Neurooncology Flashcards
What are the most common primary CNS tumours? (Benign and malignant)
Mostly: Benign
40% Bening Meningioma
17% Benign Pituitary
Malignant: 30%
What are 3 Common Familial CNS tumour syndromes and what types of CNS tumours do they cause?
Neurofibromatosis 1: neurofibroma, astrocytoma
Neurofibromatosis 2: schnwannoma, meningioma
Von Hippel Lindau: Hemangioblastoma
What primary brain tumours usually benefit most from Radiotherapy?
- Low and high grade gliomas, metastases, some benign
What primary brain tumours are usually treated by chemotherapy?
Mainly high grade gliomas (temozolomide) and lymphomas
Where do extra-axial brain tumours originate from?
Do they tend to be bening or malignant?
Cranium
softtissue
meninges
nerves
[BENIGN]
Where to intra-axial brain tumours usually originate from?
Do they tend to be belign or malignant
glial
neurons
neuroendocrine cells
Usually MALIGNANT, but rarely metastasise outside the CNS
What systemic tumours like to metastasise to the brain?
lung, breast, malignant melanoma and renal cell
What is the radiological appearance of CNS metastasis on a CT head?
Well demarcated, solitary or multiple with surrounding oedema
Can be multiple
What are infratentorial signs and symptoms of brain tumours?
- Ataxia
- Long tract signs - spasticity and hyperreflexia
- Cranial nerve palsies
Located below the tentori cerebellum –> Cerebellum + Brain stem
What are primary brain tumours derived from astrocytes called?
Astrocytomas
What are primary CNS tumours called derived from oligodendrocytes?
oligodendroglioma
BUZZWORD
“fried-egg”appearance
What are primary CNS tumours called derived from empendyma?
ependyoma
BUZZWORD
ventriculartumour hydrocephalus
What are primary CNS tumours called derived from Embryonal cells?
Medullablastoma
How does the Grading of primary CNS tumours work?
What predictions are they based on?
What are they?
Based on natural clinical behaviour (without treatment - with treatment can be different)
Grade 1–benign
Grade 2–more than 5 years survival
Grade 3–1- 5 years survival
Grade 4 – less than 1 year survival
Which CNS cells are classified as glial cells?
Astrocytes + Oligodendrocytes
(Macroglia)
Ependymal cells
Tanycytes
What are Pilocytic Astrocytomas?
What grade are they usually and what epidemiology?
Primary CNS tumours derived from Astrocytes
Usually in children (0-20 years)
and Grade 1 (benign)
What are histological features of pilocytic astrocytomas?
Piloid “hairy” cells
Rosenthal fibres
Slow mitotic divisions
What site are pilocytic astrocytomas usually occur?
Often cerebellar
Optic-hypothalamus lesions (In Neurofibromatosis type 2)
Brainstem
What genetic mutation is associated with Pilocytic astrocytomas?
BRAF mutation in 70% of tumours
What are Diffuse Gliomas?
What grade are they usually and what epidemiology?
Primary CNS tumours derived from Glial cells, usually Grade 2-3
Include Astrocytomas and Oligodendrogliomas
Age group: 20-40
What genetic mutations are diffuse Gliomas associated with?
How does this change the prognoisis?
IDH mut. is associated with longer survival and better response to chemo and radiotherapy
What are histological features of astrocytomas (diffuse Gliomas)?
Low-moderate cellularity
Low mitotic activity
No vascular proliferation
(+ IDH mutant can be detected by immunocytochemically)
What is the prognosis of Astrocytomas/ Diffuse gliomas?
Depends on Grade (2-4)
But overall you would expect progression over time
IDH mutation associated with better outcome + survival
What are Diffuse Glioblastoma multiforme?
What grade are they usually and what epidemiology?
Primary Mailgnant CNS tumour
Very aggressive (Grade 4) but most frequent primary CNS tumour in adults
(Median survival 8 months)
Age usually 50+
