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6. Neurology (Med) > Pathology of Brain Tumours > Flashcards

Pathology of Brain Tumours Flashcards

1
Q

What is the main pathology of brain tumours?

A

Raised intracranial pressure

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2
Q

What is the cranium?

A

Hard, rigid box with thick fibrous sheets inside that keeps the brain in place

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3
Q

What are the thick fibrous sheets in the cranium called?

A
  • Falx cerebri
  • Tentorium cerebelli
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4
Q

What is the opening in the cranium called for the spinal cord?

A

Foramen magnum

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5
Q

What happens to the brain during extreme raised ICP?

A

The brain cannot go through the falx, but can go around the edge, it can not go through the skull, but can move down through the foramen magnum

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6
Q

Is the brain mobile?

A

Brain is soft, like a jelly, so it moves easily

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7
Q

What are some causes of raised intracranial pressure?

A
  • Localised lesions
    • Haemorrhage (if localised called a haematoma)
    • Tumour
    • Abscess
  • Generalised pathology
    • Oedema post trauma
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8
Q

What are localised lesions that cause raised intracranial pressure?

A

Space occupying lesions (SOL)

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9
Q

What does SOL stand for?

A

Space occupying lesiosn

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10
Q

What are examples of SOH?

A
  • Tumours
  • Bleeding (haematoma)
  • Abscess
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11
Q

What are effects of SOL?

A
  • Amount of tissue increases
  • Raises intracranial pressure
  • Cause internal shift (herniation) between the intracranial spaces
    • Right-left or left-right
    • Cerebrum moves inferiorly over edge of tentorium (uncul herniation)
    • Cerebellum moves inferiorly into foramen magnum (coning)
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12
Q

What is coning?

A

Cerebellum moves inferiorly into foramen magnum

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13
Q

What is uncul hernation?

A

Cerebrum moves inferiorly over edge of tentorium

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14
Q

What is a haematoma?

A

Solid swelling of clotted blood within tissues

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15
Q

What are the different types of brain herniation?

A
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16
Q

What kind of shift does subfalcine herniation cause?

A

Subfalcine herniation causes midline shift:

  • Brian is pushed away from tumour
  • Cingulate gyrus is pushed over to side and herniates underneath falx
  • Lateral ventricle is crushed flat and displaced downwards
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17
Q

What does tentorial (uncal) herniation cause?

A
  • Brain herniates inferiorly at side of tentorium
  • Aqueduct is crushed and narrow
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18
Q

What does cerebellar tonsillar herniation cause?

A

Cerebellar tonsillar herniation causes death of brain stem due to tonsils moving inwards and downwards, crushing the brainstem

Swelling and shift causes localised ischaemia due to tumours squeezing nearby tissue

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19
Q

What is the presentation of pressure on the brain?

A

Squeeze on cortex and brainstem:

  • Morning headaches and sickness

Squeeze on optic nerve:

  • Papilloedema (seen on fundoscopy of the eye)

As pressure increases:

  • Pupillary dilation
    • Squeeze and stretch on cranial nerve III
  • Falling Glasgow coma scale
    • Squeeze on cortex and brainstem
  • Brain stem death
    • Squeezing downwards of cerebellum into foramen magnum with crushing of brainstem
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20
Q

What symptoms does squeeze on the cortex and brainstem cause?

A
  • Morning headaches and sickness
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21
Q

What symptoms does squeeze on optic nerve cause?

A
  • Papilloedema (seen on fundoscopy of the eye)
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22
Q

What is the presentation as pressure on the brain increases?

A
  • Pupillary dilation
    • Squeeze and stretch on cranial nerve III
  • Falling Glasgow coma scale
    • Squeeze on cortex and brainstem
  • Brain stem death
    • Squeezing downwards of cerebellum into foramen magnum with crushing of brainstem
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23
Q

What are the two broad categories of CNS tumours?

A
  • Primary tumours
  • Secondary (metastatic) tumours
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24
Q

Are primary CNS tumours benign or malignant?

A

Some are benign and some are malignant

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25
Q

What are examples of primary CNS tumours?

A
  • Glial cells
    • Gliomas (glioblastoma, astrocytoma, oligodendroglioma, ependymoma) (malignant)
  • Embryonic neural cells
    • Medulloblastoma (childhood malignant tumour)
  • Arachnoidal cell
    • Meningioma
  • Nerve sheath cell
    • Schwannoma, neurofibroma
  • Pituitary gland
    • Adenoma
  • Lymphoid cell
    • Lymphoma
  • Capillary vessels
    • Haemangioblastoma
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26
Q

What are tumours of glial cells called?

A

Gliomas (glioblastoma, astrocytoma, oligodendroglioma, ependymoma)

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27
Q

What are different kinds of gliomas?

A

Glioblastoma, astrocytoma, oligodendroglioma, ependymoma

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28
Q

Are gliomas benign or malignant?

A

Malignant

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29
Q

What are tumours of embryonic neural cells called?

A

Medulloblastoma

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30
Q

Are medulloblastomas benign or malignant

A
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31
Q
A
32
Q

What are tumours of arachnoidal cells called?

A

Meningioma

33
Q

What are tumours of nerve sheath cells called?

A
  • Schwannoma, neurofibroma
34
Q

What are tumours of the pituitary gland called?

A

Adenoma

35
Q

What are tumours of lymphoid cells called?

A

Lymphoma

36
Q

What are tumours of capillary vessels called?

A
  • Haemangioblastoma
37
Q

What are tumours originating inside of the brain?

A
  • Glial cells
    • Gliomas (glioblastoma, astrocytoma, oligodendroglioma, ependymoma) (malignant)
  • Embryonic neural cells
    • Medulloblastoma (childhood malignant tumour)
38
Q

What are primary CNS tumours originating outside of the brain?

A
  • Arachnoidal cell
    • Meningioma
  • Nerve sheath cell
    • Schwannoma, neurofibroma
  • Pituitary gland
    • Adenoma
  • Lymphoid cell
    • Lymphoma
  • Capillary vessels
    • Haemangioblastoma
39
Q

Is metastatic malignancy to the CNS rare in children or adults?

A

Children

40
Q

What are cancers that commonly metastasis to the CNS?

A
  • Breast
  • Lung
  • Kidney
  • Colon
  • Melanoma
41
Q

Why are nerve cell cancers rare?

A

Nerve cell cancers are rare as they do not proliferate due to being attached to far away things by axons and dendrites, only primitive neurons form tumours such as those in children

42
Q

What is the tentoirum?

A

Extension of the dura mater that separates the cerebellum from the inferior portion of the occipital lobes

43
Q

In adults, are most cancers above or below the tentorium?

A

Above

44
Q

In children, are most cancers above or below the tentorium?

A

Below

45
Q

What do gliomas resemble?

A

Resemble cells of glial differentiation:

  • Diffuse edges (not encapsulated)
  • Malignant but do not metastasise outside the CNS (cannot get past the blood brain barrier)
46
Q

Do gliomas metastasis outside of the CNS?

A
  • Malignant but do not metastasise outside the CNS (cannot get past the blood brain barrier)
47
Q

What are examples of gliomas?

A
  • Astrocytes cause astrocytoma (including glioblastoma)
  • Oligodendrocytes cause oligodendroglioma
  • Ependymal cause ependymoma
48
Q

What is cancer of astrocytes called?

A
  • Astrocytes cause astrocytoma (including glioblastoma)
49
Q

What is cancer of oligodendrocytes called?

A

Oligodendroglioma

50
Q

What is cancer of ependymal cells called?

A

Ependymoma

51
Q

What are glioblastomas?

A

Glioblastoma is a very malignant version of oligodendroglioma

52
Q

What is the shape of astrocytes?

A

Star shaped

53
Q

What do the long processes of astrocytes do?

A

Support other cells structurally and biochemically

54
Q

What are the different types of astrocytoma?

A
  • Low grade astrocytoma
    • Bland cells on microscopy (similar to normal astrocytes)
    • Grow very slowly
    • Small cells with single nucleus
  • Glioblastoma (also known as a high grade astrocytoma)
    • Cellular, atypical tumour, with necrosis under microscope
    • Grow quickly, often presenting as large tumour
    • Large cell with multiple nuclei, or large cell with irregular nucleus
55
Q

Compare the growth of low grade astrocytoma and glioblastoma?

A

Low grade - grow very slowly

High grade - grows quickly, often presenting as a large tumour

56
Q

Describe the morphology of low grade and high grade astrocytoma?

A

Low grade - small cells with single nucleus

High grade - large cell with multiple nuclie, or lage cell with irregular nucleus

57
Q

Describe how low grade and high grade astrocytoma?

A

Low grade - bland cells on microscopy

High grade - cellular, atypical tumour, with necrosis

58
Q

What is glioblastoma also called?

A

High grade astrocytoma

59
Q

What is medulloblastoma?

A

Tumour of primitive neuroectoderm (primitive neural cells):

  • Sheets of small undifferentiated cells
  • Children especially
  • Posterior fossa, especially brainstem
60
Q

What does medulloblastoma present as?

A

Presents as morning headache gradually getting worse over 6 months

61
Q

Is menginioma benign or malignant?

A

Benign, but can be locally aggressive and invade the skull

62
Q

Are meningioma slow growing or fast growing?

A

Slow growing, often resectable

63
Q

Why can meningioma have no symptoms?

A

May not have many symptoms due to causing depressions in the brain slowly, but can develop symptoms as gets bigger

64
Q

What is seen in microscopy of meningioma?

A
  • Bland cells forming small groups, sometimes with calcification
  • Small groups of cells whirl around each other resembling an arachnoid granulation
  • Calcification is sometimes called psammoma
65
Q

Where do nerve sheath tumours occur?

A

Around peripheral nerves (intracranial and extracranial)

66
Q

What is ‘acoustic neuroma’?

A
  • 8th vestibulocochlear nerve schwannoma often called ‘acoustic neuroma’ at angle between pons and cerebellum
    • Unilateral deafness
    • Benign lesion but removal technically difficult
67
Q

What does pituitary adenoma often secrete?

A

A pituitary hormone

68
Q

What can be a consequence of pituitary adenoma due to growth?

A

Grow superiorly and impinge on optic chiasma, causing visual signs

69
Q

What is CNS lymphoma?

A

High grade neoplasm

Usually diffuse large B-cell lymphoma

70
Q

Is CNS lymphoma usually T cell or B cell?

A

Usually diffuse large B-cell lymphoma

71
Q

Why is CNS lymphoma often difficult to biopsy?

A

Often deep and central site in brain

72
Q

Why is CNS lymphoma difficult to treat with drugs?

A

Difficult to treat as drugs do not cross the blood brain barrier

73
Q

Does CNS lymphoma metastasis outside of CNS?

A

Generally do not spread outside of CNS

74
Q

What is haemangioblastoma?

A

Tumour of blood vessels

75
Q

Where does haemangioblastoma often occur?

A

Most often in cerebellum

76
Q

What are consequences of haemangioblastoma?

A

Space occupying

May bleed

77
Q

What is the histology of a secondary tumour?

A

That of the primary tumour

6. Neurology (Med) (47 decks)

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