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YEAR 5: Histopathology - PK Edited > Histo: Neuro-Oncology > Flashcards

Histo: Neuro-Oncology Flashcards

1
Q

How much more common are secondary brain tumours than primary brain tumours?

A

10x more

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2
Q

Describe the radiological classification of brain tumours.

A
  • Extra-axial (coverings) - tumours of the bone, meninges and metastatic deposits
  • Intra-axial (parenchyma) - derived from normal cell populations of the CNS (e.g. glia, neurones, vessels) or derived from other cell types (e.g. lymphomas, metastases)
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3
Q

List the different cell types within the CNS that can give rise to brain tumours.

A

neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells, and microglia), choroid plexus cells, cells related to blood vessels and coverings.

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4
Q

What is the most common genetic syndrome associated with brain tumours?

A

Neurofibromatosis

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5
Q

What is the inheritance pattern of neurofibromatosis?

A

Autosomal dominant

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6
Q

Where are the genes that cause neurofibromatosis located?

A
  • NF1 = 17q11
  • NF2 = 22q12
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7
Q

List some manifestations of brain tumours that are:

  1. Supratentorial
  2. Subtentorial

and what are they referring to when you say tentorial?

A
  1. Supratentorial
    • Focal neurological defect
    • Seizures
    • Personality changes
  2. Subtentorial
    • Cerebellar ataxia
    • Long tract signs
    • Cranial nerve palsy

Tentorial - tentorium cerebelli

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8
Q

Outline the management options for brain tumours.

A
  • Surgery - aim for maximal safe resection with minimal damage to the patient. Debulking may be performed and biopsies may be taken.
  • Radiotherapy - used for gliomas and metastases
  • Chemotherapy - mainly for high-grade gliomas
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9
Q

What is the WHO classification of brain tumours based on?

A
  • Tumour type (cell of origin) e.g. astrocyte or oligodendrocyte
  • Tumour differentiation (grading) (tells you how long they are gonna live)

NOTE: metastases are not graded

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10
Q

Outline the meaning of the different WHO grades for brain tumours.

A
  • Grade I = benign, long-term survival
  • Grade II = death in > 5 years
  • Grade III = death in < 5 years
  • Grade IV = death in < 1 years

NOTE: grades I and II are low

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11
Q

Which brain tumours are staged?

A

None

Except medulloblastoma

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12
Q

What is the most common type of primary brain tumour?

A

Glial tumours

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13
Q

List some key features of pilocytic astrocytomas.

A
  • Usually grade I
  • Mainly occurs in children
  • Associated with NF1
  • Often cerebellar
  • BRAF mutation in 70% of cases
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14
Q

What is the hallmark histological feature of pilocytic astrocytoma?

A
  • Piloid (hairy) cell
  • Often see Rosenthal fibres and granular bodies
  • Slow-growing with low mitotic activity
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15
Q

List some key features of astrocytoma.

A
  • Usually Grade II-IV
  • Cerebral hemispheres are the most common site in adults
  • Can progress to become a higher grade (malignant progression)
  • IDH2 mutation in 80% of cases
  • Mitotic activity and vascular proliferation is absent
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16
Q

What can astrocytomas eventually become?

A

Glioblastoma (after 5-7 years)

17
Q

List some key features of glioblastoma multiforme.

A
  • Grade IV
  • Most patients > 50 years
  • High cellularity and high mitotic activity
  • Microvascular proliferation and necrosis
18
Q

What does glioblastoma multiforme tend to arise from?

A

90% arise de novo and have wildtype IDH

10% occur secondary to astrocytoma and have IDH mutation

19
Q

What is a characteristic histological feature of oligodendroglioma?

A

Round cells with clear cytoplasm (friend egg)

20
Q

List some key features of meningioma.

A
  • Mainly low grade (I and II)
  • Can be multiple (e.g. in NF2)
  • Can cause focal symptoms (e.g. seizures, compression)
21
Q

Which histological feature of meningioma is important in determining grade?

A

Mitotic activity (number of mitoses per 10 high power fields)

  • Grade 1: < 4
  • Grade 2: 4-20
  • Grade 3: > 20

NOTE: brain invasion is also an important thing to assess (presence of brain invasion makes it grade II)

22
Q

How does grade of meningioma affect the management options?

A

Grade II and III requires radiotherapy as well as surgery

23
Q

What is a medulloblastoma?

A
  • Embryonal tumour originating from neuroepithelial precurosrs of the cerebellum and dorsal brainstem
  • They are always found in the cerebellum
24
Q

Which tumours most commonly metastasise to the brain?

A
  • Lung
  • Breast
  • Melanoma
25
Q

Where in the brain do metastases tend to be found?

A
  • At the grey-white junction
  • This is because the cerebral blood vessels become smaller as they enter the white matter so neoplastic emboli get caught here
26
Q

what is von-hippel lindau

A

a rare, genetic multi-system disorder in which non-cancerous tumors grow in certain parts of the body.

Slow-growing hemgioblastomas—benign tumors with many blood vessels—may develop in the: Brain

27
Q

most common brain tumour in children? And mutation associated with it?
And how serious is it?
what agegroup?

A

pilocytic astrocytoma
BRAF in 70%
WHO G1 - not too shabby
0-20

28
Q

why is there no tnm staging for primary brain tumours

A

as they do not usually metastasise

29
Q

Most common brain tumour in age 20-40, and grade, and mutation associated with it?

A

Diffuse glioma
G2-3
IDH mutation is associated with longer survival and better response

30
Q

Most common brain tumour in 50+

Grade

and mutation

A

Glioblastoma multiforme

G4

IDH wildtype

31
Q

2nd most common brain tumour in children

A

medulloblastoma

32
Q

brain tumour associated with NF2?

A

meingioma

33
Q

which brain tumour’s mitotic activity determines its grading?

A

meningioma

34
Q

Grade of meningiomas?

A

G1-2

35
Q

buzzword for ependymoma appearance?

A

ventricular tumour, hydrocephalus

YEAR 5: Histopathology - PK Edited (29 decks)

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