Brain tumours Flashcards
Which type of tumours is more common in adults, primary or secondary (metastases) tumours?
Secondary tumours esp from breast, bronchus (lungs), kidney, thyroid, colon carcinomas and malignant melanomas
What is the 2nd most common tumour in children ?
Primary brain tumours, 2nd to leukaemias
What is the commonest cause of cancer related death in people <40?
Primary/ secondary brain tumours
What are the main signs/ symptoms which could suggest a brain tumour ?
- Progressive neurological deficit - this will be covered in later flashcards in terms of localising SOL’s
- Usually motor weakness
- Headache - this can occur with or without raised ICP
- Seizures
Brain tumour does not need to present with ICP but can, the signs/ symptoms of them are:
- Papilloedema
- N&V
- Headache
- Neck stiffness
- Mental changes - personality or behaviour changes
What are the indications for urgent referral for suspected brain and CNS cancers?
Focal neurological deficit - progressive neurological deficit (including personality and behavioural changes) in the absence of previously diagnosed or suspected alternative disorders such as MS
Change in behaviour - progressive deterioration in cognitive, psychological, behavioural and higher executive functions, in the absence of previously diagnosed or suspected alternative disorders such as dementia or MS
Seizures:
- Any new seizure
- Focal seizures
- Significant post-ictal focal deficit
- Epilepsy presenting as status epilepticus
- Associated preceding persistent headache of recent onset
- Seizure frequency accelerating over weeks or months
Headache presenting with vomiting &/or papilloedema
Patients with non-migranous headache with signs/ symptoms of raised ICP
What can localsiing features of SOL’s be divided into ?
- Negative symptoms - deficits caused by direct pressure or tumour invasion
- Positive symptoms - due to localised seizure activity caused by irritation of the brain parenchyma (hence more focal seizures) (these features will be covered in epilepsy notes)
What are the negative localising features suggestive of the temporal lobe being affected by a SOL?
- Dysphagia
- Contralaterla homonymous hemianopia (or upper quadrantanopia if only meyers loop affected)
- Amnesia
- Wernikes aphasia
- Many odd or seemingly inexplicable phenomena (mentioned in the positive features for this lobe)
What are the negative localising features suggesting a SOL affecting the frontal lobe ?
- Hemiparesis
- Personality change
- Brocas aphasia
- Anosmia
- Executive dysfunction (unable to plan tasks)
- General lack of drive or initiative
- Concrete thinking
- Also orbitofrontal syndrome - lack of empathy, over-eating, disinhibition, impulsive behaviour, decreased social skills, utilisation behaviour (whatever is given to them they use e.g. spectacles they put on and if give more will continue to put on more (e.g. 3 on face))
What are the negative symptoms suggestive of a SOL affecting the parietal lobe ?
Hemisensory loss (main one + the list) - Decreased 2-point discrimination, Asterognosis (unable to recognise an object by touch alone), apraxia (unable to perform learned movements on command despite understading movement)
Inferior contralateral homonymous quadrantinopia
Dysphagia
Gerstmans syndrome- characterized by the loss or absence of four cognitive abilities:
- The ability to express thoughts in writing (agraphia, dysgraphia)
- To perform simple arithmetic problems (acalculia)
- To recognize or indicate one’s own or another’s fingers (finger agnosia)
- To distinguish between the right and left sides of one’s body.
What are the negative symptoms suggestive of a SOL affecting the occipital lobe ?
- Contralteral visual field defects (macular sparing)
- Visual agnosia - inability to recognise objects when presented with them
What are the negative symptoms suggestive of a SOL affecting the cerebellum ?
Remember DASHING
- D- Dysdiadochokinesis (impaired rapidly alternating movements) and dysmetria (typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye)
- A - Ataxia (Lack of voluntary coordination)
- S - Slurred speech (dysarthria)
- H - Hypotnia (also reduced reflexes)
- I - Intention tremor (amplitude of an intention tremor increases as an extremity approaches the endpoint of deliberate and visually guided movement i.e. tip of finger to tip of finger test)
- N - Nystagmus
- G - Gait abnormality
What is the main investigation of SOL’s?
- CT +/- MRI (MRI is good for posterior cranial fossa masses)
- Consider biopsy for definitive diagnosis
- Avoid LP before imaging as risk of herniation
What are gliomas ?
Gliomas are brain tumours starting in the glial cells.
There are 3 main types:
- Astrocytoma
- Oligodendroglioma
- Ependymoma
What is an astrocytoma ?
- This is a low grade tumour occurring most frequently in the cerebrum of young adults
- Histologically the tumour is composed of cells resembling astrocytes
What are the 4 main classifications of astrocytomas ?
- I - Pilocytic, Pleomorphic xanthoastrocytoma, Subependymal giant cell (these are all astrocytomas)
- II - Low grade astrocytoma
- III - Anaplastic astrocytoma
- IV - Glioblastoma multiforme
The astrocytic tumors are graded, using a three-tier system, into astrocytoma, anaplastic astrocytoma, and glioblastoma multiforme. Grading is based on pathologic features, such as endothelial proliferation, cellular pleomorphism, and mitoses; the presence of necrosis establishes the diagnosis of glioblastoma multiforme
Go over the grading of astrocytomas and how each one is classified histologically
The astrocytic tumors are graded, using a three-tier system, into astrocytoma, anaplastic astrocytoma, and glioblastoma multiforme. Grading is based on pathologic features, such as endothelial proliferation, cellular pleomorphism, and mitoses; the presence of necrosis establishes the diagnosis of glioblastoma multiforme
What are the key points about grade 1 astrocytomas ?
- They are truly benign and Slow growing
- They mainly occur in children, young adults
- Pilocytic variant astrocytomas typically occur in the cerebellum or optic nerves
- Treatment of choice: surgery - curative
Pic shows a pilocytic astrocytoma present in the cerebellum
What are the different types of low grade astrocytomas, where do they often affect and how do they often present ?
Fibrillary, gemistocytic, protoplasmic
Predilection:
- Temporal lobe
- Posterior Frontal
- Anterior Parietal
Presentation: Seizures (obv also the normal symptoms of brain tumours, more just know that)
What are the key points about glioblastoma multiformes ?
- They may be dervied by evolution of an astrocytoma or arise anew as a glioblastoma
- Histologically there is Infiltration of surrounding brain structures, mitoses, hyperplasia and tumour necrosis
- These are the most common primary brain tumor
- They are Haemorrhagic, necrotic, expansile space occupying lesions
What is the morphological and histological appearance of oligodendroglial tumours ?
- On cut surface, the tumors are solid and often appear grayish-pink. The subarachnoid accumulations are grossly characterized by surgeons as having a “toothpaste” morphology. Mucinous change is also evident and provides a gelatinous consistency to the tumour.
- They are usually relatively circumscribed and commonly calcified
- The cells resemble oligodendroglial cells
- Also Cysts and Peritumoral haemorrhage
