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5 Neurosurgery > Oncology > Flashcards

Oncology Flashcards

1
Q

Most frequent primary brain tumor

A

GBM, then meningioma

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2
Q

Glioma and meningioma - male and female?

A

Glioma in males Meningiomas in females

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3
Q

What is the most common cancer in children?

A

Leukemia Brain malignancies are second most common

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4
Q

Where is general location of brain malignancies in children?

A

70% infratentorial

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5
Q

Most frequent infratentorial brain malignancies in children?

A

Cerebellar astrocytomas (33%) Brainstem glioma (25%) Medulloblastoma (25%) Ependymoma (12%)

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6
Q

Most frequent supratentorial brain malignancies in children?

A

Low grade astrocytoma (50%) Craniopharyngioma (12%) Optic gliomas (12%)

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7
Q

Where is the general location of brain malignancies in neonates and infants (

A

2/3 supratentorial (usually congenital)

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8
Q

Most common brain malignancy in neonates?

A

Teratoma > PNET > high-grade astrocytoma > choroid plexus papilloma

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9
Q

Findings/Symptoms of brain malignancy in neonates

A

Macrocephaly, hydrocephalus, split sutures, seizures, focal deficits

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10
Q

Most common brain tumors in older children

A

Most infratentorial Astrocytomas (50%), PNET (15%), craniopharyngioma (10%), ependymoma (10%), pineal tumor (3%)

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11
Q

Most common brain tumors in adults

A

Metastatics>Primary GBM, anaplastic astrocytoma, meningioma, pituitary, vestibular schwannomas

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12
Q

Most common infratentorial brain tumors in adults

A

Metatases, schwannoma, meningioma, epidermoid, hemangioblastoma, brainstem glioma

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13
Q

Most frequent epidural lesions in spinal cord

A

Metastatic

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14
Q

Most frequent intradural/extramedullary spinal lesion

A

Schwannoma and meningioma

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15
Q

Most frequent intramedullary spinal lesion

A

Astrocytoma and ependymoma

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16
Q

Which tumors are associated with radiation? (3)

A

Meningiomas, fibrosarcomas, gliomas

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17
Q

Which tumor is associated with immunosuppression?

A

Lymphoma

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18
Q

Which tumors are associated with viruses (EBV and HPV)?

A

EBV: Burkitt and nasopharyngeal HPV: cervical

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19
Q

Prognosis of gliomas depend on what 5 factors?

A
  1. Age 2. Histologic (necrosis) 3. Karnofsky score 4. Neurologic deficit 5. Extent of resection
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20
Q

Name the tumors (x2): AFP

A

Embryonal carcinoma Endodermal sinus tumor

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21
Q

Name the tumor: Chromogranin

A

Pituitary adenoma

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22
Q

Name the tumors (x2): Common leukocyte antigen

A

Lymphoma, germinoma

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23
Q

Name the tumors (x3): Cytokeratin

A

Carcinoma, craniopharyngioma, chordoma

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24
Q

Name the tumors (x2): Desmin

A

Rhabdosarcoma, teratoma

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25
Q

Name the tumors (x3): Epithelial membrane antigen

A

Carcinoma, meningioma, epithelial cysts

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26
Q

Name the tumor: GFAP

A

Astrocytomas and other glial tumors

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27
Q

Name the tumor: Human melanoma black (HMB)

A

Melanoma

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28
Q

Name the tumors (x2): bHCG

A

Choriocarcinoma and synctiotrophoblastic variant of germinoma

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29
Q

Name the tumor: IG kappa and lambda chains

A

Lymphomas

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30
Q

Name the tumor (x2): Neurofilament and synpaptophysin

A

Ganglioglioma, PNET

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31
Q

Name the tumors (x7): S100

A

Schwannoma, neurofibroma, glioma, PNET, chordoma, melanoma, RCC

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32
Q

Name the tumor: Synaptophysin

A

Tumors with neurons (e.g. ganglioglioma, central neurocytoma)

33
Q

Name the tumor: Transthyretin

A

Choroid plexus tumors

34
Q

Name the tumor: Vimentin

A

Meningioma

35
Q

Is mitotic index or flow cytometry more accurate? Why?

A

Flow cytometry more accurate - stains DNA and counts cells with double DNA. Mitotic index only small portion in M phase (mitosis)

36
Q

What is a “Medulloblast”?

A

Bipotential cells capable of differentiating into glia or neurons Derived from external granular layer of cerebellum or from dysplastic cell rests in anterior/posterior medullary velum

37
Q

Medulloblastoma: at what age do they occur?

A

50% before age 10 75% before age 15 2nd peak at 28 years

38
Q

What % of CNS tumor in children is medulloblastoma?

A

20% (1/3 of posterior fossa tumors in children)

39
Q

Most common genetic abnormality in medulloblastoma

A

Isochromosome 17q

40
Q

What syndrome is associated with medulloblastoma?

A

Gorlin (basal cell nevus) syndrome Mutation of PTCH gene on chromoqome 9q

41
Q

Gorlin syndrome: what mutation and what tumor is it associated with?

A

Mutation of PTCH gene on chromosome 9q Medulloblastoma

42
Q

Medulloblastoma: WHO grade

A

IV

43
Q

What is the diagnosis?

A

Medulloblastoma

44
Q
A
45
Q

What is the diagnosis?

A

Medulloblastoma

Closely packed undifferentiated cells with no discernable cytoplasm (small blue cells)

46
Q

Medulloblastoma: histology

A

Packed undifferentiated cells with no discernable cytoplasm (small blue cells) on H&E stain

47
Q

What histological structure is this?

Which 2 tumors may be associated with this?

A

Homer-Wright rosette on H&E
Central fibrillar material ringed by radially arranged cell nuclei

Medulloblastoma and neuroblastoma

48
Q

Medulloblastoma: male or female more common?

A

M:F ratio 3:1

49
Q

Medulloblastoma: Presentation

A

Rapid presentation with increased ICP/hydrocephalus, cerebellar signs

50
Q

What tumor protein predicts 5-year survival rate in medulloblastoma?

A

ERBB-2
100% if negative
54% if positive

if standard risk (no mets and no gross residual resection)

51
Q

What is the 5-year survival rate of a “high risk” medulloblastoma?

A

20%
Metastases, residual postresection

52
Q

Medulloblastoma:

A

Surgical excision
Adjuvant chemotherapy
Craniospinal radiation if age>3

53
Q
A
54
Q

Ependymoma: peak age

A

10-15 years
70% pediatric

55
Q

Ependymoma: 5-year survival in treated young patients

A

80%

56
Q

Ependymoma: 5-year survival in patients age <4 or elderly

A

40%

57
Q

Ependymoma: Treatment

A

Maximal possible resection, then fractionated radiation
MRI + LP for cytology to rule out subarachnoid mets (spinal radiation if positive)

58
Q

Ependymoma: male or female

A

No sex predominance

59
Q

Ependymoma: most frequent location

A

Infratentorial (4th ventricle out through foramen of Luschka and Magendie)

60% of intramedullary spinal cord tumors, often at filum

60
Q

Ependymoma: characteristics on CT and MRI

A

Lobulated, cricumscribed, cystic, moderately enhancing lesions with calcifications (50%) and only rarely hemorrhage

61
Q

4 Pathologic subtypes of ependymoma

A
  1. Cellular
  2. Papillary
  3. Myxopapillary
  4. Clear cell
62
Q

What is this diagnosis?

A

Cellular ependymoma: sheetlike growth of polygonal cells with true rosettes (central canal), pseudorosettes (blood vessel), and blepharoplasts (ciliary basal bodies in apical cytoplasm)

63
Q

What is the diagnosis?

A

Papillary ependymoma
Typical papillary projections - resembles choroid plexus papilloma

64
Q

What is the diagnosis?

A

Myxopapillary ependymoma

Intracellular mucin, occurs at filum and pre/postsacral area if there is local spread

65
Q

What is the diagnosis?

A

Clear cell ependymoma

Oligodendrolyte-halos

66
Q

Ependymoma: what stains?

A

GFAP and PTAH

67
Q

What is the diagnosis?

A

Ependymoma

T1 with nonehnaced and coronal of enhanced mass in 4th ventricle extending through foramen of Luschka and Magendie

68
Q
A
69
Q

What differentiate grade III ependymoma from grade I and II?

A

Frequent mitoses and endovascular hyperplasia

70
Q

Where may pre/post sacral myxopapillary ependymoma metastasize to?

A

Lung

71
Q

Ependymoblastoma: WHO grade

A

Grade IV
Occurs in childhood

72
Q

What is the normal ependyma consists of?

A

Single layer of cuboidal/columnar cell ciliated early in life with microvilli

Dual epithelial-glial nature and lie over subependymal glia

73
Q

How is “high risk” defined in medulloblastoma?

A

>1.5 cm2 postop tumor residual
Presenting at 3 years old or younger
Presence of metastases

74
Q

Which chromosome/syndrome is associated with ependymoma?

A

Loss of heterozygosity in chromosome 22q

Neurofibromatosis 2

75
Q

Ependymoma: WHO grade

A

II

76
Q

Anaplastic ependymoma: WHO grade

A

III

77
Q

Ependymoma: key pathologic feature

A

Perivascular pseudorosettes

78
Q

Best prognostic factor in ependymoma

A

Surgical resection

79
Q
A

5 Neurosurgery (4 decks)

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