WEEK 4: Neurooncology

Question 1

Most common presentation of neuroonco?

Answer 1

progressive neurologic deficit
(68%), usually motor weakness (45%)
• Headache 54%
• Seizures 26%

Question 2

Temporal profile of CNS tumors?

Answer 2

chronic and progressive

Question 3

• Headache with focal neurologic deficit or seizure were

thought to differentiate tumors form other diagnoses. T or F?

Answer 3

T

Question 4

• Occur with or without elevated ICP
• Present equally in patients with primary or metastatic tumor
(-50% of patients)
• Classically described as being worse in the morning (possibly
due to hypoventilation during sleep)

Answer 4

Headache c brain tumor

Question 5

The brain itself is not pain

sensitive.

Answer 5

T

Question 6

The brain being
enclosed in a closed vault has consistent volumes.
It is divided into three; brain parenchyma, blood,
and CSF. Any increase in any of the components
will cause increased ICP because it is
compartmentalized.

Answer 6

Monroe kellie doctrine

Question 7

Landmarks of malignancy histology:

Answer 7

Vascular

proliferation, central necrosis.

Question 8

Cushing’s Triad:

Answer 8

Hypertension, bradycardia and bradypnea.

Question 9

Most Pediatric tumors are infratentorial, adult tumors are usually supratentorial.T or F?

Answer 9

T

Question 10

The most common brain tumor is

Answer 10

metastatic

Question 11

Most common primary brain tumor is

Answer 11

glioblastoma.

Question 12

is the most aggressive type of brain tumor. It is WHO grade 4 along with anaplastic astrocytoma which may be grade 3 or grade 4. If you have these, usually you only have a prognosis of 4 months to 2 years if you have the money for chemotherapy and radiation

Answer 12

Glioblastoma multiforme

Question 13

Oligodendroglioma and other low grade astrocytomas or gliomas you have a prognosis of around

Answer 13

5 - 10 years

Question 14

Usually, high grade tumors ENHANCE T or F?

Answer 14

T

Question 15

is characterized by anaplasia, vascular proliferation and areas of necrosis.

Answer 15

GBM

Question 16

medulloblastoma vs ependymoma

Answer 16

Medulloblastoma – located in the roof of the 4th ventricle

 Ependymoma – located in the floor of the 4th ventricle

Question 17

• Arise from ependymocytes
• Infratentorial
o More common in pediatric population
o Located in the floor of the 4th ventricle, spreads to the CSF outlets (Foramina of Magendie and Luschka)

Answer 17

infratentorial ependymoma

Question 18

o More common in adults, but with poorer prognosis

o Located in the lateral or 3rd ventricle

Answer 18

supratentorial ependymoma

Question 19

Posterior fossa symptoms:

Answer 19

Posterior fossa symptoms:
o Headache
o Nausea
o Vomiting
o Ataxia

Question 20

Primitive neuroectodermal tumor of the posterior fossa
• Most common malignant pediatric brain tumor
• Usually midline, at the roof of the 4th ventricle
• Present with symptoms of increased ICP
• Histologic characteristics include densely packed small round cells with large nuclei and scant cytoplasm, unencapsulated, frequently disseminate within the CNS
• Generally, not encapsulated
• Frequently disseminate within the CNS

Answer 20

medulloblsatoma

Question 21

Poor prognosis if residual tumor is_____ cm, and the patient is _____ years old.

Answer 21

Poor prognosis if residual tumor is <1.5 cm, and the patient is <3 years old.

Question 22

• Benign epithelial tumors arising from the remnants of Rathke’s pouch in the suprasellar region

• Encapsulated extra-axial lesions with interdigitating patterns of adhesions to adjacent structures including the optic apparatus, tuber cinereum of the pituitary stalk, hypothalamus, and Circle of Willis.
• Cysts are high in lipid deposits referred to as machinery/crankcase oil.

Answer 22

Craniopharyngioma

Question 23

kind of shunt that has no exit in the peritoneum

Answer 23

Ommaya shunt

Question 24

Currently the most common primary brain tumor? genetic predisposition?

Answer 24

Meningioma; female

Question 25

The most common intracranial locations of meningioma are along the

Answer 25

falx, convexity and the sphenoid wing.

Question 26

Probable etiologies of meningioma

Answer 26

o Irradiation  It will cause neoplastic changes. o Trauma o Infectious – Inoue-Melnick virus (IMV)

Question 27

Usually called cerebellopontine angle tumors because your vestibulocochlear nerve is in the vicinity of the pons • Asymmetric sensorineural hearing loss, tinnitus, CN VII palsy  Since cranial nerves VII and VIII are bundled, you would also notice that the patient has peripheral CN VII palsy. • Grow at a rate of 2.4 mm/year

Answer 27

Acoustic schwannoma

Question 28

Two main histologic patterns of acoustic schwannoma

Answer 28

Two main histologic patterns: o Antoni A (Dense) o Antoni B (Loose) – cystic

Question 29

_______________ are pathognomonic for neurofibromatosis type 2 (NF2), a syndrome resulting from mutation of chromosome 22.

Answer 29

Bilateral acoustic neuromas are pathognomonic for neurofibromatosis type 2 (NF2), a syndrome resulting from mutation of chromosome 22.

Question 30

3 surgical management to acoustic schwannoma?

Answer 30

o Retrosigmoid o Middle fossa o Translabyrinthine • May also be managed by stereotactic radiosurgery if <3cm in diameter, or focused high-dose radiation.

Question 31

Currently, the gold standard in stereotactic surgery is __________

Answer 31

Currently, the gold standard in stereotactic surgery is gamma knife.

Question 32

Arise from the anterior pituitary gland (adenohypophysis). |  If it arises from the posterior pituitary gland, it is usually metastatic.

Answer 32

Pituitary adenoma

Question 33

are often diagnosed when quite small due to endocrine dysfunction. Secrete endocrinologically active compounds at pathologic levels  The most common endocrine syndromes are Cushing’s disease, due to adrenocorticotropic hormone secretion, Forbes-Albright syndrome, due to prolactin secretion, and acromegaly, due to growth hormone secretion.

Answer 33

Functional tumors

Question 34

are typically diagnosed as larger lesions causing mass effects as visual field deficits due to compression of the optic chiasm or panhypopituitarism due to compression of the gland.

Answer 34

non functional tumor

Question 35

usually shrink with dopaminergic therapy alone, which inhibits production and secretion of prolactin.

Answer 35

prolactin secreting tumors

Question 36

dopaminergic therapy namely?

Answer 36

bromocriptine

Question 37

Most pituitary tumors are approached through the nose via the

Answer 37

transsphenoidal approach

Question 38

The most common manifestation of pituitary adenoma are

Answer 38

bitemporal hemianopsia and anosmia.

Question 39

Hemorrhage into a pituitary tumor causes abrupt symptoms of headache, visual disturbance, decreased mental status, and endocrine dysfunction. This is known as

Answer 39

pituitary apoplexy.

Question 40

CNS lymphoma may arise either primarily in the CNS or secondarily from systemic disease. T or F?

Answer 40

T

Question 41

(Dexamethasone is oncolytic) T or F?

Answer 41

T

Question 42

Surgical excision is not indicated in lypmhoma?

Answer 42

T

Question 43

in lymphoma, Stereotactic needle biopsy usually confirms the diagnosis?

Answer 43

T

Question 44

Most common intracranial tumors; Usually located at the gray white matter junction

Answer 44

metastasis

Question 45

most common source of brain metastasis?

Answer 45

Primary lung cancer

Question 46

Highest predilection for intracranial metastases

Answer 46

melanoma