Brain Tumours Flashcards
why are brain tumours not classified according to TNM
they don’t spread beyond the CNS
what histological features are used for clasifcation
cellularity
pleomorphism
mitotic activity
grade 1 tumour
pilocytic astrocytoma
grade 2 tumour
diffuse astrocytoma (or grade 2 oligodendroglioma)
grade 3 tumour
anaplsatic astrocytoma (or grade 3 oligodendroglioma)
grade 4
glioblastoma
most common kind of brain tumour
astrocytoma
age group affected by primary glioblastoma
elderly - de novo
age group affected by secondary glioblastomas
younger - end point from low grade transformation
Genetic markers of brain tumours
IDH – astrocytoma and oligodendroglia, not primary glioblastoma
LoH1p/19q – oligodendrogliomas and anaplastic oligodendrogliomas
TP53 ATRX – astrocytoma
common clinical features
progressive neurological deficit motor weakness headaches seizures increased ICP
features of headache caused by tumours
worse in the morning, exacerbated by coughing, straining or bending downwards
supratentorial tumours cause symptoms from which lobes
frontal, parietal, temporal, occipital, sellar region
infratentorial cause symptoms from
brain stema nd cerebellum
low grade glioblastomas present in symptoms of which order
seizures»ICP»focal deficit
high grade glioblastomas present in symptoms of which order
ICP/focal deficit > seizure
shirt history
most common type of brain tumours
astrocytomas
how do astrocytomas cause regional effects
compression, invasion, destruction of brain parenchyma, arterial and venous hypoxia, competition for nutrients, release of metabolic end products and release and recruitment of cellular mediators
risk factors of astrocytic tumours
male, white, neurofibromatosis type 1, tuberous scelrosis, li-fraumeni syndrome, turcots cancer, ionising radiation
histological features of pilocytic (grade 1) astrocytomas
childhood, benign behavng, long hair like processes
pilocytic, pleomorphic xanthoastrocytoma, subependymal giant cell
histological features of grade 2
well differentiated
nuclear atypia
histological features of grade 3
anaplastic
greater nuclear atypia
mitotic activity
histological features of secondary grade 4 glioblastomas
extreme nuclear atypia
mitotic activity
necrosis and/or neovascularisation
histological features of primary grade 4 glioblastomas
extreme nucelar atypia
mitotic activty
necrosis or neovascularisation
common presenting features of pilocytic grade 1
effects children progressive headache, wide based gait, difficulty speaking Persistent/recurrent headache Balance/co-ordination/walking problems Persistent/recurrent vomiting Abnormal eye movements Blurred or double vison/loss of vision Behaviour change Fits or seizures Abnormal head position Tailing of developmental milestones
treatment of grade 1
surgical removal
low grade symptomatic development
long presymptomatic phase, apparent latency stability (will have slow underlying malignant transformation)
management of low grade gliomas (2)
watch and wait
maximal resection +/- radiotherapy (only if incomplete removal and malignant degeneration) and chemotherapy