Flashcards in Neoplasms Deck (34):
4 sx of CNS tumor
1) progresive, focal neuro deficit
2) HA worse in recumbency and associated with N/V + other sx of incr ICP
3) seizures if irritate cerebral cortex
4) gradual cognitive slowing and personality changes
def on location and rate of growth. if have sx of systemic disease like fever and wt loss, more likely to be metastatic than primary CNS tumor.
anterior frontal lobe tumor
present with weakness (primarily with CL leg), personality changes (disinhibition, poor judgement, cog slowing, aphasia for left sided lesions), urinary incontinence due to diruption of micturition inhibition center, gaze preference, primitive reflexes (grasp, suck) seizures
posterior frontal lobe tumor
present with CL weakness, expressive aphasia for left sided lesion, neglect for right, seizures
temporal lobe tumors
present with memory impairment, wenches type aphasia for left sided lesions. CL superior quadratanopsia, neglect for right sided lesions, seizures
occipital lobe tumor
CL homonymous hemianopsia, visual hallucination, alexia without agraphia for left sided tumor involving corpus callosum, seizures
tumor of thalamus
CL sensory loss, aphasia for left sided lesions
an astrocytoma of cerebral hemisphere. any tumor with necrosis, vascular prolif, pleomorphic cells positive for immunostatin stain. imaging- heterogeneously enhancing masses with non enhancing area = necrosis
type of malignant glioma characterized by extensive tumor infiltration without discrete mass or area of necrosis. no pathognomoic clinical presentation. in ppl <40yo.
tx: whole brain radiation and chemo. - 3y lifespan
5% are multi centric which look the same as metastatic disease or demyelination
HA, hydrocephalus, CN deficit IL to lesion and S/M deficit CL to lesion. no surgical resection
CNS tumor tx
grade I- complete surgical resection is curative.
high grade- surgery not curative but done for histo and to relieve mass effect. when <65yo, extent of resection correlate with survival. rads- extend survival in high grade gliomas. stereotaxic radio surgery for small tumors
radiation tx v imaging
wks to mo afterwards- reversible edema- hyper intensity on FLAIR. mo-y- demylination and damage to blood vessels, WM changes, mass effect and enhancement with contrast. so this looks like recurrent tumor. PET use to DD recurrent tumor and physio recovery from radiotherapy
juvenile pilocystic astrocytoma(JPA)
benign who grade I tumor. usually in cerebellar hemisphere but can be anywhere. present with sx of incr ICP, HA, ataxia. often a feature of neurofibromatosis type I when grow on optic pathway.
tx: surgical resection,
image- well circumscribed, large cystic component with enhancing mural nodule. cyst is isodense to CSF on all seq
most common type(50%) of IC neoplasm in children and young adult. 75% are JPAs
most freq is meduloblastomas. 2nd- JPAs
slow growing, children/young adult
mix of glial and neural element (if neural dom then ganglioneuroma), can undergo malig transformation
most commonly in temporal lobe, then frontal, parietal, occipital. may be found near hypothalamus and infratentorially. cystic tumor w/wo solid component.
variable degree of enhancement, calcification common on CT - DD from JPA and pleomorphic xanthrocytoma
benign, slow growing neoplasm in 4th ventricle, do not invade brain or cerebellum. present with sx of incr ICP.
arise from orbital groove or plan sphenoidal. present with cog changes, frontal lobe behavioral abn, seizures, HA, parplegia. part of sphenoid bone, anterior to sella truck and above sphenoid sinus
surgical resection with preoperative embolization of tumor. 25% recur. malign recur at 80%-need rad.
slow growing, usually benign. 20% of primary CNS neoplasm. arise from cells of arachnoid. adherent to dura and rarely invade brain but does invade and remodel skull. in middle aged women. multi in brain and SC could be must in chromosome 22 as part of neurofibromatosis type II.
prior rad is only RF
make sx by compress nervous tissue bc extraxial. sx depend on location. highly calcified 25% of time. some cyst formation in middle or periphery. hyperostosis
from pericytes. aggressive extra axial tumor. no calcification. tx-surgery. high recurrence
tumor of pineal area
1% of CNS tumor. HA, hydrocephalus if compress cerebral aqueduct, vertical gaze palsy if compress midbrain, circadium rhythm D. mostly germinomas
tx: chemo and rad.
serum marker: HCG and placental alkaline phosphatase
pineal region neopalsm types
arise from pineal gland- pineolblastoma (type of PNET- mostly under 10yo), pinealcytomas. germ cell origin (germinomas, teratomas, embryonal carcinomas, choriocarcinoma)- more common in kids.
60% of germ cell tumor of pineal gland. in suprasellar region. men and asian. spread throughout sf.
chemo and radio.
serum markers- HCGna d placental alkaline phosphatase
surgery and rad. 60% 5y survival rate.
less malign. tx with surgery alone. 5y survival rate 90%. clinically silent until affect midbrain and cause visual sx.
meningioma from tentorium cerebelli
ataxia, restricted up gaze if compress dorsal midbrain. HA if compromise CSF flow
meningioma of cerebellopontine angle
present with tinnitus and gradual onset of hearing loss and facial weakness. large tumors impinge on brainstem causing dysarthria, dysphagia, ataxia, weakness.
meningioma high grade
atypic- grade II. anaplatic/malig- grade III. high mtitotic rate. heterogenous enhancement and sig peritumoral edema.
low grade meningioma MRI
uniformly enhacne with contrast admin. edema. dural tail from meninges flanking bulk of tumor
optic nerve sheath meningioma
most common intraorbital tumor. mostly unilateral, present in middle age women with diplopia, transient visual obscuration, slow visual loss. surgery in pt with rapidly progressive visual loss bc surgery causes visual loss. sterotatic radiotherapy
primary CNS lymphoma
from B cells. origin unclear bc no lymphoid tissue in CNS. usually subcortical. cog decline and focal neuro deficit. spread via CSF to eyes and bone. no surgery
MRI- enahcne avidly with contrast. dark on T2 seq and bright diffusion weighted images, uniformly enhancing in immunocompetent. tx with glucocorticoid shrinks on imaging.
in immunocompent- chemo works- methotrexate and rad.
metastatic brain ca
20% ca. spread via blood. most common at gray-white junction where there is slow blood flow. lung ca -50% meta to brain then breast, melanoma, renal cell carcinoma.
glucocorticoid reduce edema and improve sx. resection of up to 3 lesions is beneficial. 30% has seizure but no prophylactic anticonvulsant