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5 Neurosurgery > Oncology > Flashcards

Oncology Flashcards

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1
Q

Most frequent primary brain tumor

A

GBM, then meningioma

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2
Q

Glioma and meningioma - male and female?

A

Glioma in males Meningiomas in females

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3
Q

What is the most common cancer in children?

A

Leukemia Brain malignancies are second most common

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4
Q

Where is general location of brain malignancies in children?

A

70% infratentorial

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5
Q

Most frequent infratentorial brain malignancies in children?

A

Cerebellar astrocytomas (33%) Brainstem glioma (25%) Medulloblastoma (25%) Ependymoma (12%)

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6
Q

Most frequent supratentorial brain malignancies in children?

A

Low grade astrocytoma (50%) Craniopharyngioma (12%) Optic gliomas (12%)

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7
Q

Where is the general location of brain malignancies in neonates and infants (

A

2/3 supratentorial (usually congenital)

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8
Q

Most common brain malignancy in neonates?

A

Teratoma > PNET > high-grade astrocytoma > choroid plexus papilloma

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9
Q

Findings/Symptoms of brain malignancy in neonates

A

Macrocephaly, hydrocephalus, split sutures, seizures, focal deficits

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10
Q

Most common brain tumors in older children

A

Most infratentorial Astrocytomas (50%), PNET (15%), craniopharyngioma (10%), ependymoma (10%), pineal tumor (3%)

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11
Q

Most common brain tumors in adults

A

Metastatics>Primary GBM, anaplastic astrocytoma, meningioma, pituitary, vestibular schwannomas

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12
Q

Most common infratentorial brain tumors in adults

A

Metatases, schwannoma, meningioma, epidermoid, hemangioblastoma, brainstem glioma

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13
Q

Most frequent epidural lesions in spinal cord

A

Metastatic

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14
Q

Most frequent intradural/extramedullary spinal lesion

A

Schwannoma and meningioma

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15
Q

Most frequent intramedullary spinal lesion

A

Astrocytoma and ependymoma

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16
Q

Which tumors are associated with radiation? (3)

A

Meningiomas, fibrosarcomas, gliomas

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17
Q

Which tumor is associated with immunosuppression?

A

Lymphoma

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18
Q

Which tumors are associated with viruses (EBV and HPV)?

A

EBV: Burkitt and nasopharyngeal HPV: cervical

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19
Q

Prognosis of gliomas depend on what 5 factors?

A
  1. Age 2. Histologic (necrosis) 3. Karnofsky score 4. Neurologic deficit 5. Extent of resection
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20
Q

Name the tumors (x2): AFP

A

Embryonal carcinoma Endodermal sinus tumor

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21
Q

Name the tumor: Chromogranin

A

Pituitary adenoma

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22
Q

Name the tumors (x2): Common leukocyte antigen

A

Lymphoma, germinoma

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23
Q

Name the tumors (x3): Cytokeratin

A

Carcinoma, craniopharyngioma, chordoma

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24
Q

Name the tumors (x2): Desmin

A

Rhabdosarcoma, teratoma

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25
Name the tumors (x3): Epithelial membrane antigen
Carcinoma, meningioma, epithelial cysts
26
Name the tumor: GFAP
Astrocytomas and other glial tumors
27
Name the tumor: Human melanoma black (HMB)
Melanoma
28
Name the tumors (x2): bHCG
Choriocarcinoma and synctiotrophoblastic variant of germinoma
29
Name the tumor: IG kappa and lambda chains
Lymphomas
30
Name the tumor (x2): Neurofilament and synpaptophysin
Ganglioglioma, PNET
31
Name the tumors (x7): S100
Schwannoma, neurofibroma, glioma, PNET, chordoma, melanoma, RCC
32
Name the tumor: Synaptophysin
Tumors with neurons (e.g. ganglioglioma, central neurocytoma)
33
Name the tumor: Transthyretin
Choroid plexus tumors
34
Name the tumor: Vimentin
Meningioma
35
Is mitotic index or flow cytometry more accurate? Why?
Flow cytometry more accurate - stains DNA and counts cells with double DNA. Mitotic index only small portion in M phase (mitosis)
36
What is a "Medulloblast"?
Bipotential cells capable of differentiating into glia or neurons Derived from external granular layer of cerebellum or from dysplastic cell rests in anterior/posterior medullary velum
37
Medulloblastoma: at what age do they occur?
50% before age 10 75% before age 15 2nd peak at 28 years
38
What % of CNS tumor in children is medulloblastoma?
20% (1/3 of posterior fossa tumors in children)
39
Most common genetic abnormality in medulloblastoma
Isochromosome 17q
40
What syndrome is associated with medulloblastoma?
Gorlin (basal cell nevus) syndrome Mutation of PTCH gene on chromoqome 9q
41
Gorlin syndrome: what mutation and what tumor is it associated with?
Mutation of PTCH gene on chromosome 9q Medulloblastoma
42
Medulloblastoma: WHO grade
IV
43
What is the diagnosis?
Medulloblastoma
44
45
What is the diagnosis?
Medulloblastoma Closely packed undifferentiated cells with no discernable cytoplasm (small blue cells)
46
Medulloblastoma: histology
Packed undifferentiated cells with no discernable cytoplasm (small blue cells) on H&E stain
47
What histological structure is this? Which 2 tumors may be associated with this?
Homer-Wright rosette on H&E Central fibrillar material ringed by radially arranged cell nuclei Medulloblastoma and neuroblastoma
48
Medulloblastoma: male or female more common?
M:F ratio 3:1
49
Medulloblastoma: Presentation
Rapid presentation with increased ICP/hydrocephalus, cerebellar signs
50
What tumor protein predicts 5-year survival rate in medulloblastoma?
ERBB-2 100% if negative 54% if positive if standard risk (no mets and no gross residual resection)
51
What is the 5-year survival rate of a "high risk" medulloblastoma?
20% Metastases, residual postresection
52
Medulloblastoma:
Surgical excision Adjuvant chemotherapy Craniospinal radiation if age\>3
53
54
Ependymoma: peak age
10-15 years 70% pediatric
55
Ependymoma: 5-year survival in treated young patients
80%
56
Ependymoma: 5-year survival in patients age \<4 or elderly
40%
57
Ependymoma: Treatment
Maximal possible resection, then fractionated radiation MRI + LP for cytology to rule out subarachnoid mets (spinal radiation if positive)
58
Ependymoma: male or female
No sex predominance
59
Ependymoma: most frequent location
Infratentorial (4th ventricle out through foramen of Luschka and Magendie) 60% of intramedullary spinal cord tumors, often at filum
60
Ependymoma: characteristics on CT and MRI
Lobulated, cricumscribed, cystic, moderately enhancing lesions with calcifications (50%) and only rarely hemorrhage
61
4 Pathologic subtypes of ependymoma
1. Cellular 2. Papillary 3. Myxopapillary 4. Clear cell
62
What is this diagnosis?
Cellular ependymoma: sheetlike growth of polygonal cells with true rosettes (central canal), pseudorosettes (blood vessel), and blepharoplasts (ciliary basal bodies in apical cytoplasm)
63
What is the diagnosis?
Papillary ependymoma Typical papillary projections - resembles choroid plexus papilloma
64
What is the diagnosis?
Myxopapillary ependymoma Intracellular mucin, occurs at filum and pre/postsacral area if there is local spread
65
What is the diagnosis?
Clear cell ependymoma Oligodendrolyte-halos
66
Ependymoma: what stains?
GFAP and PTAH
67
What is the diagnosis?
Ependymoma T1 with nonehnaced and coronal of enhanced mass in 4th ventricle extending through foramen of Luschka and Magendie
68
69
What differentiate grade III ependymoma from grade I and II?
Frequent mitoses and endovascular hyperplasia
70
Where may pre/post sacral myxopapillary ependymoma metastasize to?
Lung
71
Ependymoblastoma: WHO grade
Grade IV Occurs in childhood
72
What is the normal ependyma consists of?
Single layer of cuboidal/columnar cell ciliated early in life with microvilli Dual epithelial-glial nature and lie over subependymal glia
73
How is "high risk" defined in medulloblastoma?
\>1.5 cm2 postop tumor residual Presenting at 3 years old or younger Presence of metastases
74
Which chromosome/syndrome is associated with ependymoma?
Loss of heterozygosity in chromosome 22q Neurofibromatosis 2
75
Ependymoma: WHO grade
II
76
Anaplastic ependymoma: WHO grade
III
77
Ependymoma: key pathologic feature
Perivascular pseudorosettes
78
Best prognostic factor in ependymoma
Surgical resection
79

5 Neurosurgery (4 decks)

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