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CORE: Neuro > Brain Tumors > Flashcards

Brain Tumors Flashcards

1
Q

brain tumor complications

A

hemorrhage, hydrocephalus, herniation

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2
Q

hemorrhagic mets

A

melanoma, RCC, thyroid, choriocarcinoma

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3
Q

extra-axial mass findings

A

CSF cleft, buckling of gray matter, gray matter interposed between mass and white

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4
Q

T2 hypointense tumors

A

mets containing dessicated mucin, hypercellular tumors

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5
Q

T1 hyperintense tumors

A

melanoma, dermoid/teratoma, hemorrhagic mets

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6
Q

glial cells differentiate into?

A

astrocytes, oligodendrocytes, ependymal cells, choroid plexus cells

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7
Q

astrocyte function

A

biochemical support to endothelial cells to maintain BBB

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8
Q

oligodendrocyte function

A

maintain myelin around CNS axons

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9
Q

peripheral counterpart to oligodendrocytes

A

Schwann cell

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10
Q

ependymal cell function

A

circulate CSF with mutlipple cilia, line ventricles/central canal of spinal cord

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11
Q

choroid plexus cells

A

produce CSF; modified ependymal cells

line body/temporal horn of lateral ventricles, roof of 3rd/5th ventricle

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12
Q

grade I astrocytoma: JPA

A

juvenile pilocytic astrocytoma

seen in posterior fossa of children

well circumscribed cystic mass with enhancing nodule, little edema; may compress 4th ventricle

can also occur in optic pathway

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13
Q

JPA association

A

NF1 if it is in the optic pathway

posterior fossa JPA is not associated with NF1

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14
Q

fibrillary astrocytomas

A

low grade astrocytoma, anaplastic astrocytoma, GBM

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15
Q

low-grade astrocytoma: WHO type, imaging appearance

A

WHO grade II

T2 hyperintense mass, no enhancement; subtle

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16
Q

anaplastic astrocytoma: WHO type, imaging appearance

A

WHO grade III

thickened cortex, irreguarly enhancing mass that may appear identical to glioblastoma –> eveutaly progresses to glioblastoma

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17
Q

GMB: WHO type, patient population, imaging appearance

A

WHO IV

older adults, most common CNs malignancy

variable appearance (multiforme) but typically white matter mass with heterogenous enhancement and T2 nonenhancing prolongation

crosses midline via corpus callosum (butterfly glioma)

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18
Q

ddx for transcallosal mass

A

GBM, lymphoma, demyelinating dx

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19
Q

glioblastoma cerebri: WHO type, imaging

A

WHO II/III

affects at least 2 lobes plus extra-cortical involvement

diffuse T2

mass effect, but no enhancement

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20
Q

oligodendroma: WHO type, pt, imaging

A

WHO II

young/middle aged pt with seizures

slow growing cortical based mass; tend to calcify

variants: oligoastrocytoma, anaplastic oligodendroglioma

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21
Q

ependymoma: imaging, pts

A

typically posterior fossa kids, spinal cord older adults

pediatrics: toothpaste tumor, fills 4th ventricle (ddx is medulloblastoma)
adult: intramedullary spinal cord (ddx astrocytoma)

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22
Q

lhermitte duclos

A

WHO I; dysplastic cerebellar gangliocytoma (hamartoma/neoplasm)

corduroy/tiger striped cerebellar hemisphere; enhancement rare

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23
Q

Lhermitte duclos association

A

Cowden syndrome; multiple hamartomas, increased risk of cancer

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24
Q

PNET tumors

A

WHO IV, aggressive childhood embryonal tumors

ATRT, medulloblastoma

usually located in posterior fossa

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25
Q

atypical teratoid/rhabdoid tumor (ATRT)

A

WHO IV, aggressive tumor

occurs in younger patients, usually in posterior fossa

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26
Q

associations for ATRT

A

malignant rhabdoid tumor of kidney

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27
Q

medulloblastoma

A

WHO IV; PNET, small blue cell tumor

most common pediatric brain tumor

midline cerebellar vermis

hyperattenuating on CT
hypointense on T2, low ADC

internal hemorrhage/calcifications

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28
Q

sugar coating (Zuckerguss)

A

leptomeningeal mets, common in medulloblastoma

imaging should be performed on brain and spine

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29
Q

medulloblastoma in young adult

A

eccentric in posterior fossa

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30
Q

Ddx for tumors with cyst and enhancing nodule

A

JPA, hemangioblastoma, PXA, ganglioglioma

also neurocysterosarcosis, parasites/abscess

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31
Q

hemangioblastoma

A

WHO I
vascular tumor, cystic mass with enhancing mural nodule

typically cerebellum, medulla, spinal cord, so

associated with syrinx wiht spinal cord

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32
Q

hemangioblastoma association

A

VHL

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33
Q

pleomorphic xanthroastrocytoma

A

WHO II astrocytoma variant

kids and adolescents, usually with chronic epilepsy

supratentorial cortical cystic mass with enhancing mural nodule ; thickened dura

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34
Q

PXA vs ganglioglioma

A

PXA causes dural thickening, ganglioglioma does not

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35
Q

ganglioglioma

A

adolescent/young adult tumor with medically refractory temporal lobe epilepsy

neuroglial tumor

temporal lobe cyst and enhancing nodule, that calcifies; may cause calvairal remodeling and scalloping

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36
Q

intraventricular tumors

A

central neurocytoma, choroid plexus papilloma, intraventricular meningioma, subependymal giant cell astrocytoma, subependymoma,

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37
Q

intraventricular meningioma

A

solid mass in trigone of lateral ventricle

hypercellular, homogenously enhancing

typically older patients

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38
Q

subependymal giant cell astrocytoma

A

WHO I

enhancing mass near foramen of monroe

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39
Q

SEGA associations

A

tuberous sclerosis: subependymal nodules and hamartomas also seen

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40
Q

subependymoma

A

nonenhancing low grade tumor from subependymal astrocytes/ependymal cells/precursor cells?

middle age/older adults

obex of 4th ventricle or foramen of monro

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41
Q

CNS lymphoma

A

usually diffuse large B cell lymphoma

primary CNS lymphoma is usually periventricular ( and melts away with chemoradiaiton but can recur aggressively

appearance depends on immune status

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42
Q

CNS lymphoma vs toxoplasmosis clinical/imaging options

A
  • empiric anti-toxoplasmosis therapy
  • thallium scanning (CNS is thallium avid)
  • PET: toxo doesn’t have uptake
  • perfusion scanning: CNS has increased relative cerebral blood volume
43
Q

most common intra-axial mets, location

A

lung, breast, melanoma

commonly at the gray-white junction

44
Q

dural neoplasms

A

meningioma, dural mets

45
Q

most common extra-axial tumor

A

meningioma

46
Q

meningioma cell of origin, pt population

A

meningoepithelial cells or arachnoid “cap” cells

elderly adults with female predominance and most often asymptomatic`

47
Q

most common pediatric brain tumor

A

medulloblastoma

48
Q

most common cystic mass with enhancing mural nodule in posterior fossa in kid?

A

JPA

49
Q

intraventricular mass that pushes through 4th ventricle

A

ependymoma

50
Q

cystic mass with enhancing mural nodule and flow voids? history of VHL?

A

hemangioblastoma

51
Q

pt younger than age of medulloblastoma? renal mass present?

A

ATRT

52
Q

posterior fossa mass in adult with little/no enhancement

A

astrocytoma

53
Q

posterior fossa mass in young adult, lateral location?

A

medulloblastoma

54
Q

important landmarks of CP angle

A

pons, cerebellum, posterior aspect of petrous temporal bone

CN 5, 7, 8 and AICA

55
Q

schwannoma

A

vestibulocochlear (CN 8) nerve schwannoma is the most common CPA mass

56
Q

imaging appearance of schwannoma

A

T2 hyperintense, “ice crea cone” appearance protrouding through porus acousticus, may become cystic when larger

57
Q

second most common CPA mass

A

meningioma

58
Q

features of CPA meningioma

A

shorter dural enhancement, bony hyperostosis, calcifications

does not enlarge porous acousticus, unlike schwannoma

59
Q

arachnoid cyst

A

benign CSF filled lesion, usually congenital

usually supratentorial but may be in CPA

follows CSF on all sequences, does not restrict diffusion (unlike epidermoid cyst)

60
Q

CPA aneurysm

A

vertebrobasilar aneurysm; avidly enhances

look for flow void or pulation artifacts

61
Q

CPA epidermoid

A

arises from ectopic ectodermal epithelial tissue

cauliflower like surface as it grows and encases adjacent structures

restricts diffusion, similar to T1 and T2 cyst; does not suppress on FLAIR

62
Q

intraaxial CPA masses

A

posterior fossa mass may invade laterally into CPA, exophiytic brainstem glioma or met

lateral medulloblastoma in older children/young adults
ependymoma may squeeze into lateral 4th ventricle
hemangioblastoma

63
Q

VHL in the brain

A

hemangioblastoma, endolymphatic sac tumor (posterior petrous ridge)

64
Q

rathke’s pouch

A

invagination from primitive oral cavity

65
Q

issues with rathke’s pouch

A

rathke’s pouch cyst or craniopharyngioma

66
Q

anterior lobe of pituitary gland

A

growth hormone, ACTH, prolactin, TSH, FSH, LH

67
Q

posterior lobe of pituitary gland

A

neuroectoderm, vasopressin/oxytocin

68
Q

pituitary gland signal

A

hyperintense on T1; posterior pituitary bright spot

69
Q

empty sella

A

normal variant although may be seen with pseudotumor cerebri

70
Q

ddx for intrinsic pituitary mass

A

pituitary adenoma, rathke’s cleft cyst, hypophysitis; craniopharyngioma

71
Q

pituitary microadenoma

A

<1 cm in size; symptoms of hormone excess; usually hypoenhancing

72
Q

pituitary macroadenoma

A

> 1 cm, mass effect (compression of optic chiasm), bony sella remodeling, may encase carotid and do not narrow it (unlike meningiomas or mets); may bleed after medical treatment

73
Q

lymphocytic hypophysitis

A

autoimmune inflammatory disroder in peripartum women

presentation: diabetes insipidus, headache, visual impairment, endocrine dysfunction

MRI: thickening/intense enhancement of pituitary stalk

74
Q

granulomatous hypophysitis

A

inflammation of pituitary/infundibulum, may be secondary to sarcoid, wegener, TB, LCH

75
Q

LCH hypophysitis

A

disease of children; imaging identical to lymphocytic hypophysitis

76
Q

rathke cleft cyst

A

extrinsic to pituitary

77
Q

suprasellar mass mnemonic

A

SATCHMO

Sarcoidosis/Suprasellar extension of an adenoma.
Aneurysm.
Teratoma (dermoid cyst)/Tolosa hunt.
Craniopharyngioma/Cleft cyst (Rathke’s).
Hypothalamic glioma (adults)/Hypothalamic hamartoma (children). Meningioma/Metastasis.
Optic nerve glioma.

78
Q

craniopharyngioma

A

most common suprasellar lesion of childhood; squamous epithelial remnants of rathke’s pouch that produce keratin

79
Q

craniopharyngioma age distribution, locaiton

A

bimodal: childhood, late middle age

sella/suprasellar regions

80
Q

imaging appearance craniopharyngioma

A

enamel production > calcification with intracystic machine oil composed of desquamated squamous epithelium, keratin, cholesterol

complex cystic mass, T1 bright
avid enhancement of solid elements/cyst walls
calcifications; usually separate from pituitary

81
Q

rathke’s cleft cyst component

A

simple columnar/cuboidal epithelium; precursor of anterior lobe of pituitary gland

middle aged adults

82
Q

rathke’s cleft imaging appearance

A

cyst content: iso to CSF or T1 hyperintense

claw sign of enhancing pituitary tissue wrapping around cyst

does not calcify

83
Q

suprasellar meningioma

A

common with females, visual loss due to optic pathway involvement

84
Q

astrocytoma (optic pathway glioma)

A

second most common suprasellar mass in children

associated with NF1

85
Q

germinoma

A

most common intracranial germ cell tumor

86
Q

epidermoid/dermoid cyst

A

benign inclusion cyst

CPA middle aged adults for epidermoids; follows CSF signal and restricts diffusion

posterior fossa adult males for dermoids; contain fat which can cause meningitis with rupture

87
Q

aneurysm

A

saccular supraclinoid ICA aneurysm

pulsation artifact present on MRI

88
Q

hamartomata of tuber cinereum

A

hypothalamic hamartoma

ectopic hypothalamic neural tissue with precocious puberty and gelastic seizures (laughing spells)

does not enhance

89
Q

suprasellar pediatric masses

A

craniopharyngioma, optic pathway glioma, germ cell tumor, hypothalamic hamartoma, LCH

90
Q

suprasellar mass in adults

A

pituitary macroadenoma, meningioma, craniopharyngioma, rathke’s cleft cyst, aneurysm, lymphocytic/granulomatous hypophysitis

91
Q

pineal gland location

A

posterior aspect of 3rd ventricle; between thalami

located between cerebral veins and vein of galen

92
Q

pineal gland production

A

melatonin; does not have BBB

93
Q

complications of mass in pineal region

A

compress midbrain, compress cerebral aqueduct, compression of tectal plate (Perinaud syndrome–inability to look up, pupillary light dissociation, nystagmus)

94
Q

importance of cerebral veins an pineal region masses

A

tentorial meningiomas depress internal cerebral veins

pineal gland masses lift cerebral veins

95
Q

extragonadal germ cell tumros (brain)

A

midline

germinoma and teratoma germ cell tumors are the most and second most common pineal region tumors

96
Q

germinoma – pineal

age, imaging appearance, treatment

A

most common pineal region tumor in young people (10-1 yo)

germinoma will engulf pineal gland and be centrally calcified

image for leptomeningeal deposits

treatment with radiotherapy

97
Q

teratoma – pineal

A

second most common pineal region tumor

worse prognosis compared to germnoma

heterogenous imaging (intralesional fat); prone to hemorrhage and coarse calcifications

98
Q

pineal cysts

A

more common in women; seen commonly on MRI

usually <1 cm and asymptomatic

may have some peripheral enhancement, rim calcification, or be slightly complex

99
Q

pineocystoma

A

cystic lesion with peripheral enhancement

100
Q

pineocytoma

A

low grade WHO I/II slow growing pinealocyte tumor

solid component would enhance

101
Q

pineoblastoma

A

malignant grade WHO IV tumor of children, same as PNET (medulloblastoma)

trilateral retinoblastoma (when there is bilateral retinoblastoma + pineal gland)

quadrilateral retinoblastoma if sella also inolved

102
Q

pineoblastoma complications, imaging findings

A

obstructive hydrocephalous

restricts diffusion, periherally calcifies like an exploded calcification (vs englulfing like germinoma)

103
Q

pineal metastases

A

lack BBB, easy site of mets

leptomeningeal disease usually has pineal mets

104
Q

pineal region masses

A

glioma, vein of galen aneurysm, meningioma, quadrigeminal plate lipoma,

CORE: Neuro (21 decks)

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