Neuroscience Pathology 2 (Tumours and Infections) Flashcards
State the 5 common sites of tumour, state the common tumours found in each site
- meninges - meningioma
- brain parenchyma - medulloblastoma (embryonal tumour), central neuroctyoma (neurons), gliomas (glial tissues)
- ventricles - choroid plexus tumour, ependymomas
- midline structures - pituitary gland tumour, germ cell tumour, pineal gland tumour
- others - lymphoma, secondary metastases
State the 3 common routes of spread of tumour if metastatic
- infiltrate directly into organ
- via CSF
- extracranially (rare)
State the 4 common tumour types in children.
Are primary tumours or secondary tumours more common in children?
- medulloblastoma (infratentorial)
- ependymoma (ventricles)
- germ cell tumours (midline)
- pilocytic astrocytoma (cerebellum)
In children, primary tumours are more common than secondary tumours (3:1)
Name the 2 tumours associated with NF-2.
- meningioma
- ependymoma
State the 2 clinical presentations common in all tumours
- raised ICP - headache, nausea, vomiting, papilloedema, altered mental state, loss of consciousness, bradycardia, hypertension, neurogenic pulmonary oedema
- focal neurologic deficit
IN MENINGES: MENINGIOMA
- Originate from ____ cells
- Can occur at ____ ____ and ____ ____
- Can invade into ____ ____
- Common and ____-growing
- More common in ____
- WHO grade:
- Important tumour in ____ syndrome
- Commonest type of menigioma = ____ type
Histology:
(1)
(2)
(3)
(4)
IN MENINGES: MENINGIOMA
- Originate from ARACHNOID cells
- Can occur at FALX CEREBRI and CEREBRAL CONVEXITIES
- Can invade into SKULL BONE
- Common and SLOW-growing
- More common in FEMALES
- WHO grade: I-III
- Important tumour in NF-2 syndrome
- Commonest type of menigioma = MENINGOTHELIAL type
Histology:
(1) PSAMOMMA BODIES
(2) NUCLEAR INCLUSIONS
(3) MENINGOTHELIAL WHORLS
(4) UNIFORMED OVOID CELLS
State everything you know about meningioma
IN MENINGES: MENINGIOMA
- Originate from ARACHNOID cells
- Can occur at FALX CEREBRI and CEREBRAL CONVEXITIES
- Can invade into SKULL BONE
- Common and SLOW-growing
- More common in FEMALES
- WHO grade: I-III
- Important tumour in NF-2 syndrome
- Commonest type of menigioma = MENINGOTHELIAL type
Histology:
(1) PSAMOMMA BODIES
(2) NUCLEAR INCLUSIONS
(3) MENINGOTHELIAL WHORLS
(4) UNIFORMED OVOID CELLS
Name the tumour in brain parenchyma.
State the 3 types of cells in brain parenchyma that can be affected by tumours and name some common tumours associated with each type of cell. State any other common tumours not associated with specific cell types.
GLIOMA!
- astocytes - astrocytoma
- oligodenodrocytes - oligodendromas
- ependymal cell - ependymoma
- others - central neurocytoma (neuronal tumour), primitive tumorus (embryonal tumours)
In brain parenchyma: ASTROCYTOMA
- WHO Grade:
- General histo: ____ ____ + nuclear ____
- 3 types of astrocytoma
(1) ____ astrocytoma (Grade ____)
- Occurs in ____ (presents ____ or ____)
- May have ____ component
- Macro = ____ nodules within ____
- Micro =
(2) ____, ____-IDH (Grade ____-____)
(3) _____, _____-IDH (Grade ____)
- Prognosis: ____
- Macro = ____ and ____ brain parenchyma
- Micro =
In brain parenchyma: ASTROCYTOMA
- WHO Grade:
- General histo: INCREASED CELLULARITY + nuclear ATYPIA
- 3 types of astrocytoma
(1) PILOCYTIC astrocytoma (Grade I)
- Occurs in CHILDREN (presents SUPRATENTORIAL or INFRATENTORIAL)
- May have CYSTIC component
- Macro = SOLID nodules within CYST
- Micro = NEOPLASTIC ASTROCYTES DEMONSTRATE LONG FIBRILLARY CYTOPLASMIC PROCESSES
(2) ASTROCYTOMA, MUTANT-IDH (Grade II-IV)
(3) GLIOBLASTOMA, WILD-TYPE-IDH (Grade IV)
- Prognosis: POOR
- Macro = NECROTIC and HAEMORRHAGIC brain parenchyma
- Micro = NUCLEAR PLEOMORPHISM, PALISADING NECROSIS, MICROVASCULAR INVASION
In brain parenchyma: OLIGODENDROGLIOMAS (Grade ____-____)
- Usually occurs in ____ ____
- Defined by genetic profile: (1) ____ and (2) ____
- Prognosis:
- Micro:
In brain parenchyma: OLIGODENDROGLIOMAS (Grade II-III)
- Usually occurs in CEREBRAL CORTEX
- Defined by genetic profile: (1) IDH-MUTANT and (2) WHOLE ARM DELETION OF 1P AND 19Q
- Prognosis: GOOD (CHEMOTHERAPY)
- Micro: UNIFORMED ROUND CELLS WITH FRIED EGG APPEARANCE
State the WHO grade of ependymomas
Grade II-III (same as oligodendromas)
Name the 2 other tumours included in brain parenchyma which are not from oligodendrocytes, astrocytes or ependymal cells.
- neuronal tumour
- embryonal tumour
In brain parenchyma, NEURONAL TUMOURS
- Common in ____
- Occurs near the ____ resulting in ____
- Prognosis =
In brain parenchyma, NEURONAL TUMOURS
- Common in ADULTS
- Occurs near the 3RD VENTRICLE resulting in RAISED ICP
- Prognosis = GOOD
In brain parenchyma, EMBRYONAL TUMOURS
- Common in ____, very aggressive
- Can occur ____ or ____
(1) Supratentorial = CNS neuroblastoma —> prognosis =
(2) Infratentorial = ____
- Occurs in ____ (vermis for ____, hemispheres for ____)
- Aggressive and spreads via ____ to cause ____
- Molecular profile = ____ and ____ activation status, ____ mutant/wild-type
- Micro: (5)
In brain parenchyma, EMBRYONAL TUMOURS
- Common in CHILDREN, very aggressive
- Can occur SUPRATENTORIAL or INFRATENTORIAL
(1) Supratentorial = CNS neuroblastoma —> prognosis = POOR
(2) Infratentorial = MEDULOBLASTOMA
- Occurs in CEREBELLUM (vermis for CHILDREN, hemispheres for ADULTS)
- Aggressive and spreads via CSF to cause HYDROCEPHALUS
- Molecular profile = WNT and SHH activation status, TP53 mutant/wild-type
- Micro: (5) SHEETS OF SMALL CELLS, HIGH N/C RATIO, HIGH MITOTIC RATE, CARROT SHAPE NUCLEI, ROSETTES
State the histological features of embryoal tumours
Specifically for infratentorial - medulloblastoma
- rosettes
- carrot shape nuclei
- high n/c ratio
- high mitotic rate
- sheets of small cells
State one unique feature of medulloblastoma. State the common group associated with this tumour.
MEDULLOBLASTOMA
- WNT and SHH activation status
- TP53 mutant / wild-type
Commonly associated with children
State the specific genetic profile of oligodendrogliomas. State whether this tumour has good or poor prognosis.
OLIGODENDROGLIOMAS
- mutation in IDH1
- whole arm deletion of 1p and 19q
- good prognosis (responds well to chemotherapy)
State the histological feature of oligodendrogliomas
uniformed round cells with fried egg apperance
State the 3 types of astrocytomas
- pilocytic astrocytomas
- astrocytomas (IDH-mutant)
- glioblastoma (IDH-wild type)
State the histological features of pilocytic astrocytoma vs glioblastoma
PILOCYTIC ASTROCYTOMA
- neoplastic astrocytes demonastrate long fibrillary cytoplasmic processes
GLIOBLASTOMA
- nuclear pleomorphism
- palisading necrosis
- microvascular proliferation
State whether IDH-mutant or IDH-wild type has a better prognosis
IDH-mutant has better prognosis
IDH-wild type has worse prognosis
Name the tumour that has the histological feature
‘Uniformed round cells with fried egg apperance’
OLIGODENDROGLIOMAS
State the 2 classes of tumours that can occur in ventricles
- ependymomas
- choroid plexus tumours
In ventricles, EPENDYMOMAS:
- Can occur ____, ____ or in ____ ____
- Occurs in ____ and ____ (in children = located in ____ fossa)
- Relation to ____
- Can cause ____
- Micro:
In ventricles, EPENDYMOMAS:
- Can occur PERIVENTRICULARLY, INTRAPARENCHYMALLY or in SPINAL CORD
- Occurs in CHILDREN and YOUNG ADULTS (in children = located in POSTERIOR fossa)
- Relation to NEUROFIBROMATOSIS-2 (NF-2)
- Can cause HYDROCEPHALUS
- Micro: PERIVASCULAR PSEUDOROSETTES + TRUE ROSETTES
State the features of ependymomas
EPENDYMOMAS (in ventricles)
- Can occur periventricularly, intraparenchymally and in spinal cord
- Occurs in children (in posterior fossa) and young adults
- Associated with neurofibromatosis-2 (NF-2)
- Can cause hydrocephalus
- Histo: Perivascular pseudorosettes + True rosettes
In ventricles, CHOROID PLEXUS TUMOUR, state the 2 types of tumours and their histological feautres.
State any condition that can occur with choroid plexus tumours.
In ventricles, CHOROID PLEXUS TUMOUR
(1) CHOROID PLEXUS PAPILLOMA
- Histo: minimal nuclear atypia + moderate mitotic rate + intact basement membrane
(2) CHOROID PLEXUS CARCINOMA
- Histo: greater cellularity + increased nucelar atypia + increased mitotic rate
Hydrocephalus can occur in choroid plexus tumours.
Recall:
Name the tumour that has the histological feature:
‘True rosettes and perivascular pseudorosettes’
EPENDYMOMAS
State the 3 types of tumours in the midline structures of the brain
- pituitary gland tumours
- germ cells tumours
- pineal gland tumours
In midline structures, PITUITARY TUMOUR
- Due to ____ tumours
- Clinical presentations =
- 2 types of tumours =
In midline structures, PITUITARY TUMOUR
- Due to SELLAR tumours
- Clinical presentations = VISUAL FIELD DEFECTS (OPTIC CHIASMA COMPRESSION - BITEMPORAL HEMIANOPIA) + ENDOCRINE EFFECTS
- 2 types of tumours = ENDOCRINE TUMOUR, EMBRYONAL REMNANTS TUMOUR (Craniopharyngioma)
State everything you know about craniopharyngiomas.
CRANIOPHARYNGIOMAS are embryonal remnant tumours that affect pituitary gland
- Common in children or older adults
- 2 types = Adamantinomatous craniopharyngioma + Papillary craniopharyngioma
- Histo: Squamous epithelium + wet keratin + calcifications
State everything you know about germ cell tumours (in midline structures)
GERM CELL TUMOURS (midline structures)
- More common in male children > female adults
- Occurs more commonly in pineal gland than supresellar region
- 2 types : Teratoma + Germinoma
State the differences betwen pineocytoma and pineoblastoma
Pineal gland tumours (midline structure) occurs in or near the pineal gland
State the histological features of craniopharyngioma
- wet kerratin
- calcifications
- squamous epithelium
State everything you know about lymphomas in the brain
LYMPHOMAS (primary)
- Most are B cell and Non-hodgkin lymphomas
- Immunosuppressed patients –> EBV-driven lymphomas
- Differentials = metastases, lymphoma, infection
State the 2 types of benign metastases (non-CNS)
- schwannoma
- neurofibroma
State everything you know about schwannoma
SCHWANNOMA
- well circumscribed and encapsulated
- attached to nerve
In peripheral nerve sheath tumours (non-CNS), NEUROFIBROMA
- Non-encapsulated
- Located within ____ or ____ nerves
- Neurocutaneous syndrome = ____ ____ syndrome
- Tumours/hamartomas in skin/nervous syste are often ____
- 4 types of neurofibromas =
In peripheral nerve sheath tumours (non-CNS), NEUROFIBROMA
- Non-encapsulated
- Located within SKIN or DEEP nerves
- Neurocutaneous syndrome = FAMILIAL TURNER syndrome
- Tumours/hamartomas in skin/nervous syste are often AUTOSOMAL DOMINANT (AD)
- 2 types of neurofibromas = NEUROFIBROMATOSIS 1 (NF-1), NEUROFIBROMATOSIS 2 (NF-2), TUBEROUS SCLEROSIS, VON-HIPPEL LINDAU DISEASE
State everything you know about NEUROFIBROMATOSIS-1 (NF-1)
NEUROFIBROMATOSIS 1 (NF-1)
- Mutation of NF-1 (NEUROFIBROMIN) gene located on chromosome 17
- Gene is a tumour suppressor gene which REGULATES signal transduction
- AUTOSOMAL DOMINANT tumour
- Complications = NEURAL TUMOUR INCLUDING PLEXIFORM NF, OPTIC NERVE GLIOMA, HAMARTOMAS (lisch nodules), SARCOMATOUS TRANSFORMATION OF NEUROFIBROMAS
State everything you know about NEUROFIBROMATOSIS-2 (NF-2)
NEUROFIBROMATOSIS-2 (NF-2)
- Mutation of NF-2 (MERLIN) gene
- Autosomal dominant tumour
State the histological features associated with neurofibroma
- spindle cells present within loose stroma
- collagen fibres present within stroma
State everything you know about TUBEROUS SCLEROSIS
TUBEROUS SCLEROSIS
- Mutation of TSC-1 and TSC-2 genes which are protein products participating in cell proliferation
- Autosomal dominant non-cancerous tumour
Clinical features:
- Brain - cortical tubers + hamartomas
- Skin lesions - adenoma sebaceum + shagreen patches + ungual fibromas
- Lung lesions
- Renal angiomyolipomas
State everything you know about VON-HIPPEL LINDAU DISEASE
VON-HIPPEL LINDAU DISEASE
- Mutation of VHL tumour suppressor gene on chromosome 3 involved in regulation of angiogenesis and cell cycle
Clinical features
- Hemangioblastoma
- Cysts
- Renal cell carcinoma
- Paranglioma, phaeochromocytomas
- Endolymphatic sac tumour
With reference to MENINGITIS, state
(1) Common infective agents
(2) Investigation
(3) Complications
With reference to MENINGITIS, state
(1) Common infective agents
Acute Bacterial
- Neonates = E coli, Listeria
- Infants = Haemophilus influenzae
- Adolescents = Meningococcus (N meningitidis)
- Adults = Meningococcus, Pneumococcus (strep pneumoniae)
Tuberculous - MTB
Aseptic - viral (enterovrisues - echovirus, coxsackie)
Fungal - Cryptococcus neoformans, Candida albicans
(2) Investigation
- CSF examination by spinal tap (cloudy postiive for polymorphs (bacterial), lymphocytes (viral), either or (MTB))
(3) Complications
- Brain infarction
- Meningeal fibrosis and hydrocephalus
- Damage to cranial nerves
- Raised ICP
- Mental retardation (children mostly)
State the complications of meningitis
- Brain infarction
- Meningeal fibrosis and hydrocephalus
- Damage to cranial nerves
- Raised ICP
- Mental retardation
State the macroscopic and microscopic features of tuberculous meningitis
MACROSCOPIC:
- gelatinous exudate at base of brain
- white granules of tubercles (granulomas) along meninges and blood vessels
MICROSCOPIC
- obliterative endarteritis (cerebral ischemia and infarct)
- fibrous adhesions in arachnoid mater
- tuberculoma in brain parenchyma
State everything you know about SUBDURAL EMPYEMA
SUBDURAL EMPYEMA
- pus collection in subdural space
- local source of infection - skull or paranasal sinus infection
- presentation = local + meningitis symptoms
- complication = thrombophlebitis of bridging veins –> infarction of brain
- treatment = surgical drainage
State everything you know about EXTRADURAL EMPYEMA
EXTRADURAL EMPYEMA
- pus collection found in epidural space
- local source of infection - sinusitis or iatrogenic
- commonly associated with osteomyelitis
- severe complication = spinal cord epidural infection –> cord compression –> medical emergency
State the CNS targets of specific viruses:
(1) Neurons and glia
(2) Motor neurons
(3) Dorsal Root Ganglia
(4) Microglia
