Neuropathology 1 Flashcards
What are the general principles of Neoplasia ?
Either benign or malignant;
- Implications in brain
- Malignant - think primary? versus secondary? (invading or metastasis)
- Non-metastatic/indirect effects
Even although benign isn’t invasive, skull is small area and benign will put pressure on brain, raise ICP and compress affecting function and potentially death
Treatment of choice is often neurosurgery
What type of tumours are most common in the brain and the effects these have?
Most common = Metastatic
Common primary;
- Breast
- Melanoma
- Lung
- Kidney
- Gut
- Lymphoma/leukaemia
Effects;
- No effect
- Space occupying lesion can cause; Fits, visual, drowsiness, behavioural change
- Haemorrhage (may present as stroke but cancer)
What would lung cancer cells look like?
- Most common
- Small cell undifferentiated
- Squamous
- Adeno
What would breast cancer look like?
Image
What would Malgnant melanoma look like?
Image
What would gastric/colorectum cancer look like?
Image
What constituents can you find intracranially ?
- Brain
- Limnings - arachnoid membrane
- Pituitary
- Peripheral nerve elements VIIII cranial nerve
- Neurons
- Astrocytes - nutrition, support, signalling
- Microglia - macrophage like
- Oligodendrocyte - myelin sheath
- Ependyma - line ventricles
- Choroid plexus - ependyma and capillaries, produce CSF
Point is any tumour can metastasis to brain and any cell can give rise to neoplasm
What is the prevalence of different brain cancers?
- Malignant tumour - is metastatic (most common)
- Intracranial primary neoplasm - 1/3rd is a meningioma
- Primary neoplasms (on malignant spectrum) - 1/3rd are gliomas
- Intracranial peripheral nerve tumour - is acoustic Schwannoma (acoustic neuroma - in acoustic nerve CN VIII) <10%
What are the features of a Meningioma ?
Key bits;
- Sporadic (most cases)
- Post-irradiation - Can sometimes be if you’ve had radiation (e.g from a child who has had chemotherapy) and relapses with CNS occurrence and cord radiation activating it making it grow faster
- Part of NF2 (Neurofibromatosis type 2 - genetic factor)
Other features;
- At sites of arachnoid
- Grossly, all demarcated
- Slowly growing
- Not invasive, but erosive and compressive
- Fits, drowsiness, headaches
Need surgical removal
Grows slowly so may have a change in personality over time or gradual headaches overtime
What would a histological slide of a meningioma look like ?
See whirls of cells which die and calcify
What are the different cell types cancer in the brain can be ?
Glial;
- Astrocytes
- Oligodendroglia
- Ependyma/choroid plexus
- Microglia (less than 1%)
(Less common going down list)
Other cell types;
- Neurons (more likely to happen in children as are still producing neurons whereas in adults its permanent)
What are the features of Gliomas?
Cancer of glial cells!
Never benign but sometimes low-grade malignancy so always have a degree of invasion
Difficult to see so challenge is knowing how much to take out where is brain where is tumour?
Different Glioma’s;
- Astrocytomas
- Oligodendroglioma
- Ependymona
- Choroid plexus tumours
- Medulloblastoma and PNET
How do we grade Glioma’s ?
From WHO;
I - Localised
II - Diffuse
III - Anaplastic astrocytoma (most common)
IV - Glioblastoma multiforme
(Worse higher no)
- None are completely benign
- Grading informs prognosis and treatment
- Can happen at any age, adults maybe 40-50
- High grade is limited and often not successful
- As never benign never even know if fully gone, just wait
What would you expect to see on a low grade Glioma ?
Oligodendroglioma - low grade
Small round nucelli, packed, not doing much
Uncommon but if anything is benign its this
What would you expect to see on a grade III Glioma ?
Anaplastic astrocytoma - Grade II
Big nuclei cellls
Weird mitosis
What would you expect to see on a High grade Glioma ?
High grade astrocytoma
Blood vessels being invaded
Necrosis
Can metastasise but not commonly
What are the features of Primitive neuroectodermal tumours (PNET)?
- PNET
- Medulloblastoma (will cause balance issues as in medulla)
- Might see in children
- Neuroectoderm origin - highly aggressive
- Grows rapidly
Why is molecular genetic testing important?
Molecular testing matters! Its important for;
- Diagnosis (Can use genetics to classify disease)
- Prognosis (Info on predictive course disease)
- Prediction (Can use genetic diseases to predict which treatments to give my patient)
Some brain tumours may have a particular metabolic addiction - we could maybe design treatment to interfere here ?
What are the types of peripheral nerve tumours ?
Neural - Neuroblastoma (Aggressive in children), Ganglioneuroma
(these 2 benign and not that uncommon)
Schwannoma or neurofibroma
Remember Cranial nerve VIII - Acoustic nerve
What would a Schwannoma within a nerve look like ?
Schwan cell producing myelin sheath supports axon
Tumour in these cells schwannoma, pushes out and compresses nerve trunk may get pain, paraesthesia or paralysis
Treatment as its benign hopefully just cut out
What would a Neurofibroma within a nerve look like ?
Non-myelinating
Mixed in, not invasive its benign but due to it being around a lot of nerve its hard to cut out but often wont cause a problem, if it does is probably due to nerve compression
What are the features of Neurofibromatosis type 1?
Neurofibromatosis type 1;
- Autosomal dominant
- 50% spontaneous
- Cafe au lait spots (looks like milky coffee spilt - look image) + neurofibromas
As get nerve compression can be painful and can also become disfiguring
Some people will have multiple neuro fibromas associated with genetics
What are the features of Neurofibromatosis type 2?
Neurofibromatosis type 2;
MISME - Multiple Inherited Schwannomas, Meningiomas and Ependyomas (lining in brain)
- Bilateral acoustic Schwannoma
- Merlin NF2 (Different mutation)
Person will have multiple tumours in skin and distortion
Pain, disfigurement, can’t really cut out and radiotherapy can cause further mutations to make things worse
Treatment is managing symptoms
What type of cancer is this ?
Lung Cancer;
- Small cell undifferentiated
- Squamous
- Adeno
What type of cancer is this?
Breast Cancer
What type of cancer is this ?
Malignant Melanoma
What type of cancer is this?
Gastric / Colorectum
What type of cancer is this?
Meningioma
What type of cancer is this?
Meningioma - Whirls of cells de and calcify
What type of cancer is this?
Glioma
What type of cancer is this?
Very aggressive Glioma
What type of cancer is this?
Oligodendroglioma
Small round nucelli, packed, not doing much
Uncommon but if anything is benign its this
What type of cancer is this?
Anaplastic astrocytoma Grade III
Big nuclei cells, weird mitosis
What type of cancer is this?
High Grade astrocytoma
Blood vessels being invaded
Necrosis
Can metastasise but not commonly
What type of cancer is this?
Primitive neuroectodermal tumours (PNET) / Medulloblastoma
Might see in children
Neuroectoderm origin - highly aggressive
Grow rapildy
What kind of cancer is this ?
Schwannoma within nerve
Schwan cell producing myelin sheath supports axon
Tumour in these cells schwannoma, pushes out and compresses nerve trunk may get pain, paraesthesia or paralysis
Treatment as its benign hopefully just cut out
What kind of cancer is this ?
Neurofibroma within nerve
Non-myelinating
Mixed in, not invasive its benign but due to it being around a lot of nerve its hard to cut out but often wont cause a problem, if it does is probably due to nerve compression
