocytic sarcoma (Ishikawa JAVMA 2016)

A

Meningiomas hyperintense, most HS iso or hypointense

58
Q

What feature on MRI provided the best diagnostic accuracy for predicting the grade of canine meningiomas? (Banzato AJVR 2017)

A

Texture analysis or precontrast T1W images

Postcontrast T1W and T2W = pooer diagnostic performances

59
Q

What is the WHO definition of glioblastosis cerebri?

A

infiltration of multiple cerebral lobes

requisite forebrain involvememnt +/- involvement of other areas of CN

60
Q

What are common post-op MRI findings for dogs with brain tumors? (Chow VRU 2015)

A

abnormal meningeal enhancement, linear enhancement at margins of resection, hemorrhage and thim rim of hyperintensity surrounding the resection cavity

+/- residual tumor if contrast enhancing

61
Q

What are the subtypes of intracranial meningiomas in dogs? (Srurges JVIM 2008)

A

Meningothelial

Transitional

Microcystic

Psammomatous

Angiomatous

62
Q

Can MR differentiate meningioma subtype or grade in dogs? (Sturges JVIM 2008)

A

Noooooope

63
Q

What does T1W imaging look like for bone, air, fat, water, gray matter and white matter?

A

Bone: dark - few hydrogen protons

Air: dark - few hydrogen protons

Fat - bright

water (CSF): dark

Gray matter - gray

White matter- whiter

64
Q

What does T2W imaging look like for bone, air, fat, water, gray matter and white matter?

A

Bone - dark

Air - dark

fat - bright

water (CSF) - bright

gray matter gray

white matter darker than gray

65
Q

What is T2 FLAIR and what does it evaluate?

A

T2 FLAIR = fluida ttenuation inversion recovery

Evaluates areas of edema with CSF subtraction

66
Q

What is T2* and what is dark on these images?

A

T2 modified image

Hemorrhage and fat are dark

67
Q

What is the MR appearance of astrocytomas

A

T1W: mild to moderately hypointense

T2W: Moderately hyperintense

68
Q

_____ increases with increasing grade for astrocytomas on MR

A

contrast enhancement

69
Q

What is the MR appearance of oligodendrogliomas?

A

T2W - marked hyperintensity

T1W - hypointense

70
Q

Mixed glial cell tumors have both _____ and _____ features on MR

A

astrocytic and oligodendrocytic

71
Q

What are the MR features of epndymal tumors?

A

T2W - moderate to markedly hyperintense w/ minimal edema

T1: slightly hypointense to slightly hyperintense

Marked contrast enhancement, may be heterogenous

72
Q

50% of choroid plexus tumors arise in the _____ or _____

A

4th ventricle or lateral apertures

73
Q

What breed of dog is highly overreprsented for choroid plexus tumors? Age?

A

Golden retrievers, generally young (<6yrs)

74
Q

What are the MR characteristics of choroid plexus tumors?

A

T1W - hypo, iso or hyperintense

T2W - usually hyperintense

Mild to moderate edema typically present

Marked uniform contrast enhancement

May be intraventricular or intrathecal “drop metastasis”

75
Q

What are the MR features of a meningioma?

A

T1W: usually isointense

T2W, majority hyper (70%, rest iso)

95% have edema

Majority have uniform contrast enhancement

Well-defined tumor margins, broad-based external margin conforming to meingeal plane

often dural tail sign

76
Q

What is a dural tail sign

A

Thickening of the meninges adjacent to the tumor

77
Q

What is the MR appearance of LSA and hematopoeitc tumors?

A

T1W: iso or hyperintense

T2W slightly hyperintense

Consistently contrast enhancing to a variable degree

78
Q

What is the appearance on MR of histiocytic tumors

A

Usually extradural or intradural extraaxial masses

T1W iso to hypointense

T2W peritumoral edema

79
Q

What is the appearance of pituitary macroadenomas and carcionmas?

A

T1W isointense

T2W mildly hyperintense

marked uniform contrast enhancement

80
Q

Size cutoff for pituitary macro- vs. micro-adenoma

A

10mm

81
Q

Where do most metastatic tumors go to in the brain?

A

Gray-white matter interface due to narrowing of cortical arterioles at this interface

82
Q

What does metastatic HSA look like on MR?

A

Mixed signal intensity of T1W and T2W

Mutliple lesions with intratumoral hemorrhage

T2* - intratumoral hemorrhage; appears as a signal void (susceptibility effect)

83
Q

What volume/dose constraint is important for SRT for intracranial meningiomas (Griffen VCO 2014)

A

Volume of brain getting prescription dose should be kept <1cc

Dogs above this more likely to get fatal worsening of neuro signs w/in 6mo

84
Q

What RT protocol was compared to a standard 20x2.5Gy protocol for intracranial neoplasia in dogs? What was the outcome? (Schwarz JVIM 2018)

A

New protocol 10x4Gy; safe and efficient

No significant difference between groups; overall PFI 663d, OST 637d

85
Q

What was the response rate for dogs with encephalic or spinal cord meningiomas treated with stereotactic volume modulated arc radiotherapy? (JAAHA 2018)

A

Protocol 33Gyx5

CR + PR = 65.5%

86
Q

What was the 2-yr overall and disease specific survival rates for dogs with encephalic or spinal cord meningiomas treated with stereotactic volume modulated arc radiotherapy (Dolera JAAHA 2018)

A

Overall 74.3%, disease specific 97.4%

87
Q

Was the addition of temozolomide to stereotactic RT for treatment of canine gliomas beneficial? (Dolera VCO 2018)

A

Statistically no - numerically yes (RT MST 383d vs. RT + TMZ = 420d)

88
Q

What was positively correlated with survival in dogs treated with SRT +/- temozolomide for gliomas? (Dolera 2018 VCO)

A

Ratio b/w target and brain volume of the tumor <5%

Normal mentation at presentation

89
Q

What was the response rate to a single fraction of SRT for canine meningiomas? What was the dose? (Kelsey VRU 2018)

A

16Gy + SIBR to total dose of 20-24Gy to central part of tumor

57% had perceived clinical benefit

90
Q

What was prognostic for survival in dogs treated with a single fraction of SRT for intracranial meningiomas? (Kelsey VRU 2018)

A

Infratentorial tumor location

High gradient indicies

91
Q

Is the GTV for meningiomas in dogs larger or smaller when made with CT compared to MR? (Berlato VRU 2018)

A

CT GTV usually smaller than MR - suggested 0.3cm margin around GTV-CT to account for this

92
Q

Was there a difference in survival for dogs treated with sx + RT vs. RT alone for meningioma? (Keyerleber VCO 2015)

A

No - No difference between sx + RT vs. RT alone (~700d vs.~900? – based on Kaplan-Meier)

93
Q

Response of trigeminal n tumors to SRS or SRT? (Zwingenberger JVIM 2016)

A

4/5 progressed

94
Q

Overall MST for dogs treated with SRS or SRT for brain tumors? (Zwingenberger JVIM 2016)

A

MST 324d.

95
Q

What are the general survival times for dogs with meningiomas treated with definitive intent RT

A

Fractionated 500-900d

SRT 500d

96
Q

Infiltration of what immune cell has been found in both feline meningiomas and gliomas? (Rissi J Comp Path 2018 & McBride J Comp Path 2017)

A

CD3+ T lymphocytes

97
Q

Are primary or secondary brain tumors more common in dogs (Snyder JVIM 2008)

A

Secondary

98
Q

What are the most common types of secondary brain tumors in the dog? (Snyder JVIM 2008)

A

29% HSA

25% Pituitary

12% LSA

12% Metastatic Carcinoma

99
Q

What was the most common symptom in dogs with secondary brain tumors? (Snyder 2008 JVIM)

A

Mentation changes

100
Q

What rate of metastasis to other areas was show in dogs with secondary brain tumors (Snyder JVIM 2008)

A

47% lung

35% kidney

31% heart

101
Q

Dogs with pituitary macroadenomas had a lower ___ and ___ than dogs with microadenomas (Benchekroun Vet J 2017)

A

Heart rate and body temperature

102
Q

Diagnostic accuracy of stereotactic brain biopsy compared to surgical resection/necropsy (JVIM 2019)

A

Overall DA = 81% 100% of meningiomas 78% for gliomas

103
Q

Factors associated with tumor grade disagreement for stereotactic brain biopsy (JVIM 2019)

A

Smaller lesion volume (WHO and modified canine glioma grading), fewer numbers of biopsies attempted and obtained (WHO)

104
Q

Stereotactic brain biopsy more likely to over or under grade (JVIM 2019)

A

Under grade

105
Q

Response rate for cats with intracrania tumors + neuro signs treated with RT + PFS (Korner, JFMS 2019)

A

95.5% response (21/22); median PFS 510d.

106
Q

Median OST for cats with intracranial tumors w/ neuro signs treated with RT? (Korner JFMS 2019)

A

OST 515d (only 5/14 cats that died died because of brain tumor)

107
Q

Incidence of death w/in 30d for dogs undergoing cytoreductive surgery for primary intracranial masses & factors associated (Kohler, Javama 2018)

A

Death in 13.1% (11 during hospital, 10 after dicharge) Factors = abnormal pre-op neuro status (esp. head tilt or abnormal mentation) and subocciptal approach

108
Q

Incidence of major complications w/in 30d for dogs undergoing cytoreductive surgery for primary intracranial masses & factors associated (Kohler, Javama 2018)

A

Seizures, worsening neuro, aspiration pneumonia 18.8% factors associated with increased risk of major complications = abnormal pre-op neuro status and tumor in brainstem (al brainstem dogs died)

109
Q

Do grade II/grade III meningiomas have a higher or lower apparent diffusion coefficient (ADC) on MRI than grade I meningiomas? (Fages, VRU 2019)

A

Lower

110
Q

What was the MST for dogs with presumptive intracranial gliomas treated with CCNU? (Moirano VCO 2018)

A

MST 138d (compared to supportive care MST 35d)

Oncology Boards (26 decks)

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