W21 - Neuro-oncology Flashcards

1
Q

What are primary vs secondary CNS tumours?

A

Primary CNS tumours - tumours that originated within the CNS

Secondary CNS tumours - metastases from other cancers (10x more frequent than primary tumours in adults)

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2
Q

In the adult population, are primary or seconary CNS tumours more common?

A

Secondary (mets) are 10x more common than primary CNS tumours

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3
Q

3 S/S for each of the following:

  • Intracranial hypertension
  • Supratentorial mass
  • Subtentorial mass
A

3 S/S for each of the following:

  • Intracranial hypertension = headache, vomiting, change in mental status
  • Supratentorial mass = focal neurological deficit, seizures, personality change
  • Subtentorial mass = cerebellar ataxia, long tract signs, cranial nerve palsy
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4
Q

___ imaging is the most important in neuroimaging

A

MR imaging is the most important in neuroimaging

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5
Q

In terms of surgical intervention in CNS tumours, what 3 surgeries could be possible?

A
  1. Craniotomy for debulking - subtotal and complete resections (as much tumour as possible)
  2. Open biopsy - inoperable but approachable tumours (about 1cm), usually representative
  3. Stereotactic biopsy - if open biopsy not indicated, about 0.5cm tissue, tissue may be insufficient
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6
Q

WHO classification of tumours looks at what 3 tumour parameters?

A
  1. Tumour type
  2. Tumour grade
  3. Tumour molecular profile
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7
Q

CNS tumour type is typically defined by the ________________

A

putative cell of origin / line of differentiation

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8
Q

The most common primary CNS tumours are _____, which could arise from these 3 lineages - name them.

A

The most common primary CNS tumours are gliomas, which could arise from these 3 lineages:

1. Astrocytes

2. Oligodendrocytes

3. Ependyma

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9
Q

CNS tumours - the grading system is an attemp to stratify tumours based on what?

A

by outcome, i.e. low grade = long survival, high grade = short survival

NB:

grade 1 - benign = long-term survival

grade 2 = more than 5 years

grade 3 = less than 5 years

grade 4 = less than 1 year

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10
Q

Diffuse vs circumscribed gliomas - comment on each of their:

  • grade
  • epidemiology
  • malignancy potential
A

Diffuse gliomas:

  • grades 2 or higher
  • epidemiology: adults, supratentorial
  • malignancy potential = malignant progression

Circumscribed gliomas:

  • grades 1-2
  • epidemiology: children, often posterior fossa
  • malignancy potential = rare
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11
Q

Diffuse vs circumscribed gliomas - comment on each of their genetic profiles

A

Diffuse gliomas: IDH1/2 muttions (30%), H2 mutations (1%)

Circumscribed gliomas: MAPK pathway mutations (i.e. BRAF)

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12
Q

The most common CNS tumour in 1st and 2nd decade of life is _______

A

The most common CNS tumour in 1st and 2nd decade of life is pilocystic astrocytoma (20% of CNS tumours below 14 yrs)

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13
Q

Pilocystic astrocytoma:

  • where is it commonly found?
  • MRI findings?
  • Histology findings?
  • Genetic profile?
A

Pilocystic astrocytoma:

  • where is it commonly found = cerebellar
  • MRI findings = well circumscribed, cystic, enhancing lesions
  • Histology findings = piloid “hairy” cells, slow growing, low mitotic activity
  • Genetic profile = BRAF mutations in 70%
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15
Q

Astrocytomas:

  • Where is it normally found?
  • Patient age?
  • MRI findings?
  • Histology findings?
  • Genetic profile?
A

Astrocytomas:

  • Where is it normally found = cerebral hemispheres (superficial, in white matter)
  • Patient age = 20-40s
  • MRI findings = T1 hypointense, T2 hyperintense, non-enhancing well-circumscribed lesion
  • Histology findings = low-to-modrate cellularity, low mitotic activity
  • Genetic profile = IDH1/2
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16
Q

Diffuse glioma:

  • where is it commonly found?
  • typical patient age?
  • Genetic profile?
A

Diffuse glioma:

  • where is it commonly found = supratentorial
  • typical patient age = 20-40s
  • Genetic profile = IDH mutants (imp becuse associated with good response to chemoradiotherapy)
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18
Q

IDH mutant can be found in _____ and ______

A

IDH mutant can be found in astrocytoma and glioma

19
Q

Glioblastoma multiforme:

  • median survival?
  • typical patient age?
  • where is it most commonly found?
  • MRI findings?
  • Histology findings?
  • IDH status?
A

Glioblastoma multiforme:

  • median survival = 8 months
  • typical patient age = >50
  • where is it most commonly found = cerebral hemispheres
  • MRI findings = heterogenous (due to necrosis/haemorrhage), enhancing post-contrast
  • Histology findings = high cellularity, high mitotic activity, necrosis

​- IDH1 WT normally (hence why they dont respond well to therapy

20
Q

IDH mutant astrocytoma/glioma will alwyas progress to higher grades (i.e. grade 3/4) typically in <10 years - T or F?

21
Q

Meningiomas:

  • % of primary CNS tumours?
  • typical age of presentation?
  • MRI findings?
A

Meningiomas:

  • % of primary CNS tumours = 38%
  • typical age of presentation = rare <40, incidence goes up with age
  • MRI findings = extra-axial, isodense, well-demarcated masses typically with cleft between tumour and brain
22
Q

The most aggressive and most frequent glioma is…

A

Glioblastoma multiforme

23
Q

In meningiomas, the grading is based on a combination of morphological tests, 2 of which are very imp - name them.

A
  1. Mitotic activity
  2. Microscopic brain invasion

(although these tumours are axial, sometimes they grow into the brain tissue so careful histo is imp)

24
Q

What does this MRI of the brain show?

A

Lots of metstases

26
Q

Meningiomas originate from _______ cells

A

Meningiomas originate from meningothelial cells of the arachnoid mater

28
Q

Meningiomas - what % is grade 1, grade 2, and grade 3?

Wht does each grade mean?

A

Meningiomas:

80% grade 1 (benign, recurrence <25%)

20% grade 2 (atypical, recurrence 25-50%)

1% grade 3 (malignant, recurrence 50-90%)

31
4 most frequent tumours that give CNS metastases
Lung, breast, melanoma, renal cell carcinoma
32
Medulloblastoma are ______ tumours, originating from _______ cells
Medulloblastoma are **_embryonal_** tumours, originating from **_neuroepithelial/neuronal_** cells
33
Medulloblastoma: - typical grade? - typical location in brain? - outcome?
Medulloblastoma: - typical grade = **high (grade 4)** - typical location in brain = **cerebellum or brainstem** - outcome = **good outcome with radio-chemo**
34
Methylome profiling of certain CpG islands in CNS tumours - what does it show us?
The methylation profile is stable in CNS tumours and reflects the **_tumour cell origin_**
35
What is the most frequent brain tumour in children? A) Glioblastoma, IDH WT, grade 4 B) Pilocystic astrocytoma, grade 1 C) Medulloblastoma, grade 4 D) Astrocytoma, IDH mutant, grade 2
B) Pilocystic astrocytoma, grade 1
36
Wht is the most frequent brain tumour in adults? A) Glioblastoma, IDH WT B) Metastatic deposit C) Meningioma D) Astrocytoma, IDH mutant
B) Metastatic deposit
37
Which mutation identifies diffuse astrocytic tumours with a better prognosis? A) IDH mutation B) BRAF mutation C) EGFR mutation D) H3 mutation
A) IDH mutation
38
45 year old, headache, previous pulmonary lobectomy, CT shows crontal lesion. What is your diagnosis? A) Glioblastoma, grade 4 B) Astrocytoma, grade 2 C) metastatic carcinoma D) Meningioma, grade 1
C) metastatic carcinoma
39
5 yer old, headache, vomiting, papilloedema. MRI brain shows cystic cerebellar lesion. What is your diagnosis?
Pilocystic astrocytoma
40
70 year old with left arm and leg weakness and seizures. MRI shows heterogenous enhancing right frontal lesion. Your diagnosis: A) Glioblastoma, grade 4 B) Meningioma, grade 1 C) Metastatic carcinoma D) Astrocytoma, grade 2
A) Glioblastoma, grade 4