Primary Brain Cancer

Front 1

Most common form of primary brain cancer.

Back 1

meningioma

Front 2

Most common primary tumor in children

Back 2

Medulloblastoma

Front 3

Which population are menigiomas more common?

Back 3

women and older populations

Front 4

Meningiomas are commonly seen in this genetic disease.

Back 4

NF-2

Front 5

Menigiomas arise from which cells?

Back 5

arachnoid cap cells

Front 6

Histiologic appearance of meningiomas.

Back 6

whorls of tightly packed cells around calcified acellular material called psammoma bodies

Front 7

Primitive neuroectodermal tumors (PNETs) usually arise ?

Back 7

posterior fossa

Front 8

Medulloblastoma can metastasize to ?

Back 8

bone

Front 9

Symptoms of PNETs?

Back 9

related to mass effect in posterior fossa: ataxia, balance and equilibrium disturbances, cranial nerve palsies

Front 10

Which pathway may be involved in the development of medulloblastomas?

Back 10

Sonic Hedgehog

Front 11

Histological appearance of medulloblastoma.

Back 11

prominent nuclei w/ little cytoplasm; very uniform sheets of cells

Front 12

Oligodendrogliomas are often ___ and patients often present with ___.

Back 12

calcified, seizures

Front 13

Oligodendrogliomas are more ____ based as opposed to astrocytomas which are ____.

Back 13

cortically, deeper

Front 14

Histology of oligodendrogliomas.

Back 14

"fried egg" appearance, very fine vascular pattern described as a chicken wire appearance

Front 15

Loss of what parts of chromosomes is associated w/ oligodendrogliomas and portends a favorable prognosis.

Back 15

1p and 19q

Front 16

The majority of primary CNS lymphomas fall into the ____ category

Back 16

large B cell

Front 17

Treatment of CNS lymphoma:

Back 17

methotrexate to inhibit dihydrofolate reductase; leukovorin rescues purine synthesis pathway in the rest of the body

Front 18

Which CNS neoplasm is the most malignant?

Back 18

Astrocytoma (type IV, GBM)

Front 19

Histologically the main difference between grade III and grade IV astrocytomas.

Back 19

necrosis and neovascularizaiton

Front 20

If this gene is silenced by methylation then a patient will respond better to treatment with temozolomide.

Back 20

MGMT

Front 21

De novo GBM is associated with amplification of ___ and loss of ___.

Back 21

EGFR, PTEN

Front 22

Intermediate filament found in the cytoplasm of normal astrocytes, reactive astrocytes, and astrocytic tumors.

Back 22

GFAP
"Good For Astrocyte Peeking"

Front 23

Grade II and III frequently have a mutation in ___.

Back 23

p53

Front 24

Viable tumor cells around necrosis; seen in GBM.

Back 24

pseudopallisading necrosis

Front 25

Better prognosis: Secondary or Primary GBM?

Back 25

Secondary, but still poor

Front 26

Mutations in Secondary GBM

Back 26

p53 & Rb loss

Front 27

Mutations in Primary GBM

Back 27

EGFR amplification, p16 deletion, PTEN deletion

Front 28

Typical histological finding in ependymal tumors

Back 28

rosettes around blood vessels

Front 29

Defective oncogene seen in sporadic menigiomas.

Back 29

merlin from monosomy of chromosome 22

Front 30

Histological appearance of CNS lymphoma.

Back 30

Angiocentric pattern, with lymphocytes expanding hte Virchow-Robin space

Front 31

Most common CNS tumor in children.

Back 31

Piliocytic Astrocytoma

Front 32

Acellular eosinophilic material with a glassy appearance often found in pilocytic astrocytomas.

Back 32

Rosenthal fibers

Front 33

Tumor cells surround acellular material, seen in medulloblastomas.

Back 33

Homer-Wright rosettes

Front 34

Benign tumors found in the sella turcica, compress the pituitary and optic chiasm.

Back 34

Craniopharyngiomas

Front 35

Histology of craniopharyngiomas.

Back 35

Multiple cysts. Tumor cells show evidence of squamous differentiation w/ keratin formation.

Front 36

PNS, numerous Schwannomas and subcutaneous neurofibrommas.

Back 36

NF-1 (Von Recklinhausen's disease)

Front 37

NF-1 inheritence.

Back 37

Autosommal dominant

Front 38

NF-1 is due to ______/

Back 38

Deletion of gene on chromosome 17 for protein that inactvates Ras.

Front 39

Difference between neurofibroma and Schwannoma.

Back 39

Schwannoma only involves some of the nerve rootlets. Neurofibroma is more invasive and whole nerve will be sacrificed.

Front 40

CNS, bilateral acoustic Schwannomas, increased incidence of astrocytomas and meningiomas.

Back 40

NF-2

Front 41

NF-2 caused by deletion of gene ____.

Back 41

merlin on chromosome 22.

Front 42

Visceral schwannomas and neurofibromas and of adrenal gland.

Back 42

NF-3

Front 43

Inheritence of NF-2

Back 43

Autosommal dominant.

Front 44

Histology of schwannoma.

Back 44

Elongated nuclei, stack on top of each other forming Antoni type A or Verocay bodies.

Front 45

Two genes involved in tuberous sclerosis:

Back 45

TSC-1 on chromosome 9 (hamartin) and TSC-2 found on chromosome 16 (tuberin)

Front 46

Inheritence of tuberous sclerosis:

Back 46

AD

Front 47

Lesions seen in Tuberous Sclerosis:

Back 47

glial hamartomas, subpendymal giant cell astrocytomas

Front 48

Common location of schwannomas.

Back 48

cerebellar pontine angle involving CN VIII

Front 49

Common clinical presentation of an astrocytoma.

Back 49

headache

Front 50

Two tumors from neural CREST origin.

Back 50

menigiomas and schwannomas

Front 51

Where are more pediatric brain tumors distributed compared to adult brain tumors?

Back 51

posterior fossa

Front 52

What is the importance of doing a T1 MRI WITH CONTRAST?

Back 52

contrast can get to areas where the BBB has been breeched (e.g. a tumor!)

Front 53

Imaging of low grade astrocytoma.

Back 53

CT- low density, non enhancing
MRI - iso/hypointense on T1, hyperintense on T2
PET - hypometabolic

Front 54

Imaging of Grade III astrocytoma.

Back 54

CT - frequent mass effect
MRI - inhomogeneity, T2 diffuse area of edema
PET - hypermetabolic

Front 55

Imaging of GBM.

Back 55

CT & MRI - inhomogenous T2 hyperintense, hetergeneously enhancing b/c of necrosis
PET - hypermetabolic

Front 56

Imaging of meningioma.

Back 56

CT - iso/hypointense, homogenous, can be calcified
MRI - iso/hypointense on T1, variable on T2

Front 57

Imaging of metastases.

Back 57

CT - discrete and noninfiltrative, edema
MRI - low attenuation on T1, little attenuation on T2, often cystic or necrotic center
PET - hypermetabolic

Front 58

Imaging of medulloblastoma.

Back 58

CT - iso/hypointense w/ edema, homogenous
MRI - hypointense on T1, variable on T2, 4th ventricular extension

Front 59

Positive prognostic factors for higher grade astrocytomas.

Back 59

Grade III better than IV.
Younger patients do better.
Healthier patients do better

Front 60

Whole brain radiotherapy is appropriate in patients with greater than ____ metastatic lesions.

Back 60

3

Front 61

Gold standard to determine between a tumor and radiation necrosis.

Back 61

resection/biopsy

Front 62

What is used to prevent seizures during interoperative mapping?

Back 62

iced ringers lactate

Front 63

Balloon filled with radioactive liquid placed in the brain.

Back 63

Brachytherapy

Front 64

Gamma knife is most often used for which tumors?

Back 64

metastatic brain tumors

Front 65

Which cancer has the highest propensity to metastasize to the brain?

Back 65

Melanoma