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Peds neuro boards, V2 > Neuro Oncology > Flashcards

Neuro Oncology Flashcards

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1
Q

Most common location for metastatic brain tumors

A

Gray/white matter junction

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2
Q

Most common mets to brain:

Adult (4)

Pediatric (3)

A

Adult

  1. Lung
  2. breast
  3. renal
  4. melanoma

Pediatric

  1. leukemia
  2. germ cell tumors
  3. neuroblastoma
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3
Q

Most common malignant tumor in brain (1) and two additional specifications (2)

A

Most common malignant tumor in brain: Lung Cancer

Specifications:

  1. NSCLC is most common (80% of lung CA)
  2. SCLC has higher incidence of CNS mets, but is a less common cancer overall
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4
Q

Brain Mets most likely to bleed

A

My Cranium Really Bleeds Terribly

  1. Melanoma
  2. Choriocarcinoma
  3. Renal cell Carcinoma
  4. Bronchogenic (lung)
  5. Thyroid
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5
Q

Treatment for Metastatic Brain tumors:

Single Met (3)

Multiple Brain mets (2)

A

Single Brain Met

  1. Surgery followed by RT
  2. Stereotactic raiosurgery
  3. Whole brain radiation therapy

Multiple Brain metastesis

  1. Whole brain radiotherapy
  2. stereotactic radiosurgery to multiple lesions
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6
Q

Variant of whole brain radiation therapy used to decrease cognitive decline (1), and caveat (1)

A

Hippocampal avoidance WBRT + memantine

No defined role for up-front systemic therapy

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7
Q

Leptomeningeal Metastases
1. other names (3)

  1. relative prognosis to other mets
  2. Presenting sign / symptoms
A
  1. other names
    1. Leptomeningeal carcinomatosis
    2. carcinomatous meningitis
    3. leptomeningeal disease
  2. much poorer prognosis compared to other brain mets
  3. Presenting sings
    1. Symptoms of lesions “all over”
      1. Multiple cranial neuropathies
      2. asymmetric radiculopathies
    2. sx of increased ICP
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8
Q

Lemtomeningeal Metastesis: Workup

Imaging
CSF

A
  1. MRI Brain and Spine (i.e. whole neuroaxis)
  2. CSF
    1. Cytology
    2. Pathology review
    3. Circulating tumor DNA (ctDNA)
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9
Q

Leptomeningeal metastesis:

Treatment

A
  1. Hospice
  2. Radiotherapy
    1. Focal vs WBRT vs Craniospinal irradiation (CSI)
  3. systemic treatment
  4. intrathecal treatment
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10
Q

Treatment for Metastatic cord compression

A

High-dose steroids

Surgery > RT (better than Radiotherapy alone)

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11
Q

Integrated diagnosis of infiltrating Gliomas

A
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12
Q
  1. What is this?
  2. MRI features
  3. how would you treat it (3 + if progression)?
A

Glioblastoma (IDHwt)

MRI features

  1. heterogenously enhancing lesion

Treatment:

  1. maximal surgical resection
  2. Daily temozolomide + RT (no stereotactic radiosurgery)
  3. Temozolomide cycles (5/28 day) +/- tumor-treating fields (TTF)
  4. (if progression) consider one of the following
    1. bevacizumab (anit-VEGF ab)
    2. CCNU (nitrosurea)
    3. TTF
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13
Q
  1. What is this?
  2. MRI features (2)
  3. how would you treat it?
A
  1. Astrocytoma IDH-mutated
  2. increased T2/FLAIR; rarely enhances
  3. Treatment:
    1.
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14
Q
  1. What is this?
  2. Pathology features (2)
A

Glioblastoma (IDH WT)

  1. Endothelial proliferation
  2. pseudopalisading necrosis
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15
Q

Difference and significance between two types of GBM

A
  1. Wild type (worse prognosis)
  2. IDH mutated (better prognosis)
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16
Q

Oligodendroglioma:

  1. Grade
  2. WHO requirement for diagnosis
  3. Buzz-word clinical feature
  4. Treatment (3)
A
  1. Grade 2 or 3
  2. IDH mutation AND 1p19q co-deletion
  3. highest incidence of seizures among infiltrating glioma
  4. Treatment:
    1. Responsive to radiation
    2. Procarbazine / CCU / Vincristine (PCV)
    3. Temozolomide (TMZ)
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17
Q

Pilocytic Astrocytoma

  1. Grade
  2. Onset
  3. Imaging
  4. Pathology (4)
  5. locations (3)
  6. Treatment
A
  1. Grade 1
  2. Onset: childhood (juvenile pilocytic astrocytoma or JPA)
  3. Imaging
    1. enhancing
    2. well circumscribed
  4. Pathology
    1. circumscribed
    2. rosenthal fibers
    3. esoinophilic granular bodies
    4. Highly vascular
  5. Locations
    1. COmmon in posterior fossa
    2. Can be found elsewhere
    3. If in optic nerve, think NF1
  6. Treatment: resection
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18
Q

Ependymal Tumors

  1. Typically arise from ____
  2. Age group
  3. Imaging (3)
  4. Pathology (3)
  5. Key clinical feature
  6. Treatment (2)
A
  1. Typically arise from lining of ventricals (most commonly posterior fossa)
  2. Typically in the young
  3. Imaging:
    1. relatively circumscribed
    2. variable enhancement
    3. often cystic
  4. Pathology
    1. Perivascular pseudorosettes (around blood vessels)
    2. ependymal rosettes (around central lumen)
    3. + GFAP
  5. Clinical features
    1. spread through CSF > make sure to evaluate spine and CSF
  6. Treatment
    1. Complete surgical resection
    2. +/- RT (focal vs craniospinal)
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19
Q

What are these and what are they characteristic of?

A

Ependymal tumors

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20
Q

What is this a picture of?

A

Dysembryoplatic neuroepithelial tumor (DNET)

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21
Q

GFAP + is a marker for…

A

Astrocytic or Ependymal tumors

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22
Q

Tumor markers for Lymphoma

A

CD20

BCL6

EBV

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23
Q

Embyonal Tumors:

  1. Histopathology Buzzword
  2. Examples (6)
A
  1. Histopathology Buzzword: “small round blue cell tumor”
  2. Examples
    1. Medulloblastoma
    2. Embyonal tumor with multilayered rosettes
    3. AT/RT
    4. CNS neuroblastoma
    5. CNS ganglioneuroblastoma
    6. medulloepithelioma
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24
Q

Medulloblastoma

  1. Grade
  2. tumor type
  3. location
  4. age group
  5. _____ is associated with poorer prognosis
  6. pathology (2)
  7. Subtypes (4)
A
  1. Grade IV
  2. most common embryonal tumor
  3. Typically cerebellar (not in medulla)
  4. Age group: children
  5. if < 3 years = pooer prognositic (also more likely to suffer long-term neurologic sequelae in survivors)
  6. Pathology:
    1. dense round blue cells
    2. neuroblastic rosettes
  7. Subtypes:
    1. WNT
    2. SHH
    3. C
    4. D
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25
1. What is this? 2. What is the workup? 3. How is it treated (3)
1. (recurrent) medulloblastoma 2. MRI Brain and spine 3. LP (disseminates via CSF) - **if safe to do so** 4. Treatment 1. surgery (Goal = gross total resection) 2. Craniospinal irradiatin (CSI) 3. Chemotherapy: **CCNU / Cisplatin / vincristine** (packer regimen)
26
1. What is this? 2. MRI features 3. workup 4. treatment (3)
1. CNS lymphoma 2. MRI features 1. Diffusely enhancing 2. restricted diffusion (particularly if in a non-vascular distribution) 3. may cross corpus callosum 3. Treatment: 1. high dose methotrexate (HD-MTX) 2. (rarely) WBRT 3. NO surgery
27
CNS lymphoma 1. What type? 2. types (2) 3. patient population 4. important diagnostic note
1. Typically **B-cell** 2. types 1. primary 2. assocaited with **systemic lymphoma** 3. often in **immunocompromised** population (HIV, post-transplant, elderly) 4. **steroids are lymphocytic**: ideally give _after_ biopsy
28
Tumors that tend to cross corpus callosum
1. CNS lymphoma 2. high-grade gliomas
29
CNS lymphoma
30
1. What is this? 2. Common mutation 3. Gross histologic finding
1. Adamantinous craniopharyngioma 2. CTTNB1 3. cystic "motor oil"
31
Pituitary tumors and key points for each 1. A (3) 2. B (2) 3. C (3)
1. Pituitary Adenoma 1. Benign, micro/macroadenoma 2. may present with hormonal abnormalities (**adeno**ma) 3. Bitemporal hemianopsia 2. Pituitary Carcinoma 1. Can spread outside of CNS 2. Rare 3. Craniopharyngioma 1. Arise from **rathke's cyst remnants** 2. Ademantinous: CTNNB1 muation, cystic / "motor oil" appearance 3. Papillary: **BRAF** mutation, **solid**
32
What is this?
Pituitary Adenoma
33
Treatment: Pituitary tumors
1. Surgery 2. Radiotherapy 3. **hormonal therapy**
34
1. What is this? 2. epidemiology notes (3) 3. origin 4. Grades and subtypes 5. pathology 6. imaging 7. treatment
1. Meningioma 2. Epidemiology 1. 33% of primary CNS tumors 2. Women \> Men 3. increase markedly with age 3. arise from **arachnoid cells** in Dura 4. Grades 1. I (most common; 90%) 2. II (atypical menigioma) 3. III (anaplatic / malignant meningioma) 5. Pathology: various subtypes, require molecular subtyping (unlikely to be tested) 6. Imaging: **homogenous** enhancement with **dural tail** 7. Treatment: resection + radiation (**stereotactic \>** fractionated)
35
Pineal tumor most sensitive to radiation / chemotherapy
Germinoma | (think, radiation kills Germs)
36
Pineoblastoma 1. Grade 2. pathology buzz word 3. clinical notes (2)
1. Pineoblatsoma 2. Grade IV 3. Pathology: +/- **homer-write rosettes** 4. Clinical notes: 1. Can spread through CSF 2. can occur with **bilateral retinoblastoma**: if so think (**trilateral retinoblatoma, Rb gene mutation**)
37
Pineocytoma 1. Grade 2. Pathology buzz words (2)
1. Pineocytoma 2. Grade I 3. Pathology = neuronal markers 1. synaptophysin 2. neuron-specific enolase (NSE)
38
What is this?
Either Pineocytoma (Grade I) or Pineoblastoma (Grade IV)
39
Germ - cell tumors 1. Location (2) 2. Category 1 3. Category 2 4. spread via... 5. Biomarkers (4) 6. treatment
1. Typically a pituitary tumor, but can occur elsewhere in CNS and extra-CNS 2. Germ cell tumor (sensitive to RT and chemo) 3. Non-germinomatous germ cell tumor 1. Teratoma 2. yolk sac tumor 3. embryonal carcinoma 4. choriocarcinoma 4. Sprea via local extension or through CSF 5. Biomarkers 1. AFP 2. BhCG 3. placental alkaline phosphatase 4. carcinoembryonic antigen (CEA) 6. Treatment 1. biopsy vs surgery 2. RT 3. Chemo
40
3 main categories of peripheral nerve tumors
1. Schwannoma 2. neurofibroma 3. malignant peripheral nerve sheath tumor
41
Schwannomas 1. Grade 2. Location (2) 3. if ____ think \_\_\_ 4. histopathology classification
1. Grade I 2. Location 1. Peripheral nervous system (including spinal nerve roots) 2. cranial nerves 3. if **bilateral acoustic schwannoma** think **NF2** 4. Histopathology classification 1. Antoni A (closely packed) 2. Antoni B (loosely packed)
42
Neurofibroma 1. Grade 2. Location and association 3. types 4. pathology (2) 5. clinical note
1. Grade I 2. Peripheral nerves (associated with **NF 1)** 3. types 1. single nodule 2. plexiform 4. Pathology 1. **schwann cell** 2. **perineurial-like cell** 5. may transform into malignant peripheral nerve-sheath tumor
43
Malignant Peripheral nerve sheath tumors (MPNST) 1. Grade 2. Association 3. Most common location 4. Pathology (2)
1. Grade II, III, or IV 2. assocaited with NF 1 (50%) but also sporadic 3. most commonly in **sciatic nerve** (think about if an NF patient presents wtih sciatica) 4. Pathology 1. **sarcoma-like** 2. +/- S100
44
Neurofibromatosis Type I 1. Gene mutation 2. Chromosome 3. Inheritance 4. Diagnostic criteria
1. Neurofibromin Gene (GTPase activator) 2. Chromosome 17 3. Autosomal Dominant 4. Diagnostic criteria (need 2+) 1. **cafe au lait spots (\>/= 6)** 2. **lisch nodules (\>/= 2)** 3. **axillary frecklinkg** 4. **neurofibromas (\>/= 2 or 1 plexiform)** 5. **optic glioma** 6. **bony dysplasia** 7. **1st degree relative with NF1**
45
Neurofibromatosis Type 2 1. Gene 2. chromosome 3. inheritance 4. assiciated tumors (4)
1. Merlin gene (cytoskeleton protein) 2. Chromosome 22 3. Autosomal Dominant 4. assoicated tumors 1. **bilareal acoustic schwannomas** 2. neurofibromas 3. meningiomas 4. ependymomas
46
Most common tumors prsenting with Seizures
1. DNET 2. Astrocytoma 3. Ganglioglioma 4. Oligodendroglioma
47
Tuberous Sclerosis 1. Assocciated mutations 2. inheritance 3. Associated tumors 4. Treatment
1. TSC 1 and TSC 2 (mTOR pathway) 2. Autosomal Dominant 3. associated tumors 1. CNS "tubers" 2. SEGA 3. renal hamartomas 4. cardiac rhabdomyomas 4. Everolimus (mTOR inhibitor)
48
Von Hippel-Lindau Syndrome 1. Mutation and associated pathogenesis 2. Tumors 1. Most notable 1. location 2. Clinical note 2. Others (5)
1. Mutation in **VHL** gene \> increased **HIF1** \> incrased **angiogenesis** 2. Tumors 1. Most notable = **CNS hemangioblatoma** (grade I) 1. Infratentorial / spinal 2. Saltatory growth pattern (grows...stops...grows...) 2. Others 1. Endolymphatic sac tumors (ELST) - associated with decreased hearing 2. renal cell carcinoma 3. Pheochromocytoma 4. retinal angiomas 5. pancreatic cysts
49
Cowden Syndrome 1. Mutation and pathogenesis 2. biggest buzz-word tumor 3. other associated tumors 4. Non-tumor features
1. Mutation in PTEN \> phosphatylinositol 3-kinase (PI3K)/Akt pathway 2. **Lhermitte-duclos** 1. Dysplastic gangiocytoma of cerebellum (grade I) 2. "**tiger stripe**" appearance 3. Other associated tumors 1. breat cancer 2. follicular thyroid cancer 3. endometrial cancer 4. Non-tumor features 1. macrocephaly 2. intestinal hamartomas 3. trichilemmomas of skin
50
MEN syndrome 1. Mutation 2. Tumors 1. CNS (3) 2. non-CNS (5)
1. MEN1 mutation 2. CNS tumors 1. **meningiomas** 2. **ependymomas** 3. **pituitary tumors** 3. non-CNS tumors 1. parathyroid 2. pancreatic islet cell 3. adrenal cortex 4. carcinoid 5. pheochromocytoma
51
Post-chemotherapy Peripheral neuropahty: 1. Most common agents (4) 2. Type of neuropathy 3. comorbidiites
1. Most common agents 1. **vincristine** and other vinca alkaloids (vinblastine, vinesine) 2. **taxanes** (paclitaxel, docetaxel) 3. **platinum agents** (cisplatin, oxaliplatin) 4. **bortezomib** 2. Type: **axonal** 3. Comorobidities: increased risk in patients wiht underlying neuropathy
52
Chemotherapeutic agent associated with **cerebral Edema**
Cisplatin
53
Temozolamide: 1. used to treat 2. typical adverse effects
1. Used to treat **GBM** 2. Adverse effects (timzLOWlamide) 1. thrombocytopenia 2. leukopenia 3. anemia 4. nausea / vomiting 5. constipation
54
Bevacizumab 1. Used to treat 2. adverse effects (4)
1. Used to treat: **recurrent GBM** 2. Adverse effects 1. increased bleeding 2. incrased clotting 3. increased blood pressure (PRES) 4. increased urine protein
55
Vincristine 1. Used to treat 2. adverse effects (3)
1. Used to treat **oligodendroglioma** 2. adverse effects 1. neuropathy 2. constipation 3. myelosupprsssion
56
Methotrexate 1. used to treat 2. Most notable adverse effects
1. used to treat primary CNS lymphoma 2. **leukocencephalopathy** (similar to Normal pressure hydrocephalus picture)
57
How to differentiate Infarct edema from tumor Edema
Tumor Edema involves only **white** matter
58
High-grade oligodendrogliomas, if they metastasize, do so to .....
Bone (particularly bone marrow)
59
Features of headache arising from pheochromocytoma (3) and exacerbated by (4)
1. Bilateral and throbbing 2. Typically nocturnal attacks 3. relatively short (50% \< 15 minutes, 70% \<60 minutes) 4. Provoked by: 1. sleep 2. valsalva 3. exertion 4. micturation
60
Limbic encephalitis: 1. Symptoms 2. Antibodies 1. Most common (2) 2. Others (4) 3. Most common associated tumor
1. Symptoms 1. amnesia (anterograde) 2. aggression, paranoid delusions 3. hyperphagia 2. Antibody: 1. Most common: **anti-Hu** and **CV2** 2. Others 1. Anti-Yo 2. Anti-ANNA 3. anti-VGKC 4. anti-GABA 3. Most common associated tumor: **Lung**
61
Infusion-related symptoms associated with Oxaliplatin and what it looks like
Pharyngeolaryngeal dysthesias Symptoms 1. Cold sensation of throat 2. discomfort in breathing **without** respiratory distress or desaturation 3. Tightness in jaw
62
1. potentially fatal adverse effect of Cytarabine arabinoside 2. what causes it? 3. what does it look like?
1. acute cerebellar toxicity 2. selective loss of cerebellar Purkinje cells 3. Symptoms 1. dysarthria 2. dysmetria 3. ataxia 4. multidirectional nystagmus
63
Exam finding common to nearly all patients receiving Vincristine therapy
1. Loss of deep tendon reflexes
64
Specific localizable symptoms from Meningioma: 1. Foramen Magnum (3) 2. Parasagittal (1) 3. subfrontal (4) 4. occipital (1) 5. cerebellopotine angle (2)
1. Foramen Magnum 1. Paraparesis 2. sphincteric troubles 3. tongue atrophy + fasciculation 2. Parasagittal 1. Contralateral leg monoparesis 3. Subfrontal 1. change in mentation 2. apathy 3. disinhibited behavior 4. urinary incontinence 4. Occipital lobe 1. Contralateral hemianopsia 5. Cerebellopontine angle 1. decreased hearing 2. Possible facial weakness / numbness
65
Best imaging study to differentiate progression versus pseudoprogression of tumor
MR spectroscopy with perfusion imaging
66
Most common mutation in astrocytoma
P53 (70%)
67
Paraneoplastic Cerebellar Degeneration 1. Symptoms (5) 2. Antibodies 3. Tumors (4)
1. Symptoms 1. dysarthria 2. ataxia (midline and all limbs) 3. nystagmus 4. Diplopia 5. nausea / vomiting 2. Antibodies 1. Many (Yo, Hu, VgCC, CV2/CRMP5, MA2, Ri, Tr, GAD, mGluR1) 3. Tumors 1. Lung 2. ovary 3. breast 4. Hodgkin's lymphoma
68
Histolopathology Buzzwords: 1. Fried Egg 2. Pseudopallisading 3. perivascular pseudorosettes 4. Homer-Wright Rosettes (4) 5. Rosenthal fibers (4)
1. Fried Egg: oligodendroglioma 2. Glioblastoma 3. ependymoma 4. Homer-wright rosettes 1. Medulloblastoma (classic; pathognomonic if in posterior fossa) 2. pineoblastoma 3. primintive neuroectodermal tumors 4. olfactory neuroblastoma 5. Rosenthal fibers 1. Alexander's disease 2. pilocytic astrocytoma 3. pleomorphic xanthroastrocytoma 4. Chronic reactive Gliosis
69
MRI (3) and histologic (2)features of DNET
MRI 1. 30% of tumors enhance 2. "bubbly" appeareance on T2 3. Calcification Histology 1. specific glioneuronal elements 1. bundles of axons surrounded by oligodendrocyte-like cells 2. Floating neurons
70
Tumors presenting with enhancing mural nodule (5)
1. Central neurocytoma (pictured) 2. pleomorphic xanthroastrocytoma 3. ganglioglioma 4. DNET 5. Hemangioblastoma
71
Medulloblastoma: Factors suggestive of "higher" risk (7) Factors suggestive of "lower" risk (4+ 30) Medulloblastoma Genes associated with good (1) and poor (3) prognosis
1. High 1. Younger age (\<3 years) 2. dissemninated disease 3. MYC amplification 4. Anaplasia 5. Subtotal resection (1.5 cm of residual tumor) 6. P53 mutation 7. GL1 zinc finger mutation 2. Lower 1. WNT 2. monosomy 6 3. + staining for B catenin 4. total or near-total resection
72
Histopathologic features of pleomorphic xanthrastrocytoma
1. **Intracellular reticulin deposition** 2. Xanthomatous cells with Foamy cytoplasm 3. Eosinophilic granular bodies 4. rosenthal fibers
73
Diagnostic Critereon for Li Fraumeni syndrome Chlassic Li Fraumeni Syndrome Diagnostic criteria Comphret diagnostic criteria for li Fraumeni syndrome
Classic Li Fraumeni Syndrome (need _all_ of the following) 1. sarcoma diagnosed \< 45 2. 1st degree relative with _any_ cancer before 45 3. 1st or 2nd degree relative with _any_ cancer \<45 OR with Sarcoma diagnosed at any time Comphret (made in 1 of four circumnstances) 1. first criteria 1. 1 tumor typical of LFS prior to 46 2. (\>/=) 1st or 2nd degree relative with typical tumor of LFS before 56 3. presence of multiple tumors 2. 2nd criteria 1. many tumors (\>/=) 2 with disease spectrum 2. (\>/=) 1 prior to 46 3. Adrenocortical carcinoma or tumor of choroid plexus
74
Typical tumors of Li Fraumeni Syndrome (7)
1. brain tumor 2. adrenocortical carcinoma 3. leukemia 4. bronchoalveolar cancer 5. soft tissue sarcoma 6. osteosarcoma 7. premenopausal breast cancer
75
Testing for TP53 should be performed in (5)
1. individuals meeting criteria for Li Fraumani Syndrome 2. women with breast cancer \< 30 with **no** BRCA1 or BRCA 2 mutations 3. adrenocortical carcinoma 4. people with choroid plexus carcinoma 5. people with childhood sarcoma (exception being Ewings sarcoma)
76
antibody associated with MGUS
Anti-MAG
77
MRI features of Epidermoid cyst
1. Cerebellopontine angle diffusion-restricting lesions with otherwise largely CSF signal on CT and MRI
78
Most common CP angle tumors (3) and how you can differentiate among them
1. Acoustic schwannoma 1. NO restriction 2. Meningioma 1. may be associated with isolated CSF protein elevation (\>200 mg/dL) 2. NO chemical meningitis 3. NO diffusion restriction 3. Epidermoid cyst 1. Diffusion restriction 2. Chemical meningitis
79
Malignancies associated with: NF- 1 NF - 2
NF-1: "william, Leuk at me, phocus, youre rhabbing on my last nerve Fiber (fibrosarcoma)" 1. Fibrosarcoma 2. Leukemia 3. Pheochromocytoma 4. Rhabdomyosarcoma 5. wilms tumor NF-2 1. Acoustic Schwannoma 2. Meningioma 3. Glioma
80
Tumors associated with Von Hippel-Lindau Disease (5)
"HP makes C3PO 1. **_H_**emabgioblastoma of CNS 1. Retina 2. Brain 2. **_P_**heochromocytoma 3. **_C_**lear cell cancer of Kidney 4. Chromosome 3 (where mutation is) 5. Neuroendocrine tumors of **_p_**ancreas 6. **_O_**thers
81
Most common congenital brain tumors
remember a "TACHy PeRM" 1. MC = Intracranial **_t_**eratomas (50%) 2. **_a_**strocytomas 3. **_ch_**oroid plexus papilloma 4. **_p_**rimitive neuroectodermal tumor 5. **_r_**habdoid tumors 6. **_m_**edullowblastomas
82
what is this?
Psammoma body (meningioma) calcium organized in lamellated concentric structure "onion skin"
83
Spinal cord tumors: Most common in adults Most common in children MC with VHL
MC overall: Spinal ependymoma MC in children: Astrocytoma MC with VHL: Hemangioblastoma
84
Patient With _____ tumor has. RELA fusion what does this mean?
Patients with ependymomas and Rela fusions: 1. Poor prognostic factor 2. more common in children and young adults 3. more common in supratentorial locations
85
What type and grade of meningioma is this?
Meningothelial meningioma (Grade 1)
86
What type and grade of meningioma is this?
Fibrous meningioma | (Grade 1)
87
What type of meningioma is this?
Transitional Features of both Fibrous and meningothelial Characteristic whorls | (grade 1)
88
What type and grade is this meningioma?
Psammamomatous | (grade 1)
89
patient presents with newly diagnosed malignancy on MRI What features can help differentiate metastesis from primary tumors?
1. Metastatic lesions are often located at the gray-white junction or arterial border zones 2. though metastesis are most often solitary, multifocal lesions should prompt worry about metastesis 3. known history of cancer elsewhere in the brain 4.
90
Brain cancer MRI buzzwords: ``` Central Necrosis (3) crossing corpus callosum (2) Vasogenic Edema (2) ```
* Central necrosis: * GBM * Metastatic lesiosn * CNS lymphoma * Crossing corpus callosum * GBM * CNS lymphoma * Vasogenic edema * Metastatic * High-grde gliomas
91
Patient with asceptic meningitis, hearing loss, and headaches, subsequently found to have tumor in cerebellopontine angle What are some features you would expect to see on MRI? What cell type would you see on histology? How would you treat it?
Epidermoid cyst MRI features: * mildy enhancing * cystic * Restricted diffusion Histology: * Desquamated epilethelial cells Treatment: * Surgical resection
92
Spinal Cord tumors: MC overall * Typical location * MRI findings (3) MC Children * Typical location * MRI findings (3) MC of conus medullaris / filum terminale *
MC overall: Spinal epyndoma * Typically cervical * MRI = unencapsulated but well circumscribed mass, often with cysts * Syringomyelia (50%) * average length: 4 vertebral setments MC children: Astrocytoma * Typically thoracic, then cervical * Ill defined * eccentrically located * patchy irregular contrast enhancement MC of conus medullaris / filum terminale: myxopapillary ependymoma * heterogenious enhancement
93
How to differentiate the two tumors that can produce "Fried egg" appearance
Oligodendroglioma (most common): * GFAP+ * IDH mutation * 1p/19q co-deletion Neurocytoma * Synaptophysin * Neuron-specific Enolase
94
Tumors associated with: Anti-Ma1 and Anti-Ma2
* testicular germ cell tumors * lung cancer
95
Patient undergoing chemotherapy for cancer presents with multiple cranial neuropathies, radiculopathies, and increased ICP What is this?
Meningeal carcinomatosis (aka carcinomatous meningitis, leptomeningeal carcinomatosis)
96
Potential trip up: "rosenthal fibers" make you think of what two conditions?
1. Juvenile pilocytic astrocytoma 2. Alexander's disease
97
_What do you think if you see a Mural nodule:_ _Adult + cerebellar location_ _Child and cerebellar location_ _Temporal location_
Cerebellar + adult: Hemangioblastoma (likely in VHL disease) Cerebellar + child: _juvenile pilocytic astrocytoma_ Temporal: _pleomorphic xanthroastrocytoma_
98
"intracellular eosinophilic granular bodies" (+) Biphasic: \_\_\_\_ (-) biphasic: \_\_\_\_
99
What is the most common _Primary_ brain tumor to bleed?
Oligodendroglioma
100
fetaures of Meningiomas
"whipped" (w)horls (H)omogeneous enhancement (P)sammoma bodies (P)ositive staining for... (E)pithelial membrane antigen and (D)esmosomes, (D)ural Tail
101
name 4 relatively aggressive meningiomas
ones that present a "_Clear_ **_C_**ut, **_R_**eal **_P_**roblem" Clear cell (grade II) Choroid (Grade II) Rhabdoid (Grade III) Papillary (Grade III)
102
Child presenting with macrocephaly, hypocalcemia, and diplopia, Subsequently found to have a supratentorial tumor What is it? Where did it come from?
Craniopharyngioma Thought to arise from _rathke's pouch remnant_
103
What is a key feature needed for a tumor to be classified as a pituitary carcinoma
Metastesis
104
Cancer syndromes with primary brain mets: Associated tumors with: Cowden's disease Gorlin Syndrome Li-Fraumeni Syndrome Von Hippel-Lindau disease Tuberous Sclerosis Turcot's Syndrome
* Cowden's : Lhermitte Duclos (Dysplsatic Gangliocytoma of Cerebellum) * Gorlin syndrome: Medulloblastoma * Li-Fraumeni Syndrome: Diffuse Astrocytoma * VHL: Hemangioblastoma * TS: SEGA * Turcot's: GBM or Medulloblastoma
105
What does this show Above and Below the mass lesion?
Above: normal Below: fatty replacement of bone marrow suggsetive of radiation therapy
106
What's this?
Colloid cyst (homogenous enhancement)
107
Pineal tumors and Prognosis: Embryonal Carcinoma Mixed Germ Cell Tumor Yolk Sac tumor Choriocarcinoma Germinoma Mature Teratoma
Embryonal Carcinoma: Poor Mixed Germ cell tumor: Intermediate Yolk-Sac tumor: Poor Choriocarcinoma: Intermediate Germinoma: Excellent Mature Teratoma: Excellent
108
Urine tests for Cancer 24 hour fractionated metanephrines: urine Histamine levels
Fractionated metenephrines: pheochromocytoma Histamine: carcinoid tumor (does not exclude, however)
109
Pituitary Masses (mnemonic)
SATCHMO (S)arcoid (A)neurysm (T)eratoma, (T)uberculosis (C)raniopharyngioma, (C)hordoma, (C)left cyst (H)ypothalamic Glioma, (H)ypothalamic Hammartoma, (H)istiocytosis (M)eningiomas, (M)ets (O)ptic tract glioma
110
Histopathologic feature of Paraneoplastic cerebellar degeneration
Loss of Purkinje cells
111
How would you treat this?
Pilocytic astrocytoma Resection
112
Tumor most likely to disseminate in CSF
Posterior fossa ependymoma
113
Tumors associated with: AFP bhCG CEA
Germ cell tumors (germinoma, Teratoma, yolk sac tumor, embryonal carcinoma, choriocarcinoma)
114
Cancer patient presents with peripheral neuropathy What chemo treatments could he have been given?
* Vincristine * Taxanes * Platinum agents * Bortezumib
115
Cancer patient presents with cerebral edema What chemo treatments could he have been given?
Cisplatin
116
Cancer patient presents with pancytopenia What chemo treatments could he have been given? what kind of tumor does he have?
Temozolomide GBM
117
Cancer patient presents with intracranial bleed, increased clotting, PRES, and increased urine protein What chemo treatments could he have been given? What type of cancer does he have?
Bevacizumab Recurrent GBM
118
Cancer patient presents with Neuropathy, constipation, and myelosuppression What chemo treatments could he have been given? What kind of tumor does he have?
Vincristine Oligodendroglioma
119
Cancer patient presents with peripheral NPH like picture What is this called? What chemo treatments could he have been given? What type of cancer does he have?
Leukoencephalopathy Methotrexate Primary CNS lymphoma (most common in elderly population
120
Trip-up: Tumors associated with: Pleomorphic xanthroastrocytoma Pilocytic astrocytoma
Pleomorphic xanthroastrocytoma: Intracellular reticulin deposits Pilocytic astrocytoma: bipolar "hair like" astrocytes
121
Patient presents with diagnosis of Medulloblastoma: What are 3 features suggestive of "high risk" tumor?
Age \<3 \>1.5 cm2 residual tumor after maximal safe total resection metastatsis at initial presntation
122
patient presents iwth vertical gaze palsy but no headaches, nausea, or vomiting pupils normal Horizonal and inferior gaze normal Where is the leasion?
Pineal gland (pineal tumor)
123
"high risk" status for children with medulloblastoma (3)
Metastatsis at initial diagnosis Under age 3 over 1.5 cm2 residual tumor after maximal resection

Peds neuro boards, V2 (29 decks)

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