Primary Tumor FND Notes
description
Transcript of Primary Tumor FND Notes
-
7/21/2019 Primary Tumor FND Notes
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P
BRAIN
TUMORS
/
-
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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
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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
-
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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
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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
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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
-
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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