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Adult Brain tumors Flashcards

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1
Q

What is more common - Primary brain tumors or brain metastases?

A

Brain metastases

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2
Q

Types of glial tumors?

A

Astrocytoma, Ependymoma, oligodendroglioma

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3
Q

Are mixed glial tumors possible?

A

Yes

e.g. oligo-astrocytoma

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4
Q

Can tumors have both neuronal and glial components?

A

Yes

e.g. ganglioglioma

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5
Q

What can mimic a brain tumor?

A

Developmental Cysts

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6
Q

Types of nerve tumors?

A

Neurofibroma

Schwannomas

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7
Q

Most common primary brain neoplasms?

A 
Infiltrative astrocytoma (42%)
Glioblastoma mulitforme (GBM) (40%)
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8
Q

Intra-axial tumors?

A

Glioma, Pituitary, Lymphoma

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9
Q

Extra-Axial Tumors?

A

Meningioma

Acoustic Neuroma

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10
Q

Definite Risk factors for CNS Tumors?

A

Ionizing radiation
Immunosuppresion
Genetic Syndromes

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11
Q

Possible risk factors for CNS Tumors?

A

Electromagnetic fields
Diet
Occupation
Infections

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12
Q

Li-Fraumeni syndrome -Inheritance? Tumor type? Chromosome? Gene?

A

AD; Glioma, medulloblastoma; 17p13; TP53

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13
Q

Tuberous sclerosis -Inheritance? Tumor type? Chromosome? Gene?

A

AD; Subependymal giant cell astrocytoma, cortical tubers, glioma; 9q34, 16p13; TSC1, TSC2

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14
Q

Neurofibromatosis type 1 -Inheritance? Tumor type? Chromosome? Gene?

A

AD; Glioma(optic nerve), astocytoma, glioblastoma; 17q11; NF1

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15
Q

Neurofibromatosis type 2 -Inheritance? Tumor type? Chromosome? Gene?

A

AD; meningioma, schwannoma (bilateral acoustic neuroma), ependymomas; 22q12; NF2

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16
Q

Multiple Endocrine Neoplasia -Inheritance? Tumor type? Chromosome? Gene?

A

AD; Pituitary; 11q13; Menin

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17
Q

Retinoblastoma -Inheritance? Tumor type? Chromosome? Gene?

A

AD; Retinoblastoma; 13q14; RB1

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18
Q

Von Hippel-Lindau Disease -Inheritance? Tumor type? Chromosome? Gene?

A

AD; Hemangioblastoma; 3p25-20; VHL

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19
Q

What is the plateau wave phenomenon?

A

A phenomenon in which as intracranial volume slowly increase (e.g. tumor growth) intracranial pressure remains constant. However once compliance threshold is reached small volume increases cause large increase in intracranial pressure.

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20
Q

General signs and symptoms of CNS Tumors?

A

Headache
Vomiting
Mental status changes - depression, irritability, apathy

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21
Q

When should a headache lead you to suspect CNS tumor?

A

Worse on awakening with improvement within 1 hour
New onset at any age
Change in character or severity of headaches in chronic headache patient

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22
Q

Characteristics of vomiting associated with CNS tumors?

A

May or may not be associated with nausea
Occurs more often on awakening
More common in children

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23
Q

Focal signs and symptoms of CNS tumors?

A

Papilledema
Seizures
Focal neurologic deficits

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24
Q

Papilledema in CNS tumors is more often seen in whom?

A

Children and young adults

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25
Subfalcine herniation of cingulate gyrus may cause?
Compression of ACA and CVA
26
Dienchephalic downward herniation may cause?
Compression of upper brainstem leading to drowsiness, impaired vertical gaze and uni- or bilateral small pupils because of involvement of sympathetic fibers (Horner Syndrome)
27
Classical uncal herniation may cause?
ipsilateral oculomotor nerve palsy and contra or ipsilateral hemiparesis
28
Upward herniation through tentorium may cause?
May cause ipsilateral oculomotor, Horner (mid position unreactive pupil) and contralateral hemiparesis
29
Tonsillar herniation may cause?
BP changes, weakness, respiratory disturbance, weakness and Horner syndrome.

30
What is the gold standard for suspected tumor?
MRI w/ and w/o contrast
31
What use do CT play in identifying CNS tumors?
Help ID calcification which yield clues to the pathology of the tumor (i.e. oligodendrogioma)
32
How does water(i.e. CSF, tumor, edema) appear in T1 weighted MRI scan? What happens with contrast?
Hypointense(dark) | If leaking across disrupted BBB (i.e. Tumors with unfinished angiogenesis) will appear hyperintense(bright)
33
How does water (i.e. CSF, tumor, edema) appear in T2 weighted MRI scan?
Hyperintense(bright)
34
How does still water (i.e. tumor, edema) appear in a FLARE MRI? Moving water (i.e. CSF)?
Hyperintense (bright) | Hypointense (dark)
35
What is a glioma?
Umbrella term used to describe tumors that are derived from the supporting glial cells of the CNS
36
What is the most common primary CNS tumor?
Glioma (>50%)
37
Low grade tumors are seen in what population? High grade tumors?
Younger 50 yrs
38
Major subtypes of gliomas?
Astrocytoma Oligodendroglioma Ependymoma
39
Describe Grade 1 gliomas?
Least malignant, grow slowly, usually non-infiltrative, almost normal histo appearance, surgery alone usually effective, non-enhancing on T1 contrast. Good probability of cure with complete surgical resection.
40
Describe Grade 2 gliomas?
Relatively slow growing, more abnormal histo appearance, can invade adjacent normal tissue, may recur, sometimes recur as a higher grade. Typically non-enhancing on T1 with contrast. Low probability of cure even with good surgical resection. Survival over many years.
41
Describe Grade 3 gliomas?
Malignant, actively reproducing abnormal cells, infiltrate adjacent normal brain tissue, tend to recur, often as higher grade, typically enhancing on T1 contrast. Very low probability of cure. Median survival 2-3 yrs
42
Describe Grade 4 gliomas?
Reproduce rapidly, bizarre histo appearance, infiltrate widely, induce the formation of new blood vessels so they can maintain their rapid growth, necrosis in center. Survival months
43
Better Survival prognostic?
Younger age Good performance status Tumor grade/histo Degree of tumor resection O(6)-methyl guanine - DNA methytransferase (MGMT) methylation Isocitrate dehydrogenase 1 (IDH1) mutation 1p and 19q deletion in oligodendroglioma
44
When is the peak incidence of meningioma?
45 yrs old - women > men
45
Meningiomas are derived from what?
arachnoid membrane (arachnoid cap cells)
46
Growth rate of meningioma?
Slow
47
Common locations of meningioma?
Convexity, parasagittal, optic sheath
48
Imaging characteristics of meningioma?
Dark on T1, Bright on T2
49
Histo of meningioma?
Spindle shaped cells arranged in sheets and whorls
50
Can you see calcifications in meningiomas?
Yes
51
What are meningiomas considered?
Extra-axial tumors
52
Where are pituitary tumors typically derived from?
Anterior pituitary
53
Which type of pituitary tumors are functional? Which are non-functional?
Microadenomas (1cm)
54
What happens when Macroadenoma pituitary adenomas grow too large?
Compression and hypofunction of pituitary gland or compression of the pituitary stalk
55
Signs/Symptoms of pituitary tumors?
Headache, Endocrine dysfunction, Visual Field defects
56
What type of visual field defects are seen in pituitary tumors?
Classical Bitemporal heminopsia starting with upper quadrant (compression of chiasm) Unilateral blindness (optic n. compression) Diplopia (invasion of cavernous sinus compressing CN III, IV, VI) Facial numbness (invasion of cavernous sinus compressing CN V)
57
Another name for acoustic neuroma?
Vestibular schwannoma
58
Where do acoustic neuromas typically originate from?
Schwann cells surrounding the vestibular portion of CN VIII
59
Where do acoustic neuromas most commonly arise from?
W/n the internal auditory canal or cerebellopontine angle
60
What age group do acoustic neuromas typical frequent?
Middle Aged adults
61
Typical symptoms of acoustic neuromas?
``` Hearing loss Tinnitus Headache Dizziness Facial numbness or weakness ```
62
Bilateral acoustic neuromas are pathognomic for what?
Neurofibromatosis type 2
63
Primary CNS Lymphoma commonly affect what?
Leptomeniges and deeper periventruclar brain parenchyma
64
If Primary CNS Lymphoma is suspected when should you start steroids?
After biopsy
65
What might a lumbar puncture in a patient with CNS lymphoma show?
Monoclonal population of B-Cells in the CSF
66
Tumors that metastasize to the brain?
Small/Non-small cell lung cancer [50%] Breast Cancer [15-20%] (Most common brain metastases in females) Melanoma [10%] (highest propensity to met to brain) Colon cancer [5%] Renal Cell Carcinoma Unknown primary in 10% of Brain mets
67
Signs/symptoms of Spinal Cord Tumors?
Pain Weakness plus UMN/LMN findings Paresthesias
68
Classifications of spinal cord tumors are based on?
Origin -Primary or metastatic Location -Extra-dural or intra-dural extramedullary or intra-dural intramedullary
69
Majority of extradural spinal cord tumors are what?
Spinal Mets
70
Common primary sites of extradural spinal cord tumor mets?
Breast, lungs, prostate, renal cell carcinoma, lymphoma, and sarcoma
71
What are common types of intradural extramedullary spinal cord tumors?
Schwannomas Neurofibromas Meningiomas
72
What are common types of intradural intramedullary spinal cord tumors?
Astocytomas (most common in peds) Ependynoma (most common in adults) Hemangioblastoma

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