Neurooncology Flashcards
What are the most common primary CNS tumours? (Benign and malignant)
Mostly: Benign
40% Bening Meningioma
17% Benign Pituitary
Malignant: 30%
What are 3 Common Familial CNS tumour syndromes and what types of CNS tumours do they cause?
Neurofibromatosis 1: neurofibroma, astrocytoma
Neurofibromatosis 2: schnwannoma, meningioma
Von Hippel Lindau: Hemangioblastoma
What primary brain tumours usually benefit most from Radiotherapy?
- Low and high grade gliomas, metastases, some benign
What primary brain tumours are usually treated by chemotherapy?
Mainly high grade gliomas (temozolomide) and lymphomas
Where do extra-axial brain tumours originate from?
Do they tend to be bening or malignant?
Cranium
softtissue
meninges
nerves
[BENIGN]
Where to intra-axial brain tumours usually originate from?
Do they tend to be belign or malignant
glial
neurons
neuroendocrine cells
Usually MALIGNANT, but rarely metastasise outside the CNS
What systemic tumours like to metastasise to the brain?
lung, breast, malignant melanoma and renal cell
What is the radiological appearance of CNS metastasis on a CT head?
Well demarcated, solitary or multiple with surrounding oedema
Can be multiple
What are infratentorial signs and symptoms of brain tumours?
- Ataxia
- Long tract signs - spasticity and hyperreflexia
- Cranial nerve palsies
Located below the tentori cerebellum –> Cerebellum + Brain stem
What are primary brain tumours derived from astrocytes called?
Astrocytomas
What are primary CNS tumours called derived from oligodendrocytes?
oligodendroglioma
BUZZWORD
“fried-egg”appearance
What are primary CNS tumours called derived from empendyma?
ependyoma
BUZZWORD
ventriculartumour hydrocephalus
What are primary CNS tumours called derived from Embryonal cells?
Medullablastoma
How does the Grading of primary CNS tumours work?
What predictions are they based on?
What are they?
Based on natural clinical behaviour (without treatment - with treatment can be different)
Grade 1–benign
Grade 2–more than 5 years survival
Grade 3–1- 5 years survival
Grade 4 – less than 1 year survival
Which CNS cells are classified as glial cells?
Astrocytes + Oligodendrocytes
(Macroglia)
Ependymal cells
Tanycytes
What are Pilocytic Astrocytomas?
What grade are they usually and what epidemiology?
Primary CNS tumours derived from Astrocytes
Usually in children (0-20 years)
and Grade 1 (benign)
What are histological features of pilocytic astrocytomas?
Piloid “hairy” cells
Rosenthal fibres
Slow mitotic divisions
What are histological features of astrocytomas (diffuse Gliomas)?
Low-moderate cellularity
Low mitotic activity
No vascular proliferation
(+ IDH mutant can be detected by immunocytochemically)
What histological signs would you see on a glioblastoma multiforme?
High cellularity
High mitotic activity
Microvascular proliferation Necrosis
Where do meningiomas originate from?
Can originate from any site of craniospinal axis
Originate from meningothelial cells of the arachnoid mater
What histological features do meningiomas usually show?
Psammoma bodies (calcifications)
Mitotic activity determines grading
(<4 grade 10
4-20grade 2
>20 grade 3)
What cell types does a Medulloblastoma originate from?
What grade is it usually?
Embryonal tumour - originates from neuroepithelial cells/neuronal precursors of the cerebellum or dorsal brainstem
Often/usually Grade 4, however outcome have improved with radio-chemotherapy and subtype stratification
What radiological appearance is associated with glioblastoma multiforme?
On MRI:
heterogenous,
enhancing post contrast
