DISEASE- brain tumours Flashcards
most common neuroepithelial tumour?
Astrocytoma
describe the shape of an astrocyte
star shaped
-multipolar
role of astrocyte?
-involved in BBB
-structural support
-involved in lots of disease process
are primary or secondary brain tumours more common?
secondary
features of a cancer headache?
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
what is the grading of an astrocytoma?
WHO GRADING
Grade I- pilocytic astrocytoma
Grade II- low grade astrocytoma
Grade III- anaplastic astrocytoma
Grade IV- glioblastoma multiforme
what grade of astrocytoma are benign?
Grade I- pilocytic astrocytoma
Grade II- low grade astrocytoma
Grade II is not considered malignant but it does not act benign
what is the most common brain tumour is children?
Grade I- pilocytic astrocytoma
describe the behaviour of a Grade I pilocytic astrocytoma
benign + slow growing
treatment of a Grade I pilocytic astrocytoma
surgery
where is a grade I pylocytic astrocytoma most commonly found?
-in the cerebellum or brainstem
where is a grade II low grade astrocytoma more commonly found?
-in the temporal lobe or around the central gyrus
describe a grade II low grade astrocytoma
not considered malignant but does not act benign (there is also a chance it can differentiate into higher grade)
-vascular proliferation and nuclear atypia
treatment of a grade II low grade astrocytoma?
surgery +/- radiation/ chemo (PVC)
is a grade III anaplastic astrocytoma benign or malignant?
malignant
describe a grade III anaplastic astrocytoma
Greater nuclear atypia and mitosis
-malignant
where do grade III anaplastic astrocytomas arise from?
can arise de novo or develop from a lower grade
what is the median survival or someone with anaplastic astrocytoma?
median survival is 2 years
where do you normally find a grade IV glioblastoma multiforme?
-usually in frontal lobe and crosses the midline
describe grade IV glioblastoma multiforme
-malignant
-butterfly appearance
-necrosis and neovascularisation
how do grade IV glioblastoma multiformes spread?
through the white matter tracts/ CSF pathway
median survival of someone with grade IV glioblastoma multiforme?
cant cure
median survival <1 year
do grade IV glioblastoma multiforme metastasise?
grade IV glioblastoma multiforme rarely metastasize
management of malignant astrocytomas?
Grade III anaplastic astrocytoma and grade IV glioblastoma multiforme are malignant
not curative
Post operative radiotherapy + chemo (tenozolamide + PVC)
SE of radiotherapy (tanozolamide + PVC)?
cant drive post op- risk of seizures
SE: IQ drops by 10, skin + hair loss, tired
what would multiple glioblastoma multiformes suggest?
-NF1
-TS (turcot syndrome)
-PML
how does glioblastoma multiforme appear on ct?
On CT- peripherally enhancing lesion and hypodense centre (darker)
where are oligodendrogliomas most commonly found?
in the frontal lobe
who is typically affected by oligodendrogliomas?
adults (25-45)
how do oligodendrocytes appear microscopically?
-greyish pink
-subarachnoid accumulations
-‘toothpaste’ appearance on morphology
how do oligodendrocytes appear macroscopically?
-cysts
-calcification (usually peripheral)
-peritumoral haemorrhage
Oligodendrocytes are collision tumours
-what does this mean?
it means that they are typically found with other tumours
management of oligodendrocytes?
Treatment= surgery + chemotherapy + radiotherapy
median survival of oligodendrocytes?
median survival 10 years (can have malignant conversion)
what is the most common benign brain tumour?
meningioma
where do meningiomas arise from?
meningiomas arise from arachnoid cap cells
-they are extra axial (outwith the brain parenchyma/ functional tissue)
who is more likely to get a meningioma?
3F:2M
Can get radiation induced meningioma (think of this if midline tumour and patient had leukemia as a child)
how do meningiomas usually present?
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
what is meningioma en plaque?
morphological subgroup within meningiomas defined by a carpet/ sheet-like lesion that infiltrates the dura and sometimes invades the bone
histology of meningioma?
Spindle cells in concentric whorls and calcified psammoma bodies
MRI of meningioma?
dural tail and patent dural sinuses
CT of meningioma?
homogenous, densely enhancing, oedema, hyperostosis/ skull ‘blistering’
management and survival rate of meningioma?
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%.
