Modern Neuropathology Flashcards
Definition of tumor:
swelling formed by an abnormal growth of cells
Benign vs malignant tumors
Benign: - may be live threatening - almost never grown back - have an obvious edge or border - may become malignant Malignant: - always live threatening - likely to grow back - may spread to other parts of the body
Brain-related tissues which may grow tumors:
- bone
- meninges
- blood vessels
- astrocytes
- neurons
Most pervasive tumors:
- breast for females
- prostate for males
- lung
- bowel
How prevalent are tumors of the brain and nervous system?
Invasive tumors of the brain and central
nervous system (CNS) rank 13th”highest
in males and 17th highest in females;
however, when the non-invasive brain
and CNS tumors are also included in the
total, the ranks are 11th and 8th highest,
respectively (data not shown)
Mechanisms by which intracranial tumors produce symptoms:
- compression of axons
- destruction of axons
- increasing intracranial pressure (Monro-Kellie doctrine)
- oedema
- hydrocephalus
General symptoms of intracranial tumors
- headaches (worse in the morning)
- nausea & vomiting
- problems balancing & walking
- changes in mood, personality, concentration
- problems with memory
Focal symptoms of intracranial tumors
- changes in speech, vision, hearing (depending on location)
- muscle jerking, twitching,
- numbness or tingling in arms or legs
- muscle weakness/paralysis
Approaches to diagnosing intracranial tumors
- neurological examination
- imaging (CT/MRI)
- spinal tap
- biopsy
Types of radiation therapy and its side effects:
❖ Classical radiation: Photon
❖ Stereotactic radiation: Gamma-knife
❖ Particle therapy: Proton/Carbon-ion
Side effects:
❖ Oedema
❖ (Radio)necrosis
❖ Radiation-induced meningioma or schwannoma
Most common brain tumors:
- Meningioma
- Astrocytoma
- Vestibular schwannoma
- Pituitary adenoma
Meningioma details
❖ Account for 14-20% of all intracranial neoplasms!
❖ Arise from the arachnoid mater (not dura)!
❖ Women to men ratio of 2:1!
❖ More common in patients > 40 years!
❖ Grade I in 88-95% of cases, rarely grade II or III!
❖ Grows slowly!
❖ Surgery when documented growth on serial imaging and/or symptoms
referable to the lesion
Astrocytoma details
❖ 50% of all intracranial tumors!
❖ Derived from astrocytes: Supporting glial cells!
❖ Grade I to IV
Low-grade:
❖ 10 - 15% of astrocytoma!
❖ Epidemiology: Biphasic distribution!
❖ Childhood (6-12y)!
❖ Early adulthood (26-46y)!
❖ Histology benign, but may become malignant!
❖ Rarely cured because they cannot be completely excised
High-grade:
❖ Grade IV: Glioblastoma multiforme (GBM)!
❖ 15-25% of all intracranial tumors!
❖ Rapid growth!
❖ Worst prognosis of all CNS tumors!
❖ Median survival:!
❖ Without treatment: 3 months!
❖ With treatment: 1-2 years!
❖ Therapy: Surgery, Radiotherapy and chemotherapy
Vestibular Schwannoma details
❖ = Acousticus neurinoma! ❖ 5-10% of all intracranial tumors! ❖ Histological benign! ❖ Common early symptom triad:! ❖ Hearing loss! ❖ Tinnitus! ❖ Dysequilibrium! Management:! ❖ Follow symptoms, hearing and tumor growth on serial MRI! ❖ Radiation therapy! ❖ Surgery
Pituitary adenoma details
❖ 15-20% of all intracranial tumors! ❖ Benign! ❖ Symptoms: ! ❖ Hormone oversecretion/underproduction! ❖ Mass effect: ! ❖ Compression optic chiasm! ❖ Obstructive hydrocephalus! Treatment:! ❖ Surgery! ❖ Hormone substitution
