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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
atypical teratoid/rhabdoid tumor (ATRT)
WHO IV, aggressive tumor occurs in younger patients, usually in posterior fossa
26
associations for ATRT
malignant rhabdoid tumor of kidney
27
medulloblastoma
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
28
sugar coating (Zuckerguss)
leptomeningeal mets, common in medulloblastoma imaging should be performed on brain and spine
29
medulloblastoma in young adult
eccentric in posterior fossa
30
Ddx for tumors with cyst and enhancing nodule
JPA, hemangioblastoma, PXA, ganglioglioma also neurocysterosarcosis, parasites/abscess
31
hemangioblastoma
WHO I vascular tumor, cystic mass with enhancing mural nodule typically cerebellum, medulla, spinal cord, so associated with syrinx wiht spinal cord
32
hemangioblastoma association
VHL
33
pleomorphic xanthroastrocytoma
WHO II astrocytoma variant kids and adolescents, usually with chronic epilepsy supratentorial cortical cystic mass with enhancing mural nodule ; thickened dura
34
PXA vs ganglioglioma
PXA causes dural thickening, ganglioglioma does not
35
ganglioglioma
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
36
intraventricular tumors
central neurocytoma, choroid plexus papilloma, intraventricular meningioma, subependymal giant cell astrocytoma, subependymoma,
37
intraventricular meningioma
solid mass in trigone of lateral ventricle hypercellular, homogenously enhancing typically older patients
38
subependymal giant cell astrocytoma
WHO I enhancing mass near foramen of monroe
39
SEGA associations
tuberous sclerosis: subependymal nodules and hamartomas also seen
40
subependymoma
nonenhancing low grade tumor from subependymal astrocytes/ependymal cells/precursor cells? middle age/older adults obex of 4th ventricle or foramen of monro
41
CNS lymphoma
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
42
CNS lymphoma vs toxoplasmosis clinical/imaging options
- 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
most common intra-axial mets, location
lung, breast, melanoma commonly at the gray-white junction
44
dural neoplasms
meningioma, dural mets
45
most common extra-axial tumor
meningioma
46
meningioma cell of origin, pt population
meningoepithelial cells or arachnoid "cap" cells elderly adults with female predominance and most often asymptomatic`
47
most common pediatric brain tumor
medulloblastoma
48
most common cystic mass with enhancing mural nodule in posterior fossa in kid?
JPA
49
intraventricular mass that pushes through 4th ventricle
ependymoma
50
cystic mass with enhancing mural nodule and flow voids? history of VHL?
hemangioblastoma
51
pt younger than age of medulloblastoma? renal mass present?
ATRT
52
posterior fossa mass in adult with little/no enhancement
astrocytoma
53
posterior fossa mass in young adult, lateral location?
medulloblastoma
54
important landmarks of CP angle
pons, cerebellum, posterior aspect of petrous temporal bone CN 5, 7, 8 and AICA
55
schwannoma
vestibulocochlear (CN 8) nerve schwannoma is the most common CPA mass
56
imaging appearance of schwannoma
T2 hyperintense, "ice crea cone" appearance protrouding through porus acousticus, may become cystic when larger
57
second most common CPA mass
meningioma
58
features of CPA meningioma
shorter dural enhancement, bony hyperostosis, calcifications does not enlarge porous acousticus, unlike schwannoma
59
arachnoid cyst
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
CPA aneurysm
vertebrobasilar aneurysm; avidly enhances look for flow void or pulation artifacts
61
CPA epidermoid
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
intraaxial CPA masses
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
VHL in the brain
hemangioblastoma, endolymphatic sac tumor (posterior petrous ridge)
64
rathke's pouch
invagination from primitive oral cavity
65
issues with rathke's pouch
rathke's pouch cyst or craniopharyngioma
66
anterior lobe of pituitary gland
growth hormone, ACTH, prolactin, TSH, FSH, LH
67
posterior lobe of pituitary gland
neuroectoderm, vasopressin/oxytocin
68
pituitary gland signal
hyperintense on T1; posterior pituitary bright spot
69
empty sella
normal variant although may be seen with pseudotumor cerebri
70
ddx for intrinsic pituitary mass
pituitary adenoma, rathke's cleft cyst, hypophysitis; craniopharyngioma
71
pituitary microadenoma
<1 cm in size; symptoms of hormone excess; usually hypoenhancing
72
pituitary macroadenoma
>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
lymphocytic hypophysitis
autoimmune inflammatory disroder in peripartum women presentation: diabetes insipidus, headache, visual impairment, endocrine dysfunction MRI: thickening/intense enhancement of pituitary stalk
74
granulomatous hypophysitis
inflammation of pituitary/infundibulum, may be secondary to sarcoid, wegener, TB, LCH
75
LCH hypophysitis
disease of children; imaging identical to lymphocytic hypophysitis
76
rathke cleft cyst
extrinsic to pituitary
77
suprasellar mass mnemonic
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
craniopharyngioma
most common suprasellar lesion of childhood; squamous epithelial remnants of rathke's pouch that produce keratin
79
craniopharyngioma age distribution, locaiton
bimodal: childhood, late middle age sella/suprasellar regions
80
imaging appearance craniopharyngioma
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
rathke's cleft cyst component
simple columnar/cuboidal epithelium; precursor of anterior lobe of pituitary gland middle aged adults
82
rathke's cleft imaging appearance
cyst content: iso to CSF or T1 hyperintense claw sign of enhancing pituitary tissue wrapping around cyst does not calcify
83
suprasellar meningioma
common with females, visual loss due to optic pathway involvement
84
astrocytoma (optic pathway glioma)
second most common suprasellar mass in children associated with NF1
85
germinoma
most common intracranial germ cell tumor
86
epidermoid/dermoid cyst
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
aneurysm
saccular supraclinoid ICA aneurysm pulsation artifact present on MRI
88
hamartomata of tuber cinereum
hypothalamic hamartoma ectopic hypothalamic neural tissue with precocious puberty and gelastic seizures (laughing spells) does not enhance
89
suprasellar pediatric masses
craniopharyngioma, optic pathway glioma, germ cell tumor, hypothalamic hamartoma, LCH
90
suprasellar mass in adults
pituitary macroadenoma, meningioma, craniopharyngioma, rathke's cleft cyst, aneurysm, lymphocytic/granulomatous hypophysitis
91
pineal gland location
posterior aspect of 3rd ventricle; between thalami located between cerebral veins and vein of galen
92
pineal gland production
melatonin; does not have BBB
93
complications of mass in pineal region
compress midbrain, compress cerebral aqueduct, compression of tectal plate (Perinaud syndrome--inability to look up, pupillary light dissociation, nystagmus)
94
importance of cerebral veins an pineal region masses
tentorial meningiomas depress internal cerebral veins pineal gland masses lift cerebral veins
95
extragonadal germ cell tumros (brain)
midline germinoma and teratoma germ cell tumors are the most and second most common pineal region tumors
96
germinoma -- pineal age, imaging appearance, treatment
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
teratoma -- pineal
second most common pineal region tumor worse prognosis compared to germnoma heterogenous imaging (intralesional fat); prone to hemorrhage and coarse calcifications
98
pineal cysts
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
pineocystoma
cystic lesion with peripheral enhancement
100
pineocytoma
low grade WHO I/II slow growing pinealocyte tumor solid component would enhance
101
pineoblastoma
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
pineoblastoma complications, imaging findings
obstructive hydrocephalous restricts diffusion, periherally calcifies like an exploded calcification (vs englulfing like germinoma)
103
pineal metastases
lack BBB, easy site of mets leptomeningeal disease usually has pineal mets
104
pineal region masses
glioma, vein of galen aneurysm, meningioma, quadrigeminal plate lipoma,

CORE: Neuro (21 decks)

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