WEEK 4: Neurooncology Flashcards
Most common presentation of neuroonco?
progressive neurologic deficit
(68%), usually motor weakness (45%)
• Headache 54%
• Seizures 26%
Temporal profile of CNS tumors?
chronic and progressive
• Headache with focal neurologic deficit or seizure were
thought to differentiate tumors form other diagnoses. T or F?
T
• 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)
Headache c brain tumor
The brain itself is not pain
sensitive.
T
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.
Monroe kellie doctrine
Landmarks of malignancy histology:
Vascular
proliferation, central necrosis.
Cushing’s Triad:
Hypertension, bradycardia and bradypnea.
Most Pediatric tumors are infratentorial, adult tumors are usually supratentorial.T or F?
T
The most common brain tumor is
metastatic
Most common primary brain tumor is
glioblastoma.
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
Glioblastoma multiforme
Oligodendroglioma and other low grade astrocytomas or gliomas you have a prognosis of around
5 - 10 years
Usually, high grade tumors ENHANCE T or F?
T
is characterized by anaplasia, vascular proliferation and areas of necrosis.
GBM
medulloblastoma vs ependymoma
Medulloblastoma – located in the roof of the 4th ventricle
Ependymoma – located in the floor of the 4th ventricle
• 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)
infratentorial ependymoma
o More common in adults, but with poorer prognosis
o Located in the lateral or 3rd ventricle
supratentorial ependymoma
Posterior fossa symptoms:
Posterior fossa symptoms: o Headache o Nausea o Vomiting o Ataxia
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
medulloblsatoma
Poor prognosis if residual tumor is_____ cm, and the patient is _____ years old.
Poor prognosis if residual tumor is <1.5 cm, and the patient is <3 years old.
• 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.
Craniopharyngioma
kind of shunt that has no exit in the peritoneum
Ommaya shunt
Currently the most common primary brain tumor? genetic predisposition?
Meningioma; female
The most common intracranial locations of meningioma are along the
falx, convexity and the sphenoid wing.
Probable etiologies of meningioma
o Irradiation
It will cause neoplastic changes.
o Trauma
o Infectious – Inoue-Melnick virus (IMV)
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
Acoustic schwannoma
Two main histologic patterns of acoustic schwannoma
Two main histologic patterns:
o Antoni A (Dense)
o Antoni B (Loose) – cystic
_______________ are pathognomonic for neurofibromatosis type 2 (NF2), a syndrome resulting from mutation of chromosome 22.
Bilateral acoustic neuromas are pathognomonic for neurofibromatosis type 2 (NF2), a syndrome resulting from mutation of chromosome 22.
3 surgical management to acoustic schwannoma?
o Retrosigmoid
o Middle fossa
o Translabyrinthine
• May also be managed by stereotactic radiosurgery if <3cm in diameter, or focused high-dose radiation.
Currently, the gold standard in stereotactic surgery is __________
Currently, the gold standard in stereotactic surgery is gamma knife.
Arise from the anterior pituitary gland (adenohypophysis).
If it arises from the posterior pituitary gland, it is usually metastatic.
Pituitary adenoma
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.
Functional tumors
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.
non functional tumor
usually shrink with dopaminergic therapy alone, which inhibits production and secretion of prolactin.
prolactin secreting tumors
dopaminergic therapy namely?
bromocriptine
Most pituitary tumors are approached through the nose via the
transsphenoidal approach
The most common manifestation of pituitary adenoma are
bitemporal hemianopsia and anosmia.
Hemorrhage into a pituitary tumor causes abrupt symptoms of headache, visual disturbance, decreased mental status, and endocrine dysfunction. This is known as
pituitary apoplexy.
CNS lymphoma may arise either primarily in the CNS or secondarily from systemic disease. T or F?
T
(Dexamethasone is oncolytic) T or F?
T
Surgical excision is not indicated in lypmhoma?
T
in lymphoma, Stereotactic needle biopsy usually confirms the diagnosis?
T
Most common intracranial tumors; Usually located at the gray white matter junction
metastasis
most common source of brain metastasis?
Primary lung cancer
Highest predilection for intracranial metastases
melanoma
