Primary Tumor FND Notes

7/21/2019 Primary Tumor FND Notes

1/11

P

BRAIN

TUMORS

/


2/11

Glioma

Brain

Tumors

HO

Askooytoma

Classification

Grade

1(

Circumscribed

astnoytomas

)

Mc

subtype

:

pilocytic

ashogloma

relatively

benign

/

indolent

'

Grade

2

(

Di use

aihooytom

a)

cell

types

:

fbrillay

,

gemistogtic

,

protoplasmic

astro

oytomas

cystic

change

t

calcification

may

occur

Grade

3

(

aha

plastic

asbooyhmas

)

he

ill

.

defined

borders

+

extensive

edema

4

more

likely

to

show

enhancement

cyshc

change

.

Grade

4

(

Glioblastoma

multi

tme)

4

most

freq

.

+

most

malignant

4

necrosis

+

grows

rapidly

only

lu%

in

children

owGradlghom=

ainly

young

adults

-

partial

or

generated

sutures

E

to

%)

-

hypbmknce

IT

/

hyper

intense

TZ

-

enhancement

is

usually

rare

ipnseuce

of

enhancement

may

suggest

Mal

transformation


3/11

common

in

children

;

located

in

ophc

tracts

,

hypothalamus

,

basal

ganglia

6

a

ssx

E

NFI

MRI : well

circumscribed

;

contrast

enhancing

,

.

some

T

cysts

or

enhancing

mu

nodule

pattern

4

malignant

transformation

is

rare

4

tx

:

it

possible

:

resection

alone

Is

indicated

/

Radiation

or

chemo

for

unreadab

tumors

EpngnssivedlfiiTM

surveillance

:

MRI

repeated

once

or

twice

yearly

i

most

are

slowly

growing

2

patterns

of

progression

(

rarest

)

1

di use

extension

of

either

ipsilaleral4anNalateal-gliomalvsisarebri@acquinsfeaTuesofauaplashcashooytomas1oligodendogliomafGBmAsmgtomavs.0lig_ddglma4ASmooytoma.R

adiothoapy

Iv

mass

e ect

;

improves

st

in

so

-75%

-

chemotherapy

Oligodendrgluma

:

radiotherapy

t

chemo

Ana

plastic

Astnglvma

/

Glioblaswma

-

-

almost

never

spread

systemically

4

loco

regional

extension

;

lesser

freq

.

leptomeninge

-

malignant

ashocyloma

.

irregular

hypo

dense

lesion

/

17

hypo

intense

E

+1

-

enhanc

-

GBM

:

ring

.

like

enhancement

surrounding

irregularly

shaped

foci

presumed

ne

-

Both

:

incurable

;

aim

of

treatment

to

improve

neurological

deficits

-

Steroids

help

I

vasogenk

edema

;

improves

deficit

wlm

few

days

but

can

neg

.

interfere

E

chemo

-

so

must

we

lowest

e#cient

dose


4/11

KHshcasmdGBM-td.AE

Ds

should

not

be

prescribed

systemically

;

only

as

2

prevention

-

methylphenidate

can

tt

help

improve

new

cognitive testing

-

specific

tx

:

resechm

,

chemo

,

radiotherapy

.Ependymaltum=

-

most

common

tumor in

children

-

6-

not

of

all

pediatric

tumors

/

uj

o

33%

of

brain

tumors

iuthoie


5/11

I

Non

.

Choma

Brain

Tumors

(

alignant

Medulloblastoma

(

small

round

blue

cell

tumor

)

-

always

located

in

cerebellum

(

mfratentonab

PNETD

-

1520

%

ped

. brain

tumor

+

-

l%

of

adult

brain

tumor

-

most

common

pediatric

posterior

fossa

tumor

-

CNS

primitive

nennectodermal

tumors

{

WHO

oracle

ID

.

&

predilection

-

rapid

growth

-

Sx

of

raised

intracranial

pressure

obstructive

hydrocephalus

-

Pathology

:

extremely

cellular

classic

form

:

neunblastio

or

Homer

-

Wright

rosettes

(

neo

plastic

cell

nu

disposed

in

radial

arrangement

around

fibril

lay

processed

-

MRI :

94%

arise

in

the

cerebellum

-

majority

arise

from

the

Vanis

tend

to

protrude

into

the

4th

ventricle

adult

onset

.

usually

located

laterally

10

CNS

lymphomas

(

Ghost

tumors

/

Micagkomas

)

-

A

by

a

factor

7

-

lox

in

the

past

2

decades

in

both

immunoam

promis

+

immunowmpelent

-

EBU

plays

a

role

in

lmmmnoam

promised

forms

-

Predisposing

faetrs

:

-

EBV

prior

infxn

-

Hiv

/

AIDS

-

post

-

transplant

-

lg

A

deficiency

-

Wiskott

-

Aldrich

syndrome


6/11

CNS

lymphoma

cunt

'd

.

igns of

raised

intracranial

pressure

,

focal

neurological

disorders

,

settlers

-

Pathology

:

typically

present

as

infiltrating

mass

lesions

that

can

arise

In

artx

,

what

matter

,

deep

gray

matter

-

may

have

necrosis

esp

in

lmmunodefiaent pts

-

vast

majority

:

B

-

cell

in

origin

di

use

large

B-

cell

lymphoma

/

high

grade

Burkitt

-

like

B

cell

lymph

-

low

grade

tend

to

be

@

n

origin

-

Csf

:

T

proteins

/

N

Glucose

positive

cytology

is

uncommon

-

MRI

:

TI

hypo

intense

/T2

iso

-

wypoinlense

vivid

homogeneous

enhancem

ypically

supraknlonab

(

7585%

)

crossing

corpus

calloswm

is

NOT

infreq

.

seen

a

enhancement

is

homogeneous

4

low

grade

PCNSL

di er

-

deep

locations

/

spinal

involvement

Mc

-

enhancement

is

absent

,

irregular

or

only

mild

disseminated

meniyeab

is

Uncommon

.

in

:

predominantly

I

skrnds

(

dramatically

shrink

timor

-

should

be

avoided

prior

to

biopsy

as

histological

Interrelation

can

become

impossible

after

1

inje

+

chemo

(

high

doses

)

tt

whole

brain

irradiation

Prognosis

is

poor

;

worse

for

those

who

are

lmmuhocom

promised

Primitive

neunecto

dermal

tumors

(

PNETD

-

re

lumorj

usually

in

children

(

young

adults

>

F

;

in

supra

sell

or

region

.

8

-

Sx

:

obstructive

hydro

,

parinand

synd

,

Dl

(

compression fun

pituitary

infundibu

hypopihntnnsm

,

ophc

chiasm

compression

;

sym

o

lap

geimmman

are

SOFT

tissue

density

,

enhancing

masses

-

tend

to

engulf

normal

tissue

in

red

population

-

presence

of

Ca

in

pineal

regin

-

mefnl

maker

of

tum

M

soft

tissue mass

-

ovoid

/

lobulated

engulfing

calcified

pineal

gland

-

17

:

isomlenu

urhyrr

intense

-

TL

:

lsoihtenk

w

hypomlenfe

/

may

have

get

formation

/

+1

-

hemorrhag

central

can

-

TITC

:

vivid

thunoglncovs


11/11

ant

'd

.

Is

radiotherapy

to

-90%

buy

tem

awe

rate

;

H

-

chemo

prognosis

good

Hamartomas

-

hypothalamic

/

tuber unereum

hamarhma

-

benign

-

located

51W

mam

bodies

a

optic

chiasm

-

Sx

often

occur

early

in

infancy

+

progressive

;

often

I

cog

.

-

gelashc

serves

-

central

precocious

puberty

.

freq

.

encountered

in

there

children

occurs

fun

Gnnlt clean

LH

t

FSH

-

MRI

:

Composed

of

gray

matter

so

may

appear

on

normal

Cohex

-

do

NOT

enhance

or

grow

-

IT

:

iso

-

intense

to

cerebral

cortex

-

Tltc :

enhancement

-

TZ

:

no

-

to

hyrwintenk

higher

prupwhm

of

glial

cells

-

hyhr

TZ

Documents

Primary Tumor FND Notes