Tumours of the nervous system Flashcards
What is the prognosis for cats with PNST?
Better than dogs, as less of them are malignant.
What is the reported response rate to SC LSA in cats treated with COP and the PFI=
Response rate 50% with a duration of 3 months
Name 2 differentials to glioma based on MRI-findings?
Cerebrovascular accidents, inflammatory lesions
Signalment for dogs presenting with brain tumour?
Over 5 y, large breed, no sex predilection
Peripheral nerve lymphoma in dogs are commonly _____ phenotype
T
What is syringomyelic syndrome?
Development of hyperpathia in association with an intramedullary spinal cord tumour causing destruction of the dorsal horn
Name 4 ddx for a dog presenting with front limb lameness, no palpable mass, and neuronal thinckening on MRI
PNST
Lymphoma
Idipathic neuritis
Hyperthrophic ganglioneuritis
Estimated survival of primary brain tumours in dogs with palliative care is?
9 weeks
Which factors are prognostic for SC tumours?
Post-treatment neurological status
T/F 50% of dogs with solitary PBT present with multifocal clinical signs
True- due to the involvement of mulitple structures or secondary effects such as edema
Which tumour is the second most common primary brain tumour in dogs?
Gliomas (40%)
What are the two most common secondary brain tumours in cats?
Lymphoma and pituitary tumour
Which breeds are predisposed for meningioma?
Golden retriever, boxer, miniature schnauzer and rat terriers
Are there any breed or sex-predilections for cats developing primary brain tumours?
No
Which 3 primary brain tumour is most common in dogs (in decending frequency)?
Meningioma, glioma, choroid plexus tumour
What is more common in dogs, primary or metastatic brain tumours?
approx 50:50
What would be your ddx for patients presenting with focal vs multifocal clinical signs?
Focal: Anomaly/malfomation, infectious, immune-mediated meningoencephalitis, stroke, trauma
Multifocal or diffuse: Metabolic, neurodegenerative, meningoencephalitis
Which 3 genes on chromosome 26 in dogs have been associated with glioma in dogs?
DENR, CAMKK2, P2RX7 (latter two associated with progression in human cancer)
Which cells does mengingioma arise from?
Arachnoid cap cells
T/F With the current MRI features known, one are not able to differentiate different types of gliomas, but is able to predict grade with acceptable accuracy
F- cannot do type or grade based om MR
T/F Osteolytic vertebral lesions in cats are associated with lymphoid neoplasia
No, usually more frequent with non-lymphoid neoplasia.
Including multiple tumours- what is the reported outcome for dogs with SC tumours?
4-5 months
What is the most common clinical sign in dogs and cats with braintumours?
Dog- seizure
Cat- changes in behaviour
Gliomas are overrepresented in which breed?
Brachycephalic breeds (Boxer, Boston terrier, bullmastiff, English and French bulldog)
How many (%) of primary brain tumours in dogs are meningiomas?
45%
Which Intracranial tumours may have similar MRI features to a meningioma?
Histiocytic sarcoma, hemangioblastoma, granular cell tumours
What are the most commonly used chemotherapeutics for canine primary brain tumours?
Alkylating agent: CCNU, carmustine, temozolomide
Anti-metabolite: Hydroxyurea
wHat is the prognosis for trigeminal PNST?
Usually slowly progressing tumours, long term survival described without treatment. Surgery and RT have both been successful. SRT MST 1.5 y
What are the clinical findings identifying vestibular disease and how do you work them up include ddx list?
Main clinical signs are:
- head tilt (towards the lesion unless cerebellar involvement and it is paradoxical)
- ataxia - wide based stance, loss of balance to the side of the lesion
- circling - small circles towards the lesion
- nystagmus - Spontaneous or positional. Slow phase is towards the lesion and fast pace away from lesion.
Peripheral nystagmus - horizontal or rotary
Central nystagmus - can be in all directions and change the fast pace from away to awards lesion. So should be careful to state that a horizontal nystagmus is always peripheral
PERIPHERAL: Structures include vestibulocochlear nerve. Can Facial nerve paralysis and horners may be seen with peripheral vestibular, however horners is not a feature of central.
CENTRAL: The four pair of vestibular nuclei, close to the 4th ventricle, dorsal part of pons and medulla. Are involved in muscle tone, vomiting centre, eye positioning, some fibers also run through the thalamus.
Other CN deficits- CN 7 the facial nerve is close to the vestibulocochlear as they travel together.
How many cats presenting with meningioma have more than one intracranial tumour at the time of presentaiton?
20%
What is your main DDX with a tumour on MRI in the 4th ventricle and a CSF protein count over 80 mg/dL
Choroid Plexus Carcinoma (grade 3 choroid plexus tumour)
What is the sensitivity of MRI to identify a meningioma?
60-100%
What is the main ddx for 3 y GSD presenting with a primary spinal cord tumor in T9-L2?
Nephroblasoma,, young GSD and GR are predisposed and they arise in these segments due to the embryonic origin of the metanephric blastsema from which they arise.
Locus on which canine chromosome has been associated with glioma?
26
T/F Adjuvant RT for canine meningioma results in marked improved MST
T - increased MST from 16-30 mnd.
Explain the WHO 2007 Classification system of neurological tumours in cats and dogs:
- Meningies
* Meningioma - grade 1-3 2. - Neuroepithelium
- Astrocytic
- Pilocytic
- Diffuse
- Anaplastic
- Glioblastoma
- Oligodendroglial
- 2 Oligodentroglioma
- 3 Anaplastic
- Oligoastrocytic
- 2 Oligoastrocytoma
- 3 Anaplastic
- Choroid plexus
- Papillom
- Atypical papilloma
- Carcinoma
- Embryonal
- Primitive neuroectodermal tumour
- Ependymoma
- Ependymoma
- Anaplastic
How many dogs with a PNST will have a palpable mass on PE?
30%
Are primary or secondary intracranial tumours most common in cats?
Primary (70%)
Which biomarkers have been prognostic for outcome in dogs treated with surgery and RT for meningioma?
VEGF-expression
Progesterone receptor
What is the MST for cats after surgical removal of a meningioma?
Usually over 2 years.
Which IHC marker can be used to identify a meningioma?
Epithelial membrane antigen (EMA), they are also positive for vimentin. Other IHC markers have variable expression and intensity of expression
What are the main MRI features of meningioma?
Extra-axial
Broad based skull attachment
Well circumscribed/ distinct margins
Marke and often uniform contrast enhancement
Peri-tumoral edema
some may have:
cysts
dural tail sign
minderalisation
calvari hyperostosis
What are the negative prognostic factors for PNST?
Proximity to and invasion of vertebral canal (occur In 50% of them)
Not clean surgical margins
What is the recurrence rate after removal of a meningioma in cats?
25%
Describe MRI features of a glioma?
Intra-axial, infiltrative, displacing, ring-enhancement often associated with glioma,
What are negative prognostic factors for macro pituitary tumours treated with RT?
Sever neurological signs and large relative tumour size
Are intracranial tumours more or less common in cats than dogs?
Less
What is the most common metastatic intracranial tumour in dogs?
Hemangiosarcoma
What is the preferred primary mode of therapy for feline supratentorial meningioma?
Cytoreductive surgery
What is an approximate survival time for dogs with Primary intracranial tumours treated palliatively?
2-3 months
How can you reconstruct cranial surgical defects?
Use fascial or calvarial autografts, or polymethylmethacrylate or titanium mesh
What would be your DDX for a dog with diffuse neurological signs and a normal MRI, having ruled out extra cranial disease
Lymphomatosis and gliomatosis cerebri as tehy are known to be occult on brain MRI.
What are the MRI features of a glioma?
Intraaxial, infiltrative, poorly demarcated, may or may not be contrast enhancing and the pattern of enhancement can be variable pattern: Ring enhancement
Which has best prognosis a supratentorial tumour or infratentorial tumour?
supratentorial (25 vs 4 weeks)
What would you tell an owner regarding prognosis for a dog diagnosed with nephroblastoma?
Treatment options include both surgery and RT, bu there is not a clear recommendation. The outcome in literature is highly variable, ranging from 2 months to over a year in survival.
What is MST for PNST with surgery or RT?
MST 6 months for paraspinal and plexus PNST
MST 8 mnd reported after RT
Which tumour is the most common in cats?
Meningioma (50%)
Defibe a drop metastasis?
When a choroid plexus carcinoma metastasise wihtin the CBS by exfoliation into the CSF and implant in an new foci
Which mutations have been highly associated with glioma suseptibility?
DENR, CAMKK2, P2RX7
DENmark Royals, CAMe Kanoing and Kaiaking 2, Portugal 2 Race X7
How many cats with spinal cord lymphoma have extra neural disease involvement?
80%
Which nerves are most commonly site of origin for PNST?
Trigeminal
Spinal nerve tooth for the caudal cervical C6+T2 region.
What is a reasonable RT hyperfractionated protocol for glial tumours?
15-20 fractions of 2-3 Gy, for a total of 45-54 Gy
Gliomas arise from which cell lines?
Oligodendrocytes or astrocytes
How does tumour-involvement of the subventricular zone affect progression, metastasis and OS in dog with glial tumours?
Negative prognostic factor- progress more often, more likely to metastasis 50%, and overall survival with involvement was 300 days vs- 700. Glial tumours contacting the subventrical zone in dogs have a shorter tumour specific survival, higher met and progression rate.
What would be you tx recommendation for a GR retriever with a glioma where owner opt for palliative care?
- Anticonvulsant drug
- Corticosteroids
- Pain relief
What is the third most common primary brain tumour in dogs?
Choroid plexus tumours (5%)
Orientation? Which sequences are there? Intra or extra axial? what is your main DDX?
Transverse, post contrast images, sequence TW1 (left as only fat and contrast is enhances, and TW2 (right) - heterogenous enhancement present on T1W. Areas of fluid are hyperinteste compared to grey matter on T2W. Main ddx- meningioma, HS, hemangioblastoma,
How can you differentiate glioma from meningioma on IHC
Meningioma: V+, e-cad - and GFAP +
Glioma; vimentin +/- CK -. E-car neg and GFAP +
T/F Dural tail sign is considered a specific MRI fining for meningioma
F
Describe the sequences, what is your main DDX?
DDx: primary neoplasia- glioma could be astrocytoma, glioblastoma, oligodendroglioma
Metastatic neoplasia: HSA, carcinoma, LSA
Non-neiplasit: trauma, cerebrovascular event, infection
Describe the images, what are you dxx?
