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Systems: Neurology AB > Pathology of Brain Tumours > Flashcards

Pathology of Brain Tumours Flashcards

1
Q

What must be true for pressure to be stable?

A

For pressure to be stable must be (within certain limits) correct amount of brain tissue/blood/CSF

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2
Q

What keeps the brain in place?

A

There are thick tough fibrous sheets inside that keep the brain in place

  • Falx cerebri
  • Tentorium cerebelli
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3
Q

What is the opening to the spinal cord called?

A

Foramen magnum

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4
Q

How can the brain move around the falx?

A

Brain cannot go through falx, but can go round edge

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5
Q

The brain cannot go through the skull, but can move down through…

A

Foramen magnum

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6
Q

What localise lesions can raise intracranial pressure?

A
  • Haemorrhage
  • Tumour
  • Abscess
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7
Q

What generalised pathology can raise intracranial pressure?

A

Oedema post trauma

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8
Q

What is a localised haemorrhage called?

A

Haematoma

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9
Q

What are localised lesions also known as?

A

Space occupying lesions (SOL)

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10
Q

What are the effects of SOL?

A
  • Amount of tissue increases
  • Raises intra cranial pressure
  • Cause internal shift (herniation) between the intracranial spaces
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11
Q

What internal shift can SOL cause?

A
  • Right-left or left-right
  • Cerebrum moves inferiorly over edge of tentorium (uncal herniation)
  • Cerebellum moves inferiorly into foramen magnum (coning)
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12
Q

What are the different types of brain herniation?

A
  • Cingulate
  • Central
  • Uncal
  • Cerebrotonsillar
  • Upward
  • Transcalvarial
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13
Q

What types of shift is subfalcine herniation?

A

Midline shift

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14
Q

What happens in tentorial (uncal) herniation?

A
  • Brain herniates inferiorly at side of tentorium

- Aqueduct is crushed and narrow

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15
Q

What type of herniation results in brainstem death?

A

Cerebellar tonsillar herniation

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16
Q

What occurs in cerebellar tonsil herniation?

A

Tonsils move inwards and downwards and crush brainstem

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17
Q

What does swelling and shift cause?

A

Localised ischaemia

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18
Q

What are the signs and symptoms of increased intracranial pressure?

A
  • Squeeze on cortex and brainstem: morning headaches and sickness
  • Squeeze on optic nerve: papilloedema
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19
Q

What stages occur as pressure increases?

A
  • Pupillary dilation
  • Falling GCS
  • Brain stem death
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20
Q

Why do pupils dilate with increased pressure?

A

Squeeze and stretch on cranial nerve 3

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21
Q

Why does the GCS fall with increasing pressure?

A

Squeeze on cortex and brainstem

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22
Q

Why does brain stem death occur with increasing pressure?

A

Squeezing downwards of cerebellum into foramen magnum with crushing of brainstem

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23
Q

What are the 2 types of classification of tumours within the CNS?

A
  • Primary tumours

- Secondary (metastatic tumours

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24
Q

Other than CNS tumours what other intracranial tumours can occur?

A

Cells originating outside brian and spinal cord(eg meningioma)

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25
Q

Give examples of primary intracranial tumours.

A
  • Gliomas (glioblastoma, astrocytoma, oligodendroglioma, ependymoma)
  • Medullablastoma
  • Meningioma
  • Schwannoma, neurofibroma
  • Adenoma
  • Lymphoma
  • Haemangioblastoma
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26
Q

What metastatic malignancies can occur in the brain?

A
  • Breast
  • Lung
  • Kidney
  • Colon
  • Melanoma
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27
Q

Who is brain metastatic disease rare in?

A

Children

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28
Q

Give examples of glial cell tumours.

A

Gliomas (glioblastoma, astrocytoma, oligodendroglioma, ependymoma)

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29
Q

Give an example of embryonic neural cell tumours.

A

Medullablastoma

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30
Q

Give examples of nerve sheath tumours.

A
  • Scwhannoma

- Neurofibroma

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31
Q

Give an examples of an Arachnoidal cell tumour

A

Meningioma

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32
Q

Give an example of a pituitary gland tumour

A

Adenoma

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33
Q

Give an example of a lymphoid cell tumour.

A

Lymphoma

34
Q

Give an example of a capillary vessel tumour.

A

Haemangioblastoma

35
Q

What intracranial tumours are derived from brain cells?

A
  • Gliomas

- Medullablastomas

36
Q

What intracranial tumours are derived from cells surrounding or originating outside the brain?

A
  • Meningiomas
  • Scwhannoma
  • Neurofibroma
  • Adenoma
  • Lymphoma
  • Haemangioblastoma
37
Q

What intracranial tumours are malignant?

A
  • Gliomas

- Medullablastomas

38
Q

Where do most CNS tumours occur in adults?

A

Majority above tentorium

39
Q

Where do most CNS tumours occur in children?

A

Majority below tentorium

40
Q

What do gliomas resemble?

A

Resemble cells of glial differentiation

41
Q

What is the macroscopic appearance of gliomas?

A

Diffuse edges – not encapsulated

42
Q

Gliomas are malignant but what do the not do?

A

Malignant but do not metastasise outside the CNS

43
Q

What are tumours derived from astrocytes called?

A

Astrocytoma

44
Q

What are tumours derived from oligodendrocytes called?

A

Oligodendroglioma

45
Q

What are tumours derived from ependymal cells called?

A

Ependymoma

46
Q

What do astrocytes look like?

A
  • Star shaped cells

- Long processes support other cells structurally and biochemically

47
Q

Give 2 examples of types of astrocytoma.

A
  • Low grade astrocytoma

- Glioblastoma

48
Q

What do low grade astrocytoma’s look like on microscopy?

A

Bland cells on microscopy (similar to normal astrocytes)

49
Q

How fast do low grade astrocytomas grow?

A

Very slowly

50
Q

What is the most malignant astrocytoma?

A

Glioblastoma

51
Q

What is another name for glioblastoma?

A

Glioblastoma multiforme

52
Q

How doe glioblastomas appear on microscopy?

A

Cellular, atypical tumour, with necrosis under microscope

53
Q

How fast do glioblastomas grow?

A

Grow quickly – often present as large tumours

54
Q

What is a medullablastoma?

A

Tumour of primitive neuroectoderm (primitive neural cells)

55
Q

Who are usually affected by medullablastomas?

A

Children

56
Q

Where are medullablastomas usually located?

A

Posterior fossa, especially brainstem

57
Q

How do medulloblastoma look?

A

Sheets of small undifferentiated cells

58
Q

What are meningiomas derived from?

A

From “arachnocytes” – cells that make up the coverings of the brain

59
Q

What type of tumours are meningioma’s?

A

Benign: they do not metastasie

60
Q

How can meningioma’s cause damage?

A

They are locally aggressive and can invade the skull

61
Q

How fast do meningiomas grow?

A

Slow growing

62
Q

How are meningiomas often treated?

A

Often resectable

63
Q

How do meningiomas appear on microscopy?

A

Bland cells forming small groups which whorl around each other resembling an arachnoid granulation, sometimes with calcification

64
Q

What is the calcification sometimes present in meningiomas called?

A

The calcification is sometimes called psammoma (from ‘grain of sand’) body formation

65
Q

Where do nerve sheath tumours occur?

A

Around peripheral nerves – intracranial and extracranial

66
Q

What do normal Schwann cells do?

A

Normal schwanncells wrap around peripheral nerves and form electrical insulation

67
Q

What is an acoustic neuroma?

A

8th vestibulocochlear nerve schwannoma, at angle between pons and cerebellum

68
Q

How do acoustic neuromas present?

A

Unilateral deafness

69
Q

What type of tumours are acoustic neuromas?

A

Benign lesions but technically difficult to remove

70
Q

What type of tumour is a pituitary adenoma?

A

Benign

71
Q

Where are pituitary adenomas located?

A

Pituitary fossa

72
Q

What do pituitary adenomas often secrete?

A

Often secrete a pituitary hormone

73
Q

How do pituitary adenomas grow?

A

Grow superiorly and impinge on optic chiasma resulting in visual signs

74
Q

Why are CNS lymphomas difficulty biopsy?

A

Often deep and central site in brain

75
Q

Why are CNS lymphomas difficult to treat?

A

Difficult to treat as drug do not cross blood-brain barrier

76
Q

What do CNS lymphomas generally not do?

A

Generally do not spread outside of CNS

77
Q

What are CNS lymphomas?

A
  • High grade neoplasm

- Usually diffuse large B-cell lymphoma

78
Q

What is a Haemangioblastoma?

A

Space occupying tumour of blood vessels

79
Q

Where are Haemangioblastoma usually found?

A

Cerebellum

80
Q

What complication may Haemangioblastoma result in?

A

They may bleed

81
Q

What are most secondary tumours?

A

Carcinomas

82
Q

What is the histological appearance of a secondary tumour?

A

Histology is that of the primary tumour

Systems: Neurology AB (51 decks)

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