Who Flashcards
Pediatric brain tumor MCC age
15-19 followed by 0-4
Common pediatric tumor < 20 yes
Glioma and glioneural tumors (45%)
Embryonal tumor ( medulloblastoma) 12 %
Pituitary tumor
Nerve shear tumor
Craniopharyngioma
Incidence decrease of which tumors with younger < 20
pilocytic astrocytoma, malignant glioma, ependymal tumors, choroid plexus tumors, and embryonal tumors
MCC infratentorial tumor affecting age
12-24 months > 70%
6-12 months > 53%
MCC supratentorial tumors in pediatrics as in adulthood.
Astrocytomas
MCC infratentorial tumors
MCC Intracranial neoplasms during the first year of life ( neonate)
Tertoma
MCC supratentorial tumors in neonate
astrocytoma, choroid plexus tumors, ependymomas, and craniopharyngiomas.
MCC posterior fossa tumor in neonate
medulloblastoma and cerebellar astrocytoma
The 6 histological groups that have a younger median age of diagnosis than other types are
Pilocytic Astro median age 11
Choroid plexus e20
Neuro glial tumor 26
Pineal 32
Embryonal 8 yes
GCT 15 y
Invasion to which structure will cause headach ( pain sensitive structure )
Dura
Blood vessels
Periosteum’s
Cranial nerves
In posterior fossa tumor EVD set for how long
Set in low pressure 10 for max 72 hr
High suspicion fro Mets
Multiple brain lesion
Solitary ring enhancing lesion gray-white matter junction
Postioeor fossa
Wet loss
CPA tumor mri protocol
FIESTA MRI and audiology screening
Prophylactic antiseizure medications with brain tumors
Shouldn’t use routinely in patient dx with brain tumors w/o seizure
If undergoing craniotomy, prophylactic ASMs may be used, and if there has been no seizure, it is appropriate to taper off ASMs starting 1 week post-op
F/u mri for newly dx brain tumors
3 months to r/o stability
If stable then annually
Excellent chemotherapy passing BBB
Nitrosoureas
Temozolomide MOA
1-at physiologic pH to the active metabolite monomethyl triazenoimidazole carboxamide (MTIC)
2- ). The mutagenic/cytotoxic effect of MTIC is associated with alkylation Add methyl group»_space; the O6 and N7 positions on guanine
3-Cells can repair this damage via O6methylguanine-DNA methyltransferase (p.673) (MGMT), a protein which may be deficient to some degree in various tumors (especially astrocytomas, IDH-mutant (p.658)) which renders them more susceptible to temozolomide.
Factor disturb BBB for chemotherapy
Malignant Glioma
lipophilic agents (e.g., nitrosoureas
Intra-arterial > increase penetration BBB
iatrogenically disrupted by mannitol
Intrathecal
differentiating low grade gliomas from normal or reactive brain
limited perineuronal satellitosis is»_space; normal
astrocytoma vs. oligodendroglioma:
perineuronal satellitosis may in some cases be more pronounced in oligodendrogliomas. + fried egg apearnce > oligo
radionecrosis vs. recurrent tumor (higher grade astroctymoa or glioblastoma)
Radiation necrosis > white matter
sclerosis/hyalinization of vessels or fibrinoid necrosis of vessel walls, perivascular lymphocytes, calcifications, and the presence of macrophages
Classical histology features of menningioma
whorls, psammoma bodies, intranuclear pseudoinclusions) may be absent, and freeze artifact can create areas that resemble Antoni B fibers. 32
Immunohistochemical stains
GFAP stain postive
Oligo
Epndymoma
CPP
S-100 protein +ve Glioma
Epndymoma
Chordoma
Craniophrangioma
Mets melanoma
Schwann o a and NF
Cytokeratins
Stain epithiulime
+ve Mets carcinoma
CPP
Epithelial membrane antigen (EMA)
+ve RCC
-ve hemangioblstoma
Neuroendocrine stains
1-chromogranin
2-synaptophysin > +ve central neurocytoma
3-CD 56
4-neuron specific enolase (NSE)
Mets postive stain of CD 56
Small cell carcinoma of the lung
Phechromocytoma
Merkel cell tumor
B-hcg high in
Tertoma
Choricacrcinoma
Embryonal cell carcinoma of pineal
Alpha-fetoprotein > 500 BG/ml
Colon ca,lung, pancreases,stomach,ovary,hepatitis and NTD ,GCT
Carcinoembryonic antigen (CEA) > 1ng/ml
Colo ca, lung ca,breast ca,bladder and melanoma
S -100 high
Head Truma
Creutzfeldt-Jakob disease
leading cause of brain tumor-related death in children.
DIPG diffuse infiltration pontine Glioma
DIPG triad
Short course of CN palsy , long tract , ataxia
MCC glioma in pediatric
PCA
violating Collins’ law
considered cured if it does not recur within a time 🟰 age at diagnosis ➕ 9 months
40 % of p fossa tumor are
PCA of cerebellum🟰 cystic cerebella’s Astrocytomas
diencephalic syndrome
infiltrating glioma of the anterior hypothalamus
🔺cachexia, hyper active and euophric
3 rd most common brain tumors in pediatrics—
Brain stem Glioma
Smallest intracranial tumors can cause death 💀
Tectal Glioma
MCC brain Mets
Breast , lung , kidny , melanoma , colon ca
