Neoplasms of the Brain Flashcards Preview

Neurology Module > Neoplasms of the Brain > Flashcards

Flashcards in Neoplasms of the Brain Deck (62):
1

Prevalence of Primary Brain Tumors

2% of all cancers

2

Peak incidence of Primary brain tumors

65-79

3

Men vs Women for Brain tumors

Men > Women for most tumors.

4

Risk factors for Brain Tumors

High dose ionizing radiation.

5

Signs and Symptoms of Brain Tumors

Headaches
Seizures
Congitive/Personality Changes
Focal Weakness
N/V
Speech Difficulty
Visual Changes

6

PE findings for Brain Tumor

Papilledema
CN6 Palsy
Motor Exam
Gait disturbance

-Depends on brain tumor location.

7

Benign Brain Tumors

Meningioma (30%)
Pituitary Adenoma (5-10%)
Schwannoma (3-5%)
Craniopharyngioma (<2%)

8

Most common benign brain tumor

Meningioma

9

Malignant Brain Tumors

Gliomas
Astrocytoma (18-20%)
Glioblastoma (35-40%)
Oligodendroglioma
Pineal tumor (2%)
Medulloblastoma (<1%)

10

Most common malignant brain tumor

Glioblastomas

11

"Other" Types of Brain Tumors

neurofibromatosis
metastatic tumors

12

Most common Pediatric Brain Tumors

Medulloblastoma

13

What are the most solid tumors in children?

Brain tumors

14

Brain tumor types in children

Astrocytoma
Brain stem gliomas
Ependyoma
Craniopharyngioma
+/- others

15

Most common type of brain tumor

Meningioma

16

Meningioma Women v Men

3:1

17

Where do meningiomas come from?

Arise from the meninges in the arachnoid space

18

What may be a problem with a meningioma in the intraventricular sinus?

Hydrocephalus

19

Which meningiomas are more difficult to remove?

Those in the base of the skull.

20

What problem would a meningioma in teh posterior fossa cause?

Cranial Nerve Palsies and issues

21

Diagnosis of Meningiomas

Distinct radiological characteristics
-“dura tail”
-Indentation of brain

22

Meningioma Grading

Grade I: Meningioma (85%)- benign

Grade II: Atypical meningioma (15%)
Neither cancerous, nor benign
Grow faster, recur

Grade III: Anaplastic meningioma (1-4%)
Malignant
Invasive

23

Benign Meningioma

Grade I
85%

24

Atypical Meningioma

Grade II
15%

Neither cancerous, nor benign
Grow faster, recur

25

Anaplastic Meningioma

Grade III
1-4%

Malignant
Invasive

26

Treatment of Meningioma

Watchful waiting

Craniotomy
-Remove as much of the tumor as possible
-Location and size are factors

Radiation
-Sterotactic radiation
-“stereotactic radiosurgery”
-“gamma knife”

27

Familial Link of Pituitary Adenomas

Familial link- multiple endocrine neoplasia type 1 (MEN1)

28

Pituitary adenomas account for _____% of tumors

10

29

Presentation of pituitary adenomas depends on

type of cell abnormality

30

Signs and Symptoms of Prolactinoma

Lactotrophs
Gallactorrhea, gynecomastia
Suppression of LH:
Women: infertility, amenorrhea
Men: ED

31

Most common pituitary adenoma.

Prolactinoma

32

S/S Growth Hormone

Somatotrophs
Acromegaly

33

S/S Nonfunctioning adenoma

No hormonal abnormalities
Compresses optic nerve

34

S/S Adrenocorticotropin Hormone (ACTH)

corticotrophs
Cushing’s

35

S/S LS/FSH pitutiary adenoma

gonadotrophs

36

TSH Pituitary Adenoma

thyrotrophs
Increased TSH

Secondary Hyperthyroidism

37

Pituitary Adenoma classified by

Size

38

Pituitary Adenoma > or = 10 mm

Macroadenoma

39

Pituitary Adenoma <10 mm

Microadenoma

40

Treatment/Management of Pituitary Adenoma

Consult:
Endocrinology and Neurosurgery
Nonfunctioning: ophthalmology

Medical management

Surgical approach:
Minimally invasive endonasal endoscopic surgery

If surgery not option or recurrence:
Stereotactic- these tumors do not respond quickly to radiation and may take months to control

41

Craniopharyngiomas occur near

the pituiatary gland.

42

Craniopharyngiomas are classified as

a pituitary tumor

43

How do Craniopharyngiomas differ from pituitary adenomas?

Adenomas arise from cells in the anterior lobe

Craniopharyngiomas arrive from cells in Rathke’s duct

Craniopharyngiomas have bimodal peak- ages 5-14 and 65-74

44

S/S Craniopharyngiomas

May disrupt pituitary function
Optic nerve compression
Increased ICP

45

Treatment of Craniopharyngioma

same as pituitary adenoma except usually subtotal excision + radiation (recurrence rate 15%)

46

Peak age of Schannoma - Acoustic Neuroma

30-60

47

Acoustic Neuroma occur on CN

CN VIII - Vestibulocochlear

48

Characteristics of Schwannoma - Acoustic Neuroma

Benign but can cause serious, life threatening complications rarely (brain stem compression, hydrocephalus)

49

Symptoms of Schwannoma-Acoustic Neuroma

Usually unilateral (except in neurofibromatosis2)

Hearing loss- unilateral
Tinnitus x 1 month or longer
Vertigo- episodic

Weber’s Test - lateralizes to good ear.
Rinne- BC>AC

50

Imaging of Schwannoma-Acoustic Neuroma

MRI with attention to internal auditory canals

51

Treatment of Schwannoma-Acoustic Neuroma

Surgery:

Keyhole surgery: Retromastoid/retrosigmoid craniotomy

Minimizes risk of damage to cranial nerve and preservation of hearing

52

Malignancies arising from glial cells.

Gliomas

53

Glial Cells Include

Astrocytes
Oligodendrocytes
Ependymal

54

Functions of Astrocytes

Communicate with neurons
Supportive- nutrients
Blood brain barrier

55

Functions of Oligodendrocytes

Wrap around axons
Myelinate

56

Functions of Ependymal

Line Ventricles
Produce/Absorb CSF

57

Types of Glial Cell Malignancies/Gliomas

Astrocytoma
Brainstem glioma
Ependymoma
Mixed glioma
Oligodendroglioma
Optic nerve glioma

58

Most common type of malignancy

Astrocytoma

59

Grading of Astrocytoma

Grade I: Pilocytic (2%) (considered benign)
Grade II: Low Grade (8%) (considered benign)
Grade III: Anaplastic (20%)
Grade IV: Glioblastoma multiforme (70%)

60

Most inactive astrocytoma

Grade I - Pilocytic

61

If a pilocytic astrocytoma is disregarded it...

progresses to a higher grade.

62

Treatment of Pilocytic Astrocytoma

Surgical removal
Monitor