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Neoplasms

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A 65-year-old right-handed woman began having neurological problems about 1 week ago. She began experiencing nausea, vomiting, and numbness in the left hand and left foot. Today she had a generalized convulsion, and since then she has had a throbbing headache that is worse when she bends forward. On examination, the only deficits she has are loss of double simultaneous tactile stimulation and left lower facial droop when smiling. MRI reveals a lesion suggestive of a primary brain tumor. Which of the following is the most common cell type from which primary brain tumors arise?

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a. Glial cells

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b. Neurons

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c. Meningeal cells

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d. Lymphocytes

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e. Endothelial cells

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The answer is a. Between 2% and 5% of all tumors occurring in the general population are primary CNS tumors. In adults, the most common primary brain tumor is the astrocytoma. In children, brain tumors are more likely to arise in the posterior fossa. Even in childhood, glial cell tumors, such as the cerebellar astrocytoma and the optic glioma, are common.

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A previously healthy 31-year-old man collapses in the kitchen of his home while sitting at the table talking. His wife witnessed a convulsion that lasted about 2 minutes. He seems to recover fully within an hour. The history taken in the emergency room reveals that he has been having new headaches in the early morning hours over the past few weeks. A brain magnetic resonance imaging (MRI) indicates that there is an enhancing right frontal lesion that is most likely a primary brain neoplasm. Which of the following is the most common type of primary brain tumor?

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a. Meningioma

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b. Astrocytoma

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c. Lymphosarcoma

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d. Oligodendroglioma

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e. Medulloblastoma

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The answer is b. The most common primary brain tumors are malignant astrocytomas. These are classified as grade 3 or 4. Grade 4 astrocytoma is more commonly called glioblastoma multiforme. It is malignant in the very conventional sense that it invades adjacent tissue. This type of glial tumor is usually seen in adults; men are more susceptible than women.

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A 7-year-old girl has been diagnosed with a brain tumor. The parents are both well educated with a scientific background and have many questions. During the course of the discussion, you might tell them that most brain tumors in children are which of the following?

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a. Metastatic lesions ...

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