CNS tumours Flashcards
Are primary or secondary CNS tumours more common?
Secondary (mets) more common
Primary tumours children > adults
WHO tumour grading
Grades I-IV
Grade I - Benign (long term survival) Grade II - Death in >5y Grade III - Death in <5y Grade IV - Death in <1y I and II low grade, III and IV high grade Not all tumour types have all 4 grades
Factors used to grade brain tumours
Cellularity Mitotic activity Necrosis Endothelial proliferation (neoangiogenesis) Molecular markers
17q11
AD
Neurofibroma, pilocytic astrocytoma
NF1
22q12
AD
Schwannoma, meningioma
NF2
Most common primary tumour
Astrocytoma
Most common primaries in secondary brain tumours
Small cell lung cancer
Breast
Malignant melanoma
Ventricular tumour
Hydrocephalus
Ependymoma
Focal deficit
Seizures
Personality changes
Supratentorial symptoms
Cerebellar ataxia
Cranial nerve palsies
Infratentorial symptoms
Tumours of oligodendrocytes + astrocytes (GLIAL cells)
Gliomas
Most common primary tumours Glioma - astrocytes Peripheral - cerebral hemispheres IDH1/2 good prognosis Eventually become GBM 20-40yo
Diffuse astrocytoma
Diffusely common
Malignant astrocytoma Glial - astrocytes Poorly delineated grey-pink tumours with central yellow necrosis 90% de novo, 10% from diffuse astrocytoma Pseudo-palisading pattern >50 Heterogenous Grade IV only
Glioblastoma (GBM)
God its bloody malignant
Glial - oligodendrocytes
Slow growing
IDH1/2 co-deletion 1p/19q
Seizures often initial symptom
Small round nuclei surrounded by halos of clear cytoplasm (fried eggs)
Fine network of branching chicken wire capillaries
Calcification
Oligodendroglioma
Think: oligo - oil - fried eggs - clear cytoplasm, chicken wire capillaries, calcification, clonic seizures
Slow growing and benign
Nests of cells (wave in ocean)
Psammoma body calcifications
Female >40
Meningioma
Men in nests of cells on waves, accompanied by Psammoma bodies
Wet keratin appearance
Very slow growing and benign
Cysts of oily fluid + cells
Craniopharyngioma
Cranes sit on wet keratin to avoid the oily cysts
Glial - astrocytes Indolent childhood tumour BRAF mutation NF1 Cysts, Rosenthal fibres + granular bodies Piloid hairy cells
Pilocytic astrocytoma
Children staring at hairy stars so they are ok
Glioblastoma (GBM)
Meningioma
Oligodendroglioma
Craniopharyngoma
Supratentorial
Medulloblastoma
Pilocytic astrocytoma
Meningioma
Ependymoma
Infratentorial
Most common tumour location in children
Infratentorial
Most common malignant tumour in children
Cerebellum
Super aggressive - type IV only
‘Homer-Wright rosettes’ - dense tangles of of neurons + neuroglial cells surrounded by tumour cells
Drop metastasis to base of spine through CSF
Medulloblastoma
Children awarded medals + rosettes because it is so aggressive and can drop through CSF