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Nervous System (Year 2 GM) > Pathology of Brain Tumours > Flashcards

Pathology of Brain Tumours Flashcards

1
Q

What determines intracranial pressure?

A

Brain tissue

Blood

CSF

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2
Q

How can the brain move with relation to the falx cerebri and the foramen magnum?

A

Brain cannot go through the falx but can go round the edge

Brain cannot go through the skull but can move down through the foramen magnum

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3
Q

What are causes of raised intracranial pressure?

A

Haemorrhage

Tumour

Abscess

Generalised pathology (e.g - oedema)

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4
Q

What are the SOL? (space occupying lesions)

A

Tumours

Bleeding

Abscess

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5
Q

What is the effect of an intracranial space occupying lesion?

A

Increase in tissue

Increase in intracranial pressure

Internal herniation between the intracranial spaces:

Cerebrum moves inferiorly over the edge of tentorium (uncal herniation)

Cerebellum moves inferiorly into foramen magnum (coning)

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6
Q

What is subfalcine herniation?

A

Cingulate gyrus herniates underneath falx

Lateral ventricle is crushed flat and is displaced downwards

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7
Q

What is uncal herniation?

A

Brain herniates inferiorly at side of tentorium

Aqueduct is crushed and narrow

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8
Q

What is the cause of brainstem death?

A

Cerebellar tonsillar herniation

Tonsils move inwards an downwards and crush the brainstem

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9
Q

What is the effect of swelling on blood supply?

A

Tumours squeeze nearby tissue and cause local ischaemia

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10
Q

What are the symptoms of raised intracranial pressure?

A

Morning headaches and sickness as a result of squeeze on the cortex and the brainstem

Papilloedema (optic disk swelling) - squeeze on optic nerve

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11
Q

Why do the pupils dilate during raised intracranial pressure?

A

Squeeze and stretch on cranial nerve 3

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12
Q

Why is there a fall on the glasgow coma scale during an increase in the intracranial pressure?

A

There is a squeeze on the cortex and the brainstem

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13
Q

To recap pressure increase results in?

A

Pupillary dilation

Falling glasgow coma scale

Brainstem death

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14
Q

What are the classifications of intracranial tumours?

A

Primary tumours

Secondary tumours (metastatic tumours)

Other intracranial tumours (cells originating outside the brain and the spinal cord (eg meningioma))

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15
Q

What are the types of primary intracranial tumours that arise from brain cells?

A

Glial cells - gliomas (glioblastoma, astrocytoma, oligodendroglioma, ependymoma)

Embryonic neural cells: medulloblastoma

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16
Q

What are the primary brain tumours that arise from cells surrounding or originating outside the brain?

A

Arachnoidal cell - meningioma

Nerve sheath cell - schwannoma, neurofibroma

Pituitary gland - adenoma

Lymphoid cell - lymphoma

Capillary vessel - haemangioblastoma

For intradural think of LEMON (LMN)

Lipoma

Meningioma

Neurofibroma

For intramedullary think HEAT:

Haemangioblastoma

Ependymoma

Astrocytoma

Teratoma

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17
Q

What is the childhood malignant tumour?

A

Medulloblastoma

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18
Q

Where are the central nervous system tumours for adults and children?

A

Adults - majority are above the tentorium

Children - majority are below the tentorium

19
Q

What are the features of a glioma?

A

Resembles cells of glial differentiation

Difuse edges - not encapsulated

Malignant but do not metastasise outside the CNS

20
Q

Where does metastatic malignancy in the brain arise from?

A

Breast

Lung

Kidney

Colon

Melanoma

21
Q

What cells do gliomas resemble?

A

The cells of glial differentiation

Astrocytes - astrocytoma - including glioblastoma

Oligodendrocytes - oligodendroglima

Ependymal cells - ependymoma

22
Q

What is an example of an astrocytoma?

A

Glioblastoma

23
Q

What is the shape of an astrocyte?

A

Star shaped cell

24
Q

What are the features of astrocytomas?

A

Bland cells on microscopy (similar to normal astrocytes)

Grow very slowly

Small cell with single nucleus

25
What is the most malignant?
Glioblastoma - not to be confused with low grade astrocytoma as described previously
26
What are the features of glioblastoma?
Cellular, atypical tumour with necrosis under the microscope Grow quickly - often present as large tumours LARGE CELL WITH MULTIPLE NUCLEI LARGE CELL WITH IRREGULAR NUCLEUS
27
What is the medulloblastoma a tumour of?
It is a tumour of the primitive neuroectoderm (primitive neural cells)
28
What are the features of medulloblastoma?
Sheets of small undiferentiated cells Affects children especially Situated in the posterior fossa, especially the brainstem
29
What forms from arachnocytes?
Meningiomas Arachnocytes are cells tha make up the covering of the brain
30
Where can you find meningiomas?
They are benign and do not metastasise but can be locally aggressive and can invade the skull
31
What are the features of meningiomas?
Slow growing Often resectable Small groups of cells gather and resemble an arachnoid granulation Sometimes the cells calcify The calcification is sometimes called psammoma meaning grain of sand
32
Where can you find nerve sheath tumours?
Intracranial and extracranial
33
Give an example of a schwannoma
8th vestibulocochlear nerve schwannoma - often called **acoustic neuroma** - found at the angle between the pons and the cerebellum
34
What are the features of an acoustic neuroma?
Unilateral deafness Benign lesion but removal is difficult
35
Is a pituitary tumour benign or malignant?
Benign Tumour of the pituitary in the pituitary fossa
36
What are the features of a pituitary tumour?
Often secrete pituitary hormone Grow superiorly and impinge on optic chiasma - visual signs (bitemporal hemianopia)
37
What type of cell makes up a CNS lymphoma usually?
Usually large B-Cell lymphoma
38
Where in the brain do you find CNS lymphomas?
Often deep and central site in the brain They generally do not spread outside of the CNS
39
Why are CNS lymphomas hard to treat?
Drugs do not cross the blood rbain barrier and they are difficult to biopsy
40
What are the complications associated with haemangioblastoma?
May bleed
41
Where do you find haemangioblastomas?
Most often in the cerebellum
42
What are the features of secondary tumours?
Mostly carcinomas Common Histology - that of the primary tumour
43
Learning objectives
* Demonstrate understanding of raised intracranial pressure * Know symptoms/signs/consequences of raised intracranial pressure * Classify intracranial neoplasms * Concentrate initial learning on astrocytoma (including glioblastoma) /meningioma/schwannoma and pituitary adenoma
44

Nervous System (Year 2 GM) (47 decks)

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