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Symposium > Intracranial & CNS Tumours > Flashcards

Intracranial & CNS Tumours Flashcards

1
Q

What are symptoms of raised intracranial pressure?

A
  • Headaches (early morning)
  • Vomiting
  • Blurred vision
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2
Q

What are the causes of raised intracranial pressure?

A
  • Tumours
  • Surrounding oedema
  • Obstructive hydrocephalus
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3
Q

What neurological deficits are there?

A
  • Motor
  • Sensory
  • Cranial nerve
  • Visual
  • Cognitive
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4
Q

What neuro causes are there for seizures?

A
  • Supratentorial tumours

- Partial/complex partial/secondary generlaized

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5
Q

What investigations are used for suspected intracranial tumours?

A
  • Haematological
  • Tumour markers (PSA, Bhcg, aFP)
  • Hormonal assay
  • Visual fields
  • CXR
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6
Q

What can an fMRI identify?

A
  • Measures brain activity by detecting changes associated with blood flow
  • Speech lateralised to left hemisphere
  • Bilateral hand movements by bilateral motor cortex
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7
Q

How are intracranial tumours managed?

A
  • Medical: steroids, anti-convulsants, hormonal replacement, anti-epileptics, radio/chemo
  • Surgical: remove mass effect, biopsy (free hand, endoscopic, neuro-navigation, stereotactic), excision (total/partial)
  • Adjuvant therapy
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8
Q

What is a frozen section?

A
  • Confirm abnormal tissue
  • Difficult to establish for some intrinsic tumours
  • Oedema surrounding tumour may look abnormal
  • Tumour resection can proceed
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9
Q

What are complications of surgery?

A

-Hydrocephalus- third ventriculostomy, ventricle-peritoneal shunt

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10
Q

What CNS tumours are most common in males & females?

A

M= gliomas

F=meningioma

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11
Q

What are the types of glial cells and what are their functions?

A
  • Astrocytes (support & protect)
  • Oligodendrocytes (myelin)
  • Ependymal cells & choroid plexus cells (CSF)
  • Microglia (defence)
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12
Q

What tumours can arise from nervous tissue?

A
  • Glioma
  • Meningioma
  • Neurocytoma
  • PNET
  • Schwannoma
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13
Q

What is the histological criteria for malignancy in brain tumours?

A
  • Cellular density & atypia
  • Mitotic activity
  • Necrosis
  • Vascular proliferation
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14
Q

What are microscopic features of astrocytic tumours?

A
  • Fine fibrillary & microcystic background
  • Inc cellular density
  • Pleomorphism
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15
Q

Describe the features of a diffuse astrocytoma and its grade

A
  • 2
  • Infiltrative, microcystic, fibrillary
  • Low cellular density
  • Mild atypia
  • No mitotic activity
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16
Q

Describe the features of a anaplastic astrocytoma and its grade

A
  • 3
  • Moderate pleomorphism
  • Mitoses
  • Moderate cellular density
17
Q

Describe the features of a glioblastoma and its grade

A
  • 4
  • Necrosis
  • Vascular proliferation
  • High cellular density & mitoses
18
Q

Describe the features of pilocytic astrocytoma and its grade

A
  • 1
  • Well defined cystic
  • Children
  • Cerebellum
  • Pilocytes
  • Rosenthal fibres
  • Vascular proliferation
19
Q

Describe the features and grade of an oligodendroglioma

A
  • 2/3
  • Round uniform nuclei with clear cytoplasm (fried egg)
  • Calcifications
  • Arborising capillaries (chicken wire)
20
Q

Describe the features and grade of an ependymoma

A
  • 2/3
  • Well defined
  • Ventricles
  • Pseudorosettes
  • Round, small uniform cells
21
Q

Describe the features and grade of a meningioma

A
  • 1
  • Adult females
  • dura
  • Well defined extra axial
  • Whorls
  • Psammoma bodies
22
Q

Describe the features and grade of a PNET

A
  • AKA medulloblastoma
  • 4
  • Children
  • Cerebellum
  • Very high cellular density
  • Anaplastic hyperchromatic cells
  • Rosette formation
  • Frequent mitoses & apoptosis
23
Q

Name some nerve sheath tumours

A
  • Spindle-cell tumours
  • Schwannoma (CN8, reticulin, biphasic pattern)
  • Neurofibroma (spinal nerves rich in collagen)
24
Q

What are the causes of:

  • Meningioma
  • Lymphoma
  • NF1/2
A
  • M=radiotherapy
  • L=Immunosuppression
  • NF1/2= Familial syndromes
25
Q

What 4 markers are relevant for molecular diagnosis of gliomas?

A
  • MGMT promoter methylation
  • BRAF duplication/fusion
  • 1p/19q deletion
  • IDH1/IDH2 mutation
26
Q

What are side effects of cranial radiotherapy?

A
  • Acute= hair loss, scalp/ear erythema, cerebral oedema-raised ICP & exacerbation of neuro symptoms
  • Intermediate= somnolence syndrome-severe tiredness & exacerbation of neuro symptoms
  • Late= damage to sensitive structures-lens/cataracts, pituitary (hypopituitarism), cerebral hemispheres (memory loss)
27
Q

In which tumour types can treatment be curative?

A
  • Germ cell tumours
  • Medulloblastomas
  • Using chemo/radiotherapy, surgery or combination

Symposium (17 decks)

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