Tumors of the Nervous System Flashcards by Aimee Soileau

***The accuracy of predicting type of primary brain tumor based on MRI is ___%.

70%

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The most common primary brain tumors in dogs are _______ (__%), _______ (___%), and ______ (___%).

meningiomas (45%), gliomas (40%), choroid plexus tumors (5%)

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Secondary brain tumors comprise 1/2 of all canine intracranial tumors with _________ (___%), ________ (___%), ________ (___%), and _________ (___%) accounting for 77 - 86% of all SBTs.

hemangiosarcoma (30%), pituitary tumors (20%), lymphoma (15%), and metastatic carcinomas (15%)

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Gliomas are highly overrepresented in what brachycephalic breeds?

Boxers, Boston terriers, bullmastiffs, French and English bulldogs

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Approximately 70% of all feline intracranial brain tumors are primary brain tumors and ____% are ______.

> 50% are meningiomas

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***What is the most common clinical sign of intracranial tumors in dogs and cats?

dogs: seizures 50%
cats: behavioral change 16-67%

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***____% of cats with meningiomas have multiple brain tumors.

20%

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Peritumoral edema is observed in ___% of canine meningiomas.

> 90%

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Reported sensitivities of MRI to correctly identify canine intracranial meningiomas range from ___- ___%.

60-100%

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The MRI sensitivity for meningiomas has been estimated to be ___% in cats.

96%

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***Diagnostic yield for minimally invasive brain biopsy in dogs is ___% with reported serious adverse event rate of ___%.

95%
5%

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***The majority of feline meningiomas are grade ___ tumors. Grade ___ meningiomas account for a significantly higher proportion (___%) in dogs.

grade 1
atypical grade 2 (40%)

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Anaplastic grade 3 meningiomas are rare in humans, cats, and dogs and account for ___% of all canine and feline meningiomas.

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In the dog, approximately ___% of choroid plexus tumors are grade 1 choroid plexus papillomas , ___% are grade 3 choroid plexus carcinoma, and nearly 50% of CPTs occur in the _________.

40%
60%
fourth ventricle

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***In one study of choroid plexus tumors, CSF analysis was helpful in differentiation of papillomas from carcinomas as CSF total protein concentration greater than _____ was exclusively associated with diagnosis of carcinoma.

80mg/dl

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The MST of dogs treated with palliative care for primary brain tumors is ___.

~2 months

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***A retrospective study evaluated survival time in dogs with primary brain tumors treated with palliative care. The oMST was _____. Localization was the only prognostic factor. Dogs with supratentorial treated palliatively have better prognosis (MST _____) than those with infratentorial tumors (MST ____). The most common clinical sign of supratentorial tumors was ____ and ____ for infratentorial tumors.

oMST: 2mo
MST supra: 6 months
MST infra: 1 month
CS supra: seizures
CS infra: central vestibular dysfunction

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The prognosis of dogs with pituitary tumors treated with palliative care is more favorable than PBTs (MST _____).

12 months

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One retrospective study in 71 dogs with presumptively diagnosed brain tumors reported that CCNU-treated dogs (MST _____) experienced no
survival benefit compared with dogs receiving palliative therapy
(MST _____).

CCNU MST 3 months
Palliative care MST 2 months

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No difference in survival was reported between groups of dogs with predominantly presumptively diagnosed gliomas treated with SRT (VMAT) with (MST _____) or without (MST ____)
TMZ.

MST w/ TMZ 14 months
MST w/out TMZ 13 months

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***What is the MST of cats treated with standard cytoreductive surgery for meningiomas? Dogs? What is the recurrence rate in cats?

MST cats: 2+ years, 23-37mo
MST dogs: 7 months
LR cat: 25%

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The MST for dogs with meningiomas treated with surgery and adjuvant RT is superior to surgery alone and ranges from ____ - ______.

16 - 30 months

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***Studies of cohorts of dogs treated with RT as a sole treatment modality for brain tumors report MSTs ranging from ____ - _______.

7 - 23 months

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Extradural tumors account for ___% of all spinal cord tumors and frequently arise from the vertebrae.

50%

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***Intradural-extramedullary (ID-EM) tumors account for ____% of all tumors, and ______ are the most common ID-EM tumor in dogs and cats.

35% meningiomas

What is the most common primary spinal cord tumor in dogs and cats?

meningiomas

___% of spinal cord neoplasms are intramedullary (IM). In dogs, _______ and ________ are the most frequently diagnosed primary IM tumors, and ______ and _____________ are the most common secondary IM tumors.

15% ependymomas and gliomas HSA and TCC

_______ is the 2nd most common spinal cord disease in cats and the most common spinal cord tumor in cats.

Lymphoma

More recent reports indicate that ____% of cats with CNS lymphoma are infected with what retrovirus?

56% FeLV

Among extradural tumors arising from the vertebra, _______ is the most common followed by ______ and _______.

1. OSA 2. CSA 3. FSA

The MSTs for dogs with intraspinal meningioma treated with surgery alone vary widely and range from ____ to _____ months.

6 - 47 months

The addition of postoperative RT in dogs with meningiomas increased the MST to approximately _______.

45 months

In cats with spinal meningiomas treated surgically, reported MSTs are ____ to ______.

6 - 17 months

The long-term prognosis associated with vertebral tumors is guarded, with one study reporting an overall MST of _____ months in dogs with a variety of vertebral tumors.

5 months

Cats with malignant vertebral tumors have a guarded to poor long-term prognosis with surgical treatment, with a reported MST of ______ in one study

4 months

The MST in dogs treated with surgery and/or RT for spinal nephroblastoma range from ____ to _____. In one study, MST without surgery was ____ and MST with cytoreductive surgery was ____. Another study of dogs treated with cytoreductive surgery or RT reported a MST with treatment to be _____ and ____ with palliative care. Tumors confined to intradural - extramedullary location have superior survival (MST ______) compared to those with intramedullary component (MST _______)

- oMSTs: 2 - 12 months 1st study: - MST no surgery: 1 day - MST surgery: 2mo 2nd study: - MST w/ tx: 12 months - MST w/ palliative care: 2mo - MST ID-EM: 12mo - MST IM involvement: 5 months

For MRI of PNST, up to ___% display only nerve thickening rather than a discrete mass.

50%

The overall prognosis historically is considered guarded to poor for dogs with PNST, with MSTs of approximately ______ for dogs with paraspinal and plexus PNST. Complete resection of PNST including the use of limb sparing techniques report a MST of _______.

6 months 43 months

The treatment of canine PNST with evidence of nerve root and vertebral canal invasion with SRT reports a mean progression-free ST of _____.

8 months

In one study of 45 surgically treated cats with PNST, ___% of malignant PNST recurred compared with ___% of benign PNST.

31% 14%

The MSTs for dogs with trigeminal PNST treated with SRS or SRT ranges from _____ - _______.

15 - 25 months

A recent retrospective study evaluated adjuvant fractionated RT following hemilaminectomy in 5 young dogs with spinal nephroblastoma. MST was ______ and all were located between ____ and ___.

- MST: 3.4 years - T11 and L3

One study found that large breed dogs have an increased risk of what primary brain tumors?

meningiomas and CPTs

Name 4 dog breeds that are predisposed to intracranial meningiomas?

1. Goldens 2. Boxers 3. Rat terriers 4. Miniature schnauzer

What are the most common secondary brain tumors in cats?

- Lymphoma - 50% - Pituitary tumors - 30%

In cats, incidence of tumor-associated epilepsy is LOWER than dogs, at about ___%. In one study, seizures were more common in cats with what three tumors in decreasing order?

glioma > lymphoma > meningioma

______ pattern is often associated with gliomas on MRI but is NOT specific.

ring-enhancing pattern

Imaging features of ____, ____, and _____ tumors share similarities with those of meningiomas.

HS Granular cell tumors hemangioblastomas

What are the three most common histologic subtypes of grade 1 meningiomas?

1. Meningothelial 2. Transitional 3. Psammomatous

What is the most common glioma type in dogs and cats?

oligodendroglioma

***Canine and feline meningioma is incidentally diagnosed in ____% and ___%, respectively.

canine: 6% feline: 19%

Studies describing the use of techniques or technologies that facilitate removal of infiltrative tumors or intraoperative visualization for canine meningioma report MSTs ranging from ____-____.

MST: 16-70mo

Adverse events from surgical management of primary brain tumors is variable with reported incidence of ___-___%. If the outlier study is excluded, the average rate of surgical AEs is about ___%.

- 6-100% - 100% excluded: 11%

Extra-axial masses in dogs treated with RT as sole treatment report MST ranging from ____-_____. Intra-axial masses treated with RT report MST ranging from ____-____.

MST: - extra-axial: 9-19mo - intra-axial: 9-13mo

In one study of 17 dogs with intracranial meningioma treated with surgery and hypofractionated RT, survival was negatively associated with VEGF expression. Tumors with <75% expression had a MST of ____ compared to >75% expression at ____.

MST: - VEGF <75%: 25mo - VEGF >75%: 15mo

Progesterone receptor expression has also been shown to be inversely related to tumor proliferation index, PCNA. PCNA was predictive for survival in dogs with intracranial meningiomas after surgery and RT. PCNA >/=24% had 2-year PFS rate of ____% compared to PCNA <24% at ____.

2 year PFS: - PCNA >/=24%: 42% - PCNA <24%: 91%

***Name two negative prognostic factors for pituitary tumors treated with RT.

1. Severe neurologic dysfunction at presentation 2. Large relative tumor size

Treatment-related mortality or AE's occur in about ___% of primary brain tumors treated with RT. Delivery of high dose per fractions resulted in death of nearly ___% of treated dogs because of suspected delayed radiation side effects.

10% 15%

In a proof-of-concept trial, bacterially derived minicells were packaged with DOX, targeted to EGFR using bispecific antibodies to EGFR and administered IV to dogs with brain tumors. Durable and objective tumor response was seen in ___% of dogs.

24%

Spinal cord lymphoma in cats is secondary to a multicentric process in ___%. Concurrent brain involvement is seen in ___%.

85% 43%

Nephroblastoma of the spinal cord is seen in young dogs, usually ____ years of age. _____ and _____ are predisposed. The most common location is ______ spinal cord segments due to embryonic origin. Immunoreactivity to ____ is seen in 80%.

<3 years GSDs and Goldens T9-L2 Wt-1

What dog breed is predisposed to intraspinal meningiomas?

Boxers

What dog breeds are predisposed to intraspinal gliomas?

Boxers and other brachycephalic breeds

List 8 extradural tumor types.

1. OSA 2. CSA 3. FSA 4. HSA 5. PCT 6. Multiple myeloma 7. LSA 8. Various carcinomas

List 5 intradural-extramedullary tumor types.

1. Meningioma 2. PNST 3. LSA 4. HS 5. Nephroblastoma

List 7 intramedullary tumor types.

1. Astrocytoma 2. Ependymoma 3. Oligodendroglioma 4. Gliomatosis cerebri 5. TCC 6. LSA 7. HSA

Clinical signs of spinal cord disease in patients with secondary SC tumors occurs in ___% of dogs and is the chief complaint.

44%

Spinal cord lymphoma in cats is most commonly described as a _______ lesion.

extra-dural mass

Extradural tumors that do not involve the vertebrae are most commonly ____ tumors that arise from adipose tissue.

epidural

The most common intra-dural extramedullary spinal tumors are _____ followed by _____.

meningioma nerve sheath tumors

Among 36 cases of metastatic canine CNS LSA, ____% were B-cell and ___% were T-cell.

B cell: 55% T cell: 45%

In a study of dogs with CNS LSA, a diagnosis was made in ___% of dogs via CSF analysis.

68%

In a study of 6 cats with lymphoma involving the spinal cord treated with COP, CR was ___% and median duration of remission was _____.

- CR: 50% - Remission duration: 4mo

In cats, diffuse infiltrative peripheral nerve lymphoma, neurolymphomatosis, is ___-cell origin. In dogs, peripheral nerve lymphoma is ___-cell origin.

cat: B-cell dog: T-cell

PNSTs affecting the brachial plexus have a palpable mass in ___% of cases.

33%

________ may be indistinguishable from PNST.

Peripheral nerve lymphomas

What canine brain tumors are reported to metastasize via "CSF drop metastasis" as identified on MRI?

Choroid plexus tumor oligodendroglioma

***Intraspinal meningioma is most commonly in what segment of the spinal cord? Location correlates with grade with grade I tumors being most common in the _____.

- cervical - cervical

***A retrospective study evaluating spinal mengingiomas and NSTs in 34 dogs found that meningiomas were associated with a longer MST at ____ vs. NSTs at ____. When SRT was included in treatment (either sole therapy or once recurrence after surgery occurred), a gain in survival ranging from ____-_____ was seen.

MST: - Meningioma: 17mo - NST: 6mo SRT: - STs: 4-12mo

SRT outcomes for intraventricular brain tumors in 11 dogs was recently evaluated. MST was _____. What type of tumors or clinical presentations decreased survival?

- MST: 17mo - choroid plexus carcinoma, moderate to marked ventriculomegaly

In a recent retrospective study evaluating 61 cats with intracranial meningioma that underwent surgery and/or SRT, the MST was significantly longer for surgery treated cats compared to SRT (_____ vs. ______). ___% of both surgery and SRT cats had local recurrence. For the 5 cases that received SRT following recurrence, the MST was ____ after the last treatment.

- MST sx: 45mo - MST SRT: 11mo - LR: ~30% - MST: 23mo

Surgical and oncologic outcomes in 30 dogs with malignant PNST arising from the brachial or lumbosacral plexus was recently evaluated. Dogs with amputation +/- laminectomy were included. Intraoperative complication rate was ___% and post-op complication rate was ___%. ___% had recurrence. DFI was ____ and DSS was _____.

- 13% - 37% - 46% - DFI: 17mo - DSS: 19mo

A recent retrospective study evaluating 101 dogs with intracranial meningioma treated with surgical resection reported an oMST of ____. ________ approach has significantly decreased survival time (_______) compared to _______ approach (_____). No significant improvement was seen with adjunctive therapy.

- oMST: 12mo MST: - transfrontal approach: 6mo - rostrotentorial approach: 22mo

Efficacy of SRT for treatment of confirmed or presumed canine glioma was recently assessed in 23 dogs. ___% had improvement of clinical signs. The oMST was _____, and the DSS was _____.

- improvement: 91% - oMST: 12mo - DSS: 14mo

A recent retrospective study evaluated 38 dogs with presumed intracranial glioma treated with definitive-intent fractionated RT (15 x 3Gy over 5 weeks). The DSS was _____, 1-year survival was _____%, and 2 year survival was _____%.

- DSS: 23mo - 1 year: 74% - 2 year: 49%

A recent retrospective study of 32 dogs with presumed glial brain tumors treated with RT found that involvement of the subventricular zone was significantly associated with a shorter TTP (_____ vs. _____) and TSS (_____ vs. _____).

TTP: - Subventricular zone: 9mo - no SZ: 23mo TSS: - Suventricular zone: 10mo - no SZ: 24mo

Solitary intraventricular tumors in dogs and cats treated with RT alone or combined with ventriculoperitoneal shunting was recently evaluated. ____% of patients had marked decreased in tumor volume with RT. The VPS complication rate was ____%. TTP for RT/VPS dogs was _____ compared to RT alone at _____. MST was _____ for RT/VPS dogs vs. _____ for RT alone.

- 67% marked decreased volume - 67% complication rate TTP: - RT/VPS: 30mo - RT: 2mo MST: - RT/VPS: 36mo - RT: 5mo

A recent study evaluated dogs with intracranial GLIOMAS treated with oral lomustine. Dogs treated with lomustine had significantly improved MST of _____ compared to palliative care at _____.

MST: - CCNU: 5mo - palliative care: 1mo

A recent study of 59 dogs with primary intracranial tumors treated with Cyberknife stereotactic radiotherapy reported a PFI of _____ and MST of _____. Tumor location was significantly associated with PFI. The PFI for tumors located in the cerebrum was ____, cerebellum was _____, and brainstem was _______.

- oPFI: 12mo - oMST: 24mo PFI: - Cerebrum: 12mo - cerebellum: 3mo - brainstem: 9mo

A recent retrospective study of 52 dogs with primary brain tumors treated with fractionated definitive-intent IMRT (2.25-2.5 Gy x 18-20) reported a MST of ______.

- MST: 18mo

The efficacy of frameless SRT (Cyberknife) for treatment of presumptive intracranial glioma in 21 dogs reported an oMST of _____. For dogs that received 1 course, their MST was ____ and for dogs that received >1 course, MST was _____. Dogs that received 1 course of SRT had significantly improved survival time if they also received adjuvant chemotherapy (_____ vs. _____). The most common AE was ____ occurring in ___%.

- oMST: 21mo MST: - 1 course: 9mo - >1 course: 29mo - 1 course + adjuvant chemo: >22mo - 1 course and no chemo: 8mo - transient demyelination 14%

A randomized controlled trial evaluating the treatment of intracranial neoplasia in 57 dogs using a new RT protocol of 10 x 4Gy + 11% (boost) found that dose escalation did NOT result in better outcome compared to control dogs (10 x 4Gy). Overall TTP was _____ and MST was ______.

- oTTP: 24mo - oMST: 23mo

Tumors of the Nervous System Flashcards

(92 cards)