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Neurophysiology > Neuropathology 2 Brain Tumours > Flashcards

Neuropathology 2 Brain Tumours Flashcards

1
Q

What are 3 ways even slow-growing, well-differentiated tumours in the brain can cause serious problems?

A

1.) Compression or destruction of smaller, critical brain areas such as the medulla
2.) Tumours that are difficult to isolate from normal brain tissue can result in extensive destruction when they are removed
3.) Damage to the blood-brain barrier or development of epilepsy due to the tumour or its removal

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2
Q

What is the most common glioma?

A

astrocytomas

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3
Q

Astrocytomas range from I-IV. The higher-grade tumours exhibit:

A

1.) greater anaplasia
2.) greater invasion into the surrounding tissues
3.) increased necrosis and more sites of hemorrhage/BBB incompetence

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4
Q

Naming conventions for different grades:
I, II, III, IV

A

Grade I – pilocytic astrocytoma (commonly-used name)
Grade II – diffuse astrocytoma
Grade III – anaplastic astrocytoma
Grade IV – glioblastoma multiforme (commonly-used name)

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5
Q

Which grade of astrocytomas tends to occur in children and young adults?

A

Grade I aka pilocytic astrocytomas

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6
Q

Where are Grade 1 astrocytomas often found? What kind of mass? Well differentiated? Easy to separate? Size? How many processes? Hemorrhagic areas? Necrosis? BBB? What

A

cerebellum, optic nerves, 3rd ventricle

solid or cystic mass

Well-differentiated, easy to separate from surrounding normal brain tissue

Large, 2 processes

Few hemorrhagic areas, less necrosis, preservation of BBB

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7
Q

Grade I astrocytomas is usually due to excessive activation of what?

A

Raf

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8
Q

Which grade of astrocytomas is more common in adults, found above the tentorium in the cerebrum?

A

Grade II & III

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9
Q

Grade III are similar to grade II in that they are both poorly differentiated cells and invade surrounding brain. But how are they different?

A

More mitotic figures, larger cells

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10
Q

What are mutations of grade II and III?

A

1.) PTEN: inactivated PTEN –> excessive signaling through the PI3K pathway
Increased EGF or PDGF receptor activity or expression
Epidermal growth factor, platelet-derived growth factor
P16, p14 or p53 inactivation
IDH mutations – isocitrate dehydrogenase mutations that produce a metabolite (2-hydroxyglutarate) that “dysregulates” epigenetic signaling in the glial cell  excessive activation of the RAS pathways

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11
Q

Which brain tumour in adults in the most common?

A

Grade IV astrocytomas aka glioblastoma multiforme

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12
Q

Which brain tumour has the worst prognosis?

A

Grade IV

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13
Q

Which brain tumour has prominent hemorrhage, necrosis, rapid growth, and tendencies to invade the adjacent tissue more than other types?

A

Grade IV

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14
Q

Which mutations are more common in grade IV?

A

p53, EGFR (epidermal growth factor receptor) mutations are more common

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15
Q

What are the signs and symptoms of astrocytomas?

A

Headache (worse in the morning), intensified by straining and coughing, nausea, vomiting, 6th cranial nerve palsy, focal changes caused by invasion/damage of normal brain tissue (seizures, hemiparesis (one-sided weakness), ataxia, memory loss)

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16
Q

What percent of astrocytomas are grade II-IV?

A

80%

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17
Q

What is the median survival for Grade II?

A

5-6 year

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18
Q

What is the median survival rate for Grade IV?

A

less than 1 year

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19
Q

Worse prognosis is associated with what 3 things?

A

1.) infiltration of normal tissue
2.) hemorrhage and necrosis
3.) rapid cell division

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20
Q

What is the best imaging method?

A

MRI

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21
Q

What treatment methods are commonly used? Is treatment for all types the same?

A

Radiation, chemotherapy, and surgery

no

22
Q

What are the signs/symptoms of increased intracranial pressure?

A

1.) Slowing of mental capacity
2.) headaches (especially if more severe in the morning)
3.) vomiting (more likely in the morning)
4.) blurred and/or double vision
5.) blurred = optic nerve atrophy due to papilledema, double vision = 6th cranial nerve palsy (usually)
6.) In kids – precocious puberty, stunted growth due to hypothalamic impairment
7.) Difficulty walking (spasticity)

23
Q

Which cranial nerve causes double vision?

A

CN VI palsy

24
Q

Which type of herniate are more likely with cerebral masses?

A

sub-falcine and transtentorial

25
Q

What percent of gliomas are Oligodendrogliomas? What age group?

A

5-15%

40’s and 50’s

26
Q

Where are Oligodendrogliomas found?

A

cerebral hemispheres, around white matter areas

27
Q

Which mutations are common in Oligodendrogliomas?

A

IDH

28
Q

Are Oligodendrogliomas a quick onset or slowly increasing in intracranial pressure

A

slowly increasing

29
Q

Are seizures common in Oligodendrogliomas?

A

Yes

30
Q

Is the treatment of Oligodendrogliomas similar or different to astrocytomas?

A

similar

31
Q

Is the prognosis of Oligodendrogliomas better or worse than that of astrocytomas?

A

better

32
Q

Where do Ependymomas arise from?

A

ependymal cells of the ventricular system

33
Q

In kids, which ventricle is frequently blocked? Which canal?

A

4th ventricle, central

34
Q

Because Ependymomas can produce a lot of CSF, what can they cause?

A

communicating (excess CSF) or non-communicating (blockage of CSF movement) hydrocephalus

35
Q

What location are Ependymomas easier to remove from?

A

spinal cord

36
Q

Ependymomas in which ventricle have a worse prognosis?

A

4th ventricle/posterior fossa

37
Q

Signs and symptoms of Ependymomas are typical of what condition?

A

hydrocephalus and elevated intracranial pressure if in the cranium

38
Q

If Ependymomas have spinal cord compression, what signs/symptoms are present?

A

paresis, pain, sensory deficits

39
Q

Which tumors are usually fairly benign and in adults?

A

meningiomas

40
Q

Where are Meningiomas attached and where do they often arise from?

A

attached to dura, arise from the meningothelial cell of the arachnoid

41
Q

What percent of all primary brain tumours do Meningiomas make up?

A

20%

42
Q

Where are Meningiomas found?

A

along the external surfaces of the brain and within the ventricular system

43
Q

What are the pathological findings of Meningiomas?

A

rounded masses with a dural base that compresses underlying brain but are easily separated from it by a thin fibrous capsule

Sometimes extension into the overlying bone or “sheet-like” spreading through the brain

44
Q

Meningiomas pathogenesis? Clinical features? Prognosis (FYI???)

A

Loss of the NF2 gene – regulates signaling through a variety of receptors that are involved in growth and the cell cycle
We’ll see it again in the disease neurofibromatosis
Clinical Features
Symptoms/signs of elevated intracranial pressure
Symptoms/signs caused by compression of
The cortex near the falx cerebri
Wing of the sphenoid
Foramen magnum
Interestingly, meningiomas tend to grow quite rapidly during pregnancy (not sure why)
Prognosis tends to be good – they tend to grow slowly and do not usually invade adjacent tissue
Surgery main treatment

45
Q

What is a tumour with very poorly-differentiated, “primitive-looking” cells with rapid growth, highly anaplastic and can metastasize widely and even extend all the way into the cauda equina?

A

Medulloblastomas

46
Q

Who does Medulloblastomas occur in?

A

children and adults

47
Q

Where do medulloblastomas occur?

A

cerebellum

48
Q

Due to encroachment on the 4th ventricle by Medulloblastomas, what can happen?

A

Obstruction of CSF flow

49
Q

What are the signs/ symptoms of Medulloblastomas similar to?

A

hydrocephalus due to impaired CSF and damage to cerebellum

50
Q

What kind of treatment is Medulloblastomas very responsive to?

A

radiation therapy

51
Q

Does Medulloblastomas have a good prognosis?

A

Yes

52
Q

What is a non primary brain tumour called? Where are they often found? (2)

A

metasteses

meninges
deep into cortical structures

Neurophysiology (9 decks)

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