Intracranial Tumours Flashcards
What are some examples of primary intracranial tumour types?
Glioma - glioblastoma, astrocytoma, oligodendroglioma, ependymoma
Embryonic neural cell - medullablastoma
Arachnoidal cell - meningioma
Nerve sheath cell - schwannoma, neurofibroma
Pituitary gland - adenoma
Lymphoid cell - lymphoma
Capillary vessels - haemangioblastoma
What are common origins of CNS metastases?
Breast Lung Kidney Colon Melanoma
Which are the four most notable CNS tumours?
Glioma
Meningioma
Schwannoma
Adenoma
How does the location of CNS tumours vary in children vs adults?
Mostly above tentorium in adults
Mostly below tentorium in children
What are signs/symptoms of intracranial tumours?
As in raised ICP
Focal neurological deficit
Epileptic fits, focal/generalised and only if above tentorium
CSF obstruction
What are some examples of focal neurological deficits?
Hemiparesis Dysphasia Hemianopia Cognitive impairment (memory, sense of direction) Cranial nerve palsy Endocrine disorders
What investigations might be done in suspected intracranial mass?
CT
MRI
PET
Angiography
If suspected metastases
- CT chest/abdo/pelvis
- mammography
- biopsy skin lesions/lymph nodes
NEVER perform LP in suspected mass
What are the goals in intracranial tumour management?
Accurate diagnosis Improve QoL - decreasing mass effect - improve neurological deficit Aid effect of adjuvant therapy Prolong life expectancy
What are various types of treatment in intracranial tumours?
Surgery Radiotherapy Chemotherapy Endocrine replacementCorticosteroids - dexamethasone Treat epilepsy - anticonvulsants Analgaesics/anti-emetics Counselling
What are the treatments for glioblastoma multiforme?
Steroids/anticonvulsants
Radiotherapy
Chemotherapy (temazolamide)
Complete surgical excision impossible - biopsy or debulk
What is the management in metastatic-origin CNS tumours?
Confirm diagnosis
11% with abnormal imaging and cancer history DO NOT have mets
Steroids/anticonvulsants
Radiotherapy (whole brain or stereotactic)
Surgery
Features of gliomas?
Resemble cells of glial differentiation
Diffuse edges - not encapsulated
Malignant but don’t metastasise outside CNS
Low grade astrocytoma - bland cells on microscopy - similar to normal astrocytes, slow growth
Glioblastoma - cellular, atypical, with necrosis under microscope, grow quickly - often present as large tumours, spread through white matter and CSF
Features of medullablastoma?
Tumour of primitive neuroectoderm (primitive neural cells)
Sheets of small undifferentiated cells
Children especially
Posterior fossa, especially brainstem
Features of meningioma?
From arachnocytes
Benign but can be locally aggressive and can invade the skull
Slow growing
Often resectable
On miscroscopy, bland cells forming small groups, sometimes with calcification (psammoma)
Small groups of cells whorl around each other, resembling arachnoid granulation
Features of nerve sheath tumours?
Around peripheral nerves - intracranial and extracranial
e. g. Schwannoma on CNVIII
- acoustic neuroma at angle between pons and cerebellum
- unilateral deafness
- benign lesion but removal technically difficult
