Neuro shelf - CNS tumors

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Author:
ashboeri
ID:
102449
Filename:
Neuro shelf - CNS tumors
Updated:
2011-09-18 10:48:18
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neurology
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  1. ionizing radiation
    associated with increased risk of meningiomas, astrocytomas, and sarcomas
  2. NF 1
    chromosome 17

    glioma (optic nerve) and ependymoma
  3. NF 2
    chromosome 22q12 meningioma and glioma
  4. von hippel lindau
    chromosome 3p25

    hemangioblastoma
  5. li fraumeni cancer
    chromosome 17p13.1

    glioma and medulloblastoma
  6. signs of posterior fossa tumor in kids
    decreased appetite and weight loss, reduced school performance, dizziness, ataxia, neck pain, bulbar weakness, gaze palsy, opisthotonos
  7. MRI spectroscopy sign of brain tumors
    decreased peak of N-acetyl aspartate (NAA) associated with neuronal loss
  8. most common primary brain tumors
    gliomas and meningiomas
  9. types of gliomas
    • astrocytoma
    • oligodendroglioma
    • ependymoma
    • choroid plexus papilloma
  10. GBM
    arises from astrocytes. See necrosis and neovascular proliferation

    tx: chemo - temozolamide and BCNU (gliadel wafers) implanted in cavity to slow delivery of the nitrosourea drug

    prognosis: poor
  11. low-grade astrocytoma
    arises from astrocytes or ependymoma cells

    in kids, more common in cerebellar hemispheres, but more common in 4th decate of life

    seizure typical presentation of slow growing tumors

    prognosis: medial survival 7 years
  12. oligodendroglioma
    arises from oligodendrocytes

    peak incidence ages 35-45. common in frontal lobes, though can appear in basal ganglia and thalamus

    calcifications common. microscopically "fried-egg" appearance (perinuclear halos with swollen cytoplasm)

    prognosis: tends to recur locally and progress into a malignant form
  13. ependymoma
    arises from ependymal lining of ventricles

    in kids, 90% are intracranial (often 4th ventricle) with subarachnoid spread. in adults 75% arise in spinal canal as intramedullary tumors of spine

    path: perivasular pseudorosettes
  14. meningioma
    arises from meningothelial (mesodermal) cells of dura mater

    almost always benign, more common in women ages 40-60. NF2 may cause.

    path: sheets of plump, uniform meningothelial cells with tendency to form whorls. progesterone receptors found frequently. calcifications seen on CT

    hyperostosis on CT may indicate tumor invasion of the bone
  15. medulloblastoma
    arises at the medullary velum of the 4th ventricle. a primitive neuroectodermal tumors (PNET)

    path: small round cells with high mitotic index

    presents as fast growing tumor that infiltrates surrounding tissue and extends towards 4th ventricle, producing hydrocephalus with headache, unsteadiness, and vomiting. May spread via CSF
  16. schwannoma
    arises from schwann cells

    more common in middle-aged women, common in vestibular cranial nerve (acoustic neuroma) at the cerebellopontine agnle. Bilateral schwannomas in NF2

    path: sheets of uniform spinde cells, forming palisades called verocay bodies
  17. ganglioglioma
    seen in kids and young adults, include a mixture of neurons and glial cells. usually located in the cerebral hemisphere and have slow growth. T2 MRI shows characteristic swollen gyri. can be surgically removed
  18. hemangioblastoma
    cerebellar cystic lesions, often associated with von hippel lindau disease (hereditary retinal angiomas, pancreatic cysts, and kidney tumors)
  19. Most frequent metastatic brain tumors
    lung, skin (melanoma), kidney (renal cell carcinoma), breast, colon

    located at junction of gray and white matter, tend to be solitary
  20. drop metastases
    intradural extramedullary spinal mets that arise from intracranial lesions. most common source is ependymomas and medulloblastomas
  21. NF 2 associated tumors
    bilateral vestibular schwannomas, meningiomas, and intramedullary ependymomas
  22. mets that bleed easily
    melanoma, renal carcinoma, and choriocarcinoma

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