Neuro Tumors Flashcards
1
Q
The most common brain tumors in dogs are:
A
meningtiomas (45%), gliomas (40%) choroid plexus tumors (5%)
2
Q
What gene locus is strongly associated with glioma in multiple breeds
A
CFA 26
3
Q
Single nucleotide variants ____ ____ and ___ have been shown to be strongly associated with glioma
A
DENR, CAMKK2, P2RX7
4
Q
What are the most common secondary brain tumors in cats?
A
LSA and pituitary
5
Q
What is the most common clinical manifestation of intracranial neoplasia in dogs?
A
Seizures - 50% of dogs with forebrain tumors
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
7
Q
What is the most frequently reported clinical signs in cats with brain tumors?
A
Behavior change - 16-67% of cats
8
Q
What is the most common clinical manifestation of brain tumors affecting the brainstem?
A
central vestibular signs
9
Q
What percent of cats with meningiomas present with multiple tumors?
A
20%
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
11
Q
What is the rate of dogs with simultaneous and unrelated tumors in dogs with primary brain tumors?
A
3-23%
12
Q
Meningiomas are extra or intra axial
A
extraaxial
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
14
Q
What pattern is associated with gliomas on MR?
A
“Ring enhancing” - circular ring of contrast enhancement surrounding nonenhancing abnormal tissue
15
Q
What brain diseases can cause a ring enhancing pattern
A
GLIOMA, but also other neoplasia, vascular and inflammatory brain disease
16
Q
What are the most common brain tumors in the intraventricular location
A
choroid plexus tumors and ependymomas
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
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
19
Q
Nearly 50% of canine CPTs are found in ______
A
the fourth ventricular region
20
Q
A CSF total protein concentration greater than ____ was exclusively associated with a diagnosis of choroid plexus carcinoma (vs. papilloma)
A
80mg/dL
21
Q
Animals that have what feature on MRI are more likely to respond favorably to treatment with steroids?
A
Peritumoral vasogenic edema
22
Q
What percent of canine and feline meningiomas are identified incidentally?
A
6-19%
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
24
Q
What is the current preferred primary mode of therapy for feline supratentorial meningiomas?
A
cytoreductive surgery
25
Survival time for cats with cerebral meningiomas treated surgically?
MST 23-27mo, usually over 2 yrs (but most recur)
26
Is surgery or RT better as a primary therapy for canine meningiomas
Trick question - both similar, one not superior to the other
27
The MST for dogs with VEGF expression of ____ had a longer MST than for dogs with VEGF expression of \_\_\_\_
≤75% of cells or fewer = 25mo \>75% of cells = 15mo
28
What spinal cord tumors are extradural
OSA, chondro, FSA, plasmacytoma, MM, LSA, HSA
29
What spinal cord tumors are intradural-extramedullary
Meningioma, PNS, nephroblastoma, HS, LSA
30
What spinal cord tumors are intramedullary
Astrocytoma, ependymoma, oligodendroglioma, gliomatosis cerebri, HSA, TCC, LSA
31
Extradural tumors account for ~\_\_\_\_\_% of spinal cord and frequently arise from the \_\_\_\_\_\_\_
50%; vertebrae
32
What is the most common spinal cord tumor diagnosed in dogs and cats?
Meningiomas
33
80-90% of cats diagnosed with CNS LSA were seropositive for _____ historically. Newer data suggests ~56%
FeLV p27 antigen
34
What breeds are predisposed to nephroblastoma
Young German Shep. and golden retrievers
35
What breed is overrepresented in intraspinal meningiomas?
Boxers
36
What % of dogs with intramedullary spinal cord tumors present with paraspinal hyperpathia
68%
37
Nephroblastomas almost always are found between ____ spinal cord segments because \_\_\_\_\_
T9 and L2 because of the embryologic origin of the metanephric blastema from which they arise
38
Approximately 80% of canine nephroblastomas will demonstrate immunoreactivity to\_\_\_\_
WT-1 (human nephroblastoma gene product)
39
What is the MST for palliative treatment of vertebral and spinal cord tumors?
0-105 d
40
What is the MST for dogs with intraspinal meningioma treated with surgery? What can increase this?
6-47mo Post-op Rt - MST 45mo
41
MST of cats treated with surgery for spinal meningiomas
6-17mo
42
Cats have a higher proportion of benign or malignant PNSTs than dogs?
benign
43
What is the most frequently affected cranial nerve for PNST in dogs?
Trigeminal nerve
44
What is the most common spinal nerve roots affected by PNSTs in dogs?
Caudal cervical (C6-T2) followed by lumbar intumescence
45
What are the signs of trigeminal PNSTs?
Severe, unilateral masticatory mm atrophy, diminished jaw tone, decreased facial sensation, Horners
46
What % of brachial plexus tumors will have a palpable mass on PE?
33%
47
Up to 50% of PNST will display only what on MRI
Only nerve thickening (w/o a discrete mass)
48
What are negative prognostic indicators for dogs with PNST?
proximity to and invasion of the vertebral canal (occurs in 45% of tumors) and incomplete margins after surgery
49
What is the overall MST for dogs with paraspinal and plexus PNST?
6mo
50
What is the prognosis for cats with PNST
better - only low low percent recur after surgery
51
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
16 days
52
Results of safety study investigating intrathecal cytosar and methotrexate in cats and dogs? (Genoni VCO 2016)
n = 1 tonic/clonic seizure responsive to diaz. otherwise no AE in short term
53
A systematic review of brain tumors in dogs (HU JVIM 2015) showed what about chemotherapy, RT and surgery?
No support for CCNU as effective tx
No difference in outcome b/w RT and surgery
54
What was the MST for dogs treated symptomatically with steroids and anti-epileptics vs. support + CCNU for intracranial lesions? (Van Meervenne VCO 2014)
Supportive MST 60d
CCNU 93d
no difference
55
**What was found to be predictive of outcome for postsurgical survival time in dogs treated for intracranial glioma? What wasnt? (MacLellan JAVMA 2018)**
**Tumor grade predictive of outcome - invasive bx needed to determine**
preop tumor volume via MRI neither assoc or predictive of outcome
56
What was MST for low grade gliomas vs. high grade gliomas treated with surgery? (MacLellan JAVMA 2018)
low grade w/ small volumes = 727d
High grade 174d
57
What is the difference on MRI for canine meningiomas vs. intracranial histiocytic sarcoma (Ishikawa JAVMA 2016)
Meningiomas hyperintense, most HS iso or hypointense
58
What feature on MRI provided the best diagnostic accuracy for predicting the grade of canine meningiomas? (Banzato AJVR 2017)
Texture analysis or precontrast T1W images
Postcontrast T1W and T2W = pooer diagnostic performances
59
What is the WHO definition of glioblastosis cerebri?
infiltration of multiple cerebral lobes
requisite forebrain involvememnt +/- involvement of other areas of CN
60
What are common post-op MRI findings for dogs with brain tumors? (Chow VRU 2015)
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
What are the subtypes of intracranial meningiomas in dogs? (Srurges JVIM 2008)
Meningothelial
Transitional
Microcystic
Psammomatous
Angiomatous
62
Can MR differentiate meningioma subtype or grade in dogs? (Sturges JVIM 2008)
Noooooope
63
**What does T1W imaging look like for bone, air, fat, water, gray matter and white matter?**
**Bone: dark - few hydrogen protons**
**Air: dark - few hydrogen protons**
**Fat - bright**
**water (CSF): dark**
**Gray matter - gray**
**White matter- whiter**
64
**What does T2W imaging look like for bone, air, fat, water, gray matter and white matter?**
**Bone - dark**
**Air - dark**
**fat - bright**
**water (CSF) - bright**
**gray matter gray**
**white matter darker than gray**
65
**What is T2 FLAIR and what does it evaluate?**
**T2 FLAIR = fluida ttenuation inversion recovery**
**Evaluates areas of edema with CSF subtraction**
66
**What is T2\* and what is dark on these images?**
**T2 modified image**
**Hemorrhage and fat are dark**
67
**What is the MR appearance of astrocytomas**
**T1W: mild to moderately hypointense**
**T2W: Moderately hyperintense**
68
\_\_\_\_\_ increases with increasing grade for astrocytomas on MR
contrast enhancement
69
**What is the MR appearance of oligodendrogliomas?**
**T2W - marked hyperintensity**
T1W - hypointense
70
Mixed glial cell tumors have both _____ and _____ features on MR
astrocytic and oligodendrocytic
71
**What are the MR features of epndymal tumors?**
**T2W - moderate to markedly hyperintense w/ minimal edema**
**T1: slightly hypointense to slightly hyperintense**
**Marked contrast enhancement, may be heterogenous**
72
50% of choroid plexus tumors arise in the _____ or \_\_\_\_\_
4th ventricle or lateral apertures
73
What breed of dog is highly overreprsented for choroid plexus tumors? Age?
Golden retrievers, generally young (\<6yrs)
74
**What are the MR characteristics of choroid plexus tumors?**
**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
**What are the MR features of a meningioma?**
**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
**What is a dural tail sign**
**Thickening of the meninges adjacent to the tumor**
77
What is the MR appearance of LSA and hematopoeitc tumors?
T1W: iso or hyperintense
T2W slightly hyperintense
Consistently contrast enhancing to a variable degree
78
What is the appearance on MR of histiocytic tumors
Usually extradural or intradural extraaxial masses
T1W iso to hypointense
T2W peritumoral edema
79
**What is the appearance of pituitary macroadenomas and carcionmas?**
**T1W isointense**
**T2W mildly hyperintense**
**marked uniform contrast enhancement**
80
**Size cutoff for pituitary macro- vs. micro-adenoma**
**10mm**
81
Where do most metastatic tumors go to in the brain?
Gray-white matter interface due to narrowing of cortical arterioles at this interface
82
**What does metastatic HSA look like on MR?**
Mixed signal intensity of T1W and T2W
## Footnote
**Mutliple lesions with intratumoral hemorrhage**
**T2\* - intratumoral hemorrhage; appears as a signal void (susceptibility effect)**
83
**What volume/dose constraint is important for SRT for intracranial meningiomas (Griffen VCO 2014)**
**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
What RT protocol was compared to a standard 20x2.5Gy protocol for intracranial neoplasia in dogs? What was the outcome? (Schwarz JVIM 2018)
New protocol 10x4Gy; safe and efficient
No significant difference between groups; overall PFI 663d, OST 637d
85
What was the response rate for dogs with encephalic or spinal cord meningiomas treated with stereotactic volume modulated arc radiotherapy? (JAAHA 2018)
Protocol 33Gyx5
CR + PR = 65.5%
86
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)
Overall 74.3%, disease specific 97.4%
87
Was the addition of temozolomide to stereotactic RT for treatment of canine gliomas beneficial? (Dolera VCO 2018)
Statistically no - numerically yes (RT MST 383d vs. RT + TMZ = 420d)
88
What was positively correlated with survival in dogs treated with SRT +/- temozolomide for gliomas? (Dolera 2018 VCO)
Ratio b/w target and brain volume of the tumor \<5%
Normal mentation at presentation
89
What was the response rate to a single fraction of SRT for canine meningiomas? What was the dose? (Kelsey VRU 2018)
16Gy + SIBR to total dose of 20-24Gy to central part of tumor
57% had perceived clinical benefit
90
What was prognostic for survival in dogs treated with a single fraction of SRT for intracranial meningiomas? (Kelsey VRU 2018)
Infratentorial tumor location
High gradient indicies
91
Is the GTV for meningiomas in dogs larger or smaller when made with CT compared to MR? (Berlato VRU 2018)
CT GTV usually smaller than MR - suggested 0.3cm margin around GTV-CT to account for this
92
Was there a difference in survival for dogs treated with sx + RT vs. RT alone for meningioma? (Keyerleber VCO 2015)
No - No difference between sx + RT vs. RT alone (~700d vs.~900? – based on Kaplan-Meier)
93
Response of trigeminal n tumors to SRS or SRT? (Zwingenberger JVIM 2016)
4/5 progressed
94
Overall MST for dogs treated with SRS or SRT for brain tumors? (Zwingenberger JVIM 2016)
MST 324d.
95
What are the general survival times for dogs with meningiomas treated with definitive intent RT
Fractionated 500-900d
SRT 500d
96
Infiltration of what immune cell has been found in both feline meningiomas and gliomas? (Rissi J Comp Path 2018 & McBride J Comp Path 2017)
CD3+ T lymphocytes
97
**Are primary or secondary brain tumors more common in dogs (Snyder JVIM 2008)**
**Secondary**
98
**What are the most common types of secondary brain tumors in the dog? (Snyder JVIM 2008)**
**29% HSA**
**25% Pituitary**
**12% LSA**
**12% Metastatic Carcinoma**
99
**What was the most common symptom in dogs with secondary brain tumors? (Snyder 2008 JVIM)**
**Mentation changes**
100
**What rate of metastasis to other areas was show in dogs with secondary brain tumors (Snyder JVIM 2008)**
**47% lung**
**35% kidney**
**31% heart**
101
Dogs with pituitary macroadenomas had a lower ___ and ___ than dogs with microadenomas (Benchekroun Vet J 2017)
Heart rate and body temperature
102
Diagnostic accuracy of stereotactic brain biopsy compared to surgical resection/necropsy (JVIM 2019)
Overall DA = 81% 100% of meningiomas 78% for gliomas
103
Factors associated with tumor grade disagreement for stereotactic brain biopsy (JVIM 2019)
Smaller lesion volume (WHO and modified canine glioma grading), fewer numbers of biopsies attempted and obtained (WHO)
104
Stereotactic brain biopsy more likely to over or under grade (JVIM 2019)
Under grade
105
Response rate for cats with intracrania tumors + neuro signs treated with RT + PFS (Korner, JFMS 2019)
95.5% response (21/22); median PFS 510d.
106
Median OST for cats with intracranial tumors w/ neuro signs treated with RT? (Korner JFMS 2019)
OST 515d (only 5/14 cats that died died because of brain tumor)
107
Incidence of death w/in 30d for dogs undergoing cytoreductive surgery for primary intracranial masses & factors associated (Kohler, Javama 2018)
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
Incidence of major complications w/in 30d for dogs undergoing cytoreductive surgery for primary intracranial masses & factors associated (Kohler, Javama 2018)
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
Do grade II/grade III meningiomas have a higher or lower apparent diffusion coefficient (ADC) on MRI than grade I meningiomas? (Fages, VRU 2019)
Lower
110
What was the MST for dogs with presumptive intracranial gliomas treated with CCNU? (Moirano VCO 2018)
MST 138d (compared to supportive care MST 35d)
