1. Brain Tumours Flashcards
What proportion of brain tumours are secondary?
15%
What are the most common cancers that met to the brain?
Lung
Breast
What is the presentation of brain tumours?
Seizures
Signs of raised intracranial pressure
Hydrocephalus
Focal neuro deficits
What are the signs and symptoms of raised ICP?
Postural headache: early morning and late night
Vomiting
Papilloedema
Clouding of consciousness
What are the 2 types of cerebral oedema?
Vasogenic due to vessel damage: increased intercellular fluid
Cytotoxic due to damage to cells: increased intracellular fluid
What does brain swelling result in?
Compression of vessels > vascular insufficiency > cytotoxic oedema worsening ICP > herniation
What are the types of cerebral herniation?
Subfalcine Transtentorial Transforaminal Upward herniation of cerebellum Craniectomy
What is a subfalcine herniation?
Cingulate gyrus under the falx cerebri
What is compressed in a subfalcine herniation?
Anterior cerebral artery
What is a transtentorial herniation?
Temporal lobe uncus through the tentorium
What is compressed in a transtentorial herniation?
CN3
Posterior cerebral artery
Corticospinal tracts in midbrain
What is hydrocephalus?
Increased CSF volume within the ventricular system
What are the causes of hydrocephalus?
Neoplasm interfering with flow Malformation of CSF tract Infection causing scarring Haemorrhage Giosis CSF overproduction Failure of CSF absorption
Name 2 tumours causing hydrocephalus
Posterior fossa tumours
Pineal gland neoplasm
What are the symptoms and signs of hydrocephalus in infants?
Enlarged head Bulging fontanelle Vomiting Irritability Sleepiness Downward eyes
What are the symptoms and signs of hydrocephalus in children?
Headache
Blurred vision
Poor balance
Seizures
What are the symptoms and signs of hydrocephalus in adults?
Memory loss
Bladder control problems
What is the most common benign tumour of the brain?
Meningioma
What is the most common malignant tumour of the brain?
Gliomas
What stain is associated with atypical teratoid rhaboid tumour?
INI1
What is the most common glioma?
Glioblastoma
What method of spread is used by gliomas?
Secondary structures of Scherer
What is the prognosis of a brain tumour based on?
Grade predicts behaviour
Site is very important: resection, involvement of ‘eloquent areas’
Give an example of a grading system
- is a tumour
- no high grade features
- mitosis
- vascular proliferation +/- mitosis
What are the methods of molecular neuropathology?
aCGH
DNA sequencing panels
Methylation
Fusion specific qPCR
What is the role of molecular neuropathology?
Make a diagnosis
Indicate grade
Predict response to therapy
Predict behaviours
What radiology is used for brain tumours?
CT
MRI with contrast
What is the treatment for brain tumours?
Gross total resection
+/- radio and chemo therapy
What mutation gives a poor prognosis in a glioma?
H3K27M
What does a ‘fried egg’ appearance suggest?
1p19q co-deletion: defines oligodendroglioma
Responds to PCV therapy
Which cancer is a BRAF gene fusion seen in?
Posterior fossa pilocytic astrocytomas
What does a BRAF gene mutation V600 indicate?
Tumour may respond to BRAF inhibitor therapy
eg. Vemurafenib
What does an IDH mutation suggest?
Better prognosis in glioma
What does MGMT methylation indicate?
Responsiveness to temozolamide in gliomas
What does histone mutation suggest?
Automatic high grade tumour; very bad prognosis
What tumours are related to NF type 1?
Neurofibroma
Optic pathway gliomas
What tumours are related to NF type 2?
Schwannoma
Epenymoma
What tumour is related to von Hippel Lindau disease?
Haemangioblastoma
What tumour is related to tuberous sclerosis?
Subependymal giant cell astrocytoma
What tumours are related to Li Fraumeni syndrome?
Glioma
Embryonal
Choroid plexus tumour
What tumour is related to Cowden syndrome?
L’hermitte duclos
What tumour is related to Turcot sydrome?
Glioma
What name is given to haemorrhage in the brainstem due to herniation?
Duret haemorrhage
