DISEASE- brain tumours

Question 1

most common neuroepithelial tumour?

Answer 1

Astrocytoma

Question 2

describe the shape of an astrocyte

Answer 2

star shaped
-multipolar

Question 3

role of astrocyte?

Answer 3

-involved in BBB
-structural support
-involved in lots of disease process

Question 4

are primary or secondary brain tumours more common?

Answer 4

secondary

Question 5

features of a cancer headache?

Answer 5

Progressive neurological deficit (68%)
Usually motor weakness (45%)
Seizures (26%)
Headache (54%)
* May occur with/without raised ICP
* Worse in morning
* Worse when coughing/ leaning forward (30%)
* N+V
* Similar to migraine, difference: headache pattern erratic in cancer, tension like, vomiting Is prolonged and repetitive, new motor weakness common in cancer but not migraine
Worsens with valsalva in a cancer headache

Question 6

what is the grading of an astrocytoma?

Answer 6

WHO GRADING
Grade I- pilocytic astrocytoma
Grade II- low grade astrocytoma
Grade III- anaplastic astrocytoma
Grade IV- glioblastoma multiforme

Question 7

what grade of astrocytoma are benign?

Answer 7

Grade I- pilocytic astrocytoma
Grade II- low grade astrocytoma

Grade II is not considered malignant but it does not act benign

Question 8

what is the most common brain tumour is children?

Answer 8

Grade I- pilocytic astrocytoma

Question 9

describe the behaviour of a Grade I pilocytic astrocytoma

Answer 9

benign + slow growing

Question 10

treatment of a Grade I pilocytic astrocytoma

Answer 10

surgery

Question 11

where is a grade I pylocytic astrocytoma most commonly found?

Answer 11

-in the cerebellum or brainstem

Question 12

where is a grade II low grade astrocytoma more commonly found?

Answer 12

-in the temporal lobe or around the central gyrus

Question 13

describe a grade II low grade astrocytoma

Answer 13

not considered malignant but does not act benign (there is also a chance it can differentiate into higher grade)

-vascular proliferation and nuclear atypia

Question 14

treatment of a grade II low grade astrocytoma?

Answer 14

surgery +/- radiation/ chemo (PVC)

Question 15

is a grade III anaplastic astrocytoma benign or malignant?

Answer 15

malignant

Question 16

describe a grade III anaplastic astrocytoma

Answer 16

Greater nuclear atypia and mitosis
-malignant

Question 17

where do grade III anaplastic astrocytomas arise from?

Answer 17

can arise de novo or develop from a lower grade

Question 18

what is the median survival or someone with anaplastic astrocytoma?

Answer 18

median survival is 2 years

Question 19

where do you normally find a grade IV glioblastoma multiforme?

Answer 19

-usually in frontal lobe and crosses the midline

Question 20

describe grade IV glioblastoma multiforme

Answer 20

-malignant
-butterfly appearance
-necrosis and neovascularisation

Question 21

how do grade IV glioblastoma multiformes spread?

Answer 21

through the white matter tracts/ CSF pathway

Question 22

median survival of someone with grade IV glioblastoma multiforme?

Answer 22

cant cure

median survival <1 year

Question 23

do grade IV glioblastoma multiforme metastasise?

Answer 23

grade IV glioblastoma multiforme rarely metastasize

Question 24

management of malignant astrocytomas?

Answer 24

Grade III anaplastic astrocytoma and grade IV glioblastoma multiforme are malignant

not curative

Post operative radiotherapy + chemo (tenozolamide + PVC)

Question 25

SE of radiotherapy (tanozolamide + PVC)?

Answer 25

cant drive post op- risk of seizures SE: IQ drops by 10, skin + hair loss, tired

Question 26

what would multiple glioblastoma multiformes suggest?

Answer 26

-NF1 -TS (turcot syndrome) -PML

Question 27

how does glioblastoma multiforme appear on ct?

Answer 27

On CT- peripherally enhancing lesion and hypodense centre (darker)

Question 28

where are oligodendrogliomas most commonly found?

Answer 28

in the frontal lobe

Question 29

who is typically affected by oligodendrogliomas?

Answer 29

adults (25-45)

Question 30

how do oligodendrocytes appear microscopically?

Answer 30

-greyish pink -subarachnoid accumulations -'toothpaste' appearance on morphology

Question 31

how do oligodendrocytes appear macroscopically?

Answer 31

-cysts -calcification (usually peripheral) -peritumoral haemorrhage

Question 32

Oligodendrocytes are collision tumours -what does this mean?

Answer 32

it means that they are typically found with other tumours

Question 33

management of oligodendrocytes?

Answer 33

Treatment= surgery + chemotherapy + radiotherapy

Question 34

median survival of oligodendrocytes?

Answer 34

median survival 10 years (can have malignant conversion)

Question 35

what is the most common benign brain tumour?

Answer 35

meningioma

Question 36

where do meningiomas arise from?

Answer 36

meningiomas arise from arachnoid cap cells -they are extra axial (outwith the brain parenchyma/ functional tissue)

Question 37

who is more likely to get a meningioma?

Answer 37

3F:2M Can get radiation induced meningioma (think of this if midline tumour and patient had leukemia as a child)

Question 38

how do meningiomas usually present?

Answer 38

often asymptomatic- due to slow growing tumour symptoms usually more due to compression than tumour itself: -headache, regional anatomical disturbances -if at skull base may have cranial nerve neuropathies

Question 39

what is meningioma en plaque?

Answer 39

morphological subgroup within meningiomas defined by a carpet/ sheet-like lesion that infiltrates the dura and sometimes invades the bone

Question 40

histology of meningioma?

Answer 40

Spindle cells in concentric whorls and calcified psammoma bodies

Question 41

MRI of meningioma?

Answer 41

dural tail and patent dural sinuses

Question 42

CT of meningioma?

Answer 42

homogenous, densely enhancing, oedema, hyperostosis/ skull 'blistering'

Question 43

management and survival rate of meningioma?

Answer 43

Expectant if small enough. Pre op embolisation, Surgery, radiotherapy (Meningiomas are vascular- may help to do angiography +/- embolization before surgery) Recurrence depends on grade 5 year survival 90%.