Neoplasms: Types of tumors

Question 1

Astrocytoma is a Glioma or Non-glioma

Answer 1

Glioma

Question 2

Oligodendroglioma is a Glioma or Non-glioma

Answer 2

Glioma

Question 3

Ependymoma is a Glioma or Non-glioma

Answer 3

Glioma

Question 4

Medulloblastoma is a Glioma or Non-glioma

Answer 4

Non-glioma

Question 5

Meningioma is a Glioma or Non-glioma

Answer 5

Non-glioma

Question 6

Pituitary adenoma is a Glioma or Non-glioma

Answer 6

Non-glioma

Question 7

Neurinoma (Schwannoma)

is a Glioma or Non-glioma

Answer 7

Non-glioma

Question 8

Primary CNS lymphoma is a Glioma or Non-glioma

Answer 8

Non-glioma

Question 9

Pediatric Brain Tumors are located and name 3 types

Answer 9

Predominant brain tumors in children are infratentorial in location

Cerebellar astrocytoma

Medulloblastoma

Fourth Ventricular ependymoma

Question 10

Which type of tumor is most prevalent

Answer 10

Gliomas

Question 11

Glial cells can be subdivided into and give rise to

Answer 11

Astrocytes – Have a nutritive role for neurons

Oligodendrocytes – Produce the myelin sheath

Ependymal cells – Line the ventricles

These cells can give rise to tumors called astrocytomas, oligodendrogliomas & ependymomas, respectively

Question 12

Gliomas arise from and are found

Answer 12

Arise from glial cells, which are the cells that support, insulate, & metabolically assist neurons

Neurons are rarely the basis for neoplastic formation

Found mostly in cerebral hemispheres in adults, & in the cerebellum in pediatrics

Question 13

Low-grade Astrocytoma

are, growth rate, location, WHO grade

Answer 13

Benign neoplasms that are slow growing and often cystic (encapsulated - Well differentiated)

Usually located in the frontal lobe, but can be anywhere in the cerebrum

Almost always infiltrative and progressive

WHO: 1-2

Question 14

Can you have surgery to remove a low grade astrocytoma

Answer 14

With surgery, survivability is high; without surgery the prognosis is poor due to progressive nature

Damage is usually from compression so when tumor is removed you usually recover pretty well

Cystic (encapsulated) – damage will be compressive rather than infiltrative – easier to remove surgically

However it can come back and if it comes back it is usually more aggressive —> GBM

Question 15

Do Low Grade Astrocytomas cause damage

Answer 15

Although benign, can still be catastrophic due to

• Location
• Conversion into higher grade tumor
• ->Once this occurs, the tumor becomes more infiltrative

Question 16

High Grade Astrocytomas are, growth rate, location, WHO grade

Answer 16

High grade astrocytomas (grade III & IV) are apt to invade the cerebral hemispheres via the corpus callosum

Very aggressive (esp Grade IV) & will eventually recur

Question 17

Anaplastic Astrocytoma is a type of and WHO grade

Answer 17

High Grade Astrocytomas

Grade 3

Question 18

What is the name of a (WHO) grade 4 high grade astrocytoma

Answer 18

Glioblastoma Multiforme (GBM)

Question 19

Glioblastoma Multiforme
Grade
Location
Prognosis

Answer 19

Grade 5

Predominantly located in the deep white matter of cerebral hemispheres
50% are bilateral & occupies > 1 lobe

Highly malignant & fatal

Question 20

What is the hallmark of an oligodendroglioma

Answer 20

Radiographic evidence of calcification

Question 21

Why are oligodendrogliomas so well treated?

Answer 21

Because of the calcification and they are encapsulated so you can remove them and the brain will survive pretty well

Question 22

Oligodendroglioma
Growth rate
Prognosis

Answer 22

Slow growing, solid calcified tumor

Can bleed spontaneously
-> stroke-like sx

After a long post-treatment inactive period, the probability of a more aggressive recurrence is high

Question 23

Ependymoma

Location
Prognosis

Answer 23

Derived from the ependymal cells lining the ventricular system & the central canal of the SC

More common in the fourth ventricle

Common in children & highly metastatic via CSF

Question 24

Why are ependymomas likely detected early

Answer 24

Because of the location it can block flow coming out and limit flow of CSF and increase ICP

Due to signs of ↑ ICP in the posterior fossa (HA, vomiting, papilledema)

Question 25

Ependymoblastomas (anaplastic ependymoma) commonly affects which population and how dangerous are they

Answer 25

common in children & highly metastatic via CSF

Question 26

``` Medulloblastoma Arises from Growth rate Common in Results in ```

Answer 26

Rapidly growing malignant embryonal tumor that arises from the vermis of the Cb Metastasizes to the surface of the remaining CNS via CSF pathways, more commonly into the spine Most common malignant 1° tumor in children Often results in hydrocephalus, ↑ ICP, and cerebellar signs

Question 27

Medulloblastoma Typical location Survival rate

Answer 27

Posterior fossa Usually since kids are pretty resilient it has a high survival rate

Question 28

Meningioma Growth Location

Answer 28

Slow growing benign lesions that occur predominantly along the dural folds and cerebral convexities May occur in the SC as well May infiltrate the dura, dural sinuses and bone, but not the brain parenchyma

Question 29

What is the good thing about Meningiomas and what does this mean for the prognosis ?

Answer 29

They affect the meninges and not the brain Prognosis is better because in order to remove it you do not have to go that deep into the parenchyma, these are usually pretty superficial Better prognosis bc it is pretty superficial however close to the skull but that can lead to hyperostosis thickening of the skull

Question 30

What do you have to worry about with meningiomas

Answer 30

They can lead to hyperostosis which is a thickening of the skull because the meninges metastasized into the skull

Question 31

What is hyperostosis and what cancer can cause this

Answer 31

It's an osteoblastic response leading to a thickening of the skull seen with meningiomas

Question 32

clinical signs and meningiomas

Answer 32

They can become quite large before clinical signs and symptoms are evident

Question 33

Pituitary Adenoma is and results in

Answer 33

Benign epithelial tumor derived from the anterior pituitary gland Frequently encroaches on the optic chiasm Result in hyposecretion or hypersecretion of pituitary hormones

Question 34

Pituitary Hormones

Answer 34

Anterior Pituitary Gland – GH, TSH, ACTH, FSH, LH, Prolactin Posterior Pituitary Gland – vasopressin (ADH) & oxytocin

Question 35

Associated syndromes due to a pituitary adenoma

Answer 35

Galactorrhea – excess prolactin (20 prolactinoma) - abnormal milk discharge Amenorrhea – excess prolactin (20 prolactinoma)-(absents of menstrual cycle ) Gigantism – excess GH Acromegaly – excess GH - bones thicken because growth plates are fused Cushing’s disease – excess ACTH

Question 36

Hypopituitarism can lead to

Answer 36

Fatigue, weakness and hypogonadism A 2nd presentation consists of suppression of 2° sex characteristics and hypothyroidism A 3rd presentation consists of HA with visual loss

Question 37

Neurinomas are and originate from

Answer 37

Slow growing, encapsulated, benign tumors that originate from Schwann cells (Technically outside of the CNS)

Question 38

Neurinomas develop in

Answer 38

The vestibular portion of CN VIII (affects CN 7) -Acoustic neuroma or vestibular schwannomas -Typically located in the IAC, may extend into cerebellopontine angle

Question 39

Clinical presentation of neurinomas

Answer 39

Clinical presentation is sensorineural hearing loss, tinnitus & vertigo Late features include dysphagia & facial muscle weakness

Question 40

Neurinoma treatment

Answer 40

Cure is achieved through surgical excision, although it may result in hearing loss. The earlier the surgery, the greater likelihood of hearing preservation.

Question 41

Primary CNS lymphoma | Who is as risk and how fast

Answer 41

Aggressive Non-Hodgkin’s Lymphoma usually found in the immunosuppressed (ie. AIDS patients)

Question 42

Primary CNS lymphoma leads to what type of changes/deficits

Answer 42

Leads to behavior/cognitive changes in 2/3 patients 50% has HP, aphasia, & visual field deficits 15-20% present with seizures

Question 43

Diagnosis of Brain Tumors

Answer 43

``` MRI * CT * PET scan Angiography Biopsy Craniotomy (open) Stereotactic needle biopsy ```

Question 44

Medical & Surgical Management of brain tumors

Answer 44

Traditional surgery Chemotherapy Radiation Therapy Stereotactic Radiosurgery

Question 45

Stereotactic biopsy/surgery

Answer 45

Small needle inserted into skull Direction of needle guided by MRI/CT Cells “suctioned out” through needle

Question 46

Craniotomy

Answer 46

Resection of skull overlying tumor Removal of tumor Replacement of bone flap

Question 47

What do they do if the is an increase in CSF?

Answer 47

They put in a shunt to drain VP Shunt Placement To bypass blockage of CSF To relieve pressure

Question 48

Indications for radiation

Answer 48

Inoperable tumors | Partial resection

Question 49

Methods of radiation

Answer 49

External Beam RT Brachytherapy (GBM) Whole Brain RT

Question 50

External Beam RT

Answer 50

It goes straight in and they try to aim at one specific point

Question 51

Brachytherapy is done by

Answer 51

They stick radioactive sources by the tumor because they do not want to get as close and the radiation helps reduce the size of the tumors. Done for different areas of the brain

Question 52

Chemotherapy can be done to enhance RT effects by

Answer 52

Ommaya Reservoir Chemotherapy wafers (Wafers are soaked with a chemotherapy drug (BCNU) and are implanted in the space where the tumor was. The wafers destroy the remaining tumor cells)

Question 53

Medications for brain tumors

Answer 53

Dexamethasone - Steroid - ↓ cerebral edema - Helps relieve headaches - Alleviate symptoms 24-48 hours - Maximum effect days 4-5 - Gradually tapered Anticonvulsants -For patients with focal changes to prevent seizure activity