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Neuro Pathology > Pathology of Brain Tumours > Flashcards

Pathology of Brain Tumours Flashcards

1
Q

What are the thick tough fibrous sheets that keep the brain in place?

A

Falx cerebri

Tentorium cerebelli

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2
Q

Where does the spinal cord open through the skull?

A

Through the foramen magnum

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3
Q

Causes of raised ICP

A 
Localised lesions
- haemorrhage (haematoma if localised)
- tumour
- abscess
Generalized pathology 
- e.g. oedema post trauma
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4
Q

What does SOL stand for?

A

Space occupying lesion

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5
Q

Examples of SOL in the head

A

Tumours
Bleeding (haematoma)
Abscess

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6
Q

Effects of intracranial SOLs

A

Amount of tissue increases
Raises ICP
Causes internal shift (herniation) between intracranial spaces
- 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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7
Q

What does swelling and shift of brain tissue lead to?

A

Localised ischaemia

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8
Q

Presentation of a squeeze on the cortex and brainstem

A

Morning headaches

Sickness

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9
Q

Presentation of a squeeze on the optic nerve

A

Papilloedema (on fundoscopy)

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10
Q

Presentation of a rising ICP

A

Pupillary dilation - squeeze and stretch on CN 3
Falling GCS - squeeze on cortex and brainstem
Brain stem death - squeezing downwards of cerebellum into foramen magnum with crushing of brainstem

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11
Q

What does a subfalcine herniation lead to?

A

A midline shift - brain pushed away from the tumour

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12
Q

What type of herniation causes brainstem death?

A

Cerebellar Tonsillar Herniation

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13
Q

Types of intracranial tumours

A 
CNS
- primary 
- secondary (metastatic)
Other
- originating from outside brain and spinal cord e.g. meningioma
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14
Q

Examples of primary intracranial tumours

A 
Gliomas
Medulloblastoma
Meningioma
Schwannoma
Neurofibroma
Adenoma
Lymphoma
Haemangioblastoma
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15
Q

Types of gliomas

A

Glioblastoma
Astrocytoma
Oligodendroglioma
Ependyoma

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16
Q

What do gliomas originate from?

A

Glial cells

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17
Q

What do medulloblastomas originate from?

A

Embryonic neural cells

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18
Q

What do meningiomas originate from?

A

Arachnoidal cells

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19
Q

What do schwannomas and neurofibromas originate from?

A

Nerve sheath cells

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20
Q

What do adenomas arise from?

A

Pituitary gland

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21
Q

What do lymphomas arise from?

A

Lymphoid cells

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22
Q

What do hemangioblastomas arise from?

A

Capillary vessels

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23
Q

What cancers commonly metastasize to the brain?

A 
Breast 
Lung
Kidney 
Colon 
Melanoma
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24
Q

Are glial cell tumours (gliomas) malignant or benign?

A

Malignant

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25
Q

What are embryonic neural cell tumours (medulloblastomas)?

A

Childhood malignant tumours

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26
Q

Where are the majority of CNS tumours found in an adult?

A

Above the tentorium

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27
Q

Where are the majority of CNS tumours found in a child?

A

Below the tentorium

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28
Q

Features of gliomas

A

Resemble cells of glial differentiation
Diffuse edges
Not encapsulated
Malignant but do NOT metastasize outside of the CNS

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29
Q

Examples of gliomas resembling cells of glial differentiation

A

Astrocytes (astrocytoma)
Oligodendrocytes (oligodendroglioma)
Ependymal cells (ependymoma)

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30
Q

Main type of glioma

A

Astrocytoma

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31
Q

What is another name for astrocytoma?

A

Glioblastoma

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32
Q

Features of meningiomas

A 
Benign 
Does not metastasise 
Can be locally aggressive and invade the skull 
Slow growing
Often resectable
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33
Q

What is a pituitary adenoma?

A

Benign tumour of the pituitary in the pituitary fossa

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34
Q

How does pituitary adenoma grow?

A

Superiorly

Impinge on the optic chiasma

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35
Q

Features of a CNS Lymphoma

A

High grade neoplasm
Usually diffuse large B-cell lymphoma
Often deep and central site in the brain (difficult to biopsy)

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36
Q

Where do people most often get hemangioblastoma?

A

Cerebellum

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37
Q

What is a schwannoma around the 8th CN called?

A

Acoustic neuroma

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38
Q

Presentation of acoustic neuroma

A

Unilateral deafness

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39
Q

How are brain tumours classified?

A

Tissue of origin
Location
Primary or secondary (metastatic)
Grading

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40
Q

What is the second most common brain tumour after glioma?

A

Meningioma

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41
Q

Who gets meningiomas?

A

40 - 70 y/o

F > M

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42
Q

Pathology of meningioma

A

Arise from arachnoidal cap cell type from arachnoid membrane
Usually non invasive

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43
Q

What are meningiomas associated with?

A

NF-2

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44
Q

Where can meningiomas be located?

A

Parasagittal region
Sphenoid wing
Parasellar region

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45
Q

Presentation of meningioma

A

Asymptomatic
Symptomatic
- focal or generalised seizure or gradually worsening neurological deficit

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46
Q

Investigations of meningioma

A

CT

MRI

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47
Q

What does meningioma look like on CT?

A

Isodense or hypodense
Homogenous extra-axial mass with smooth or lobulated, clearly demarcated contours which enhance homogenously and densely with contrast
Frequently have areas of calcification and produce hyperostosis of adjacent bone

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48
Q

What does meningioma look like on MRI?

A

Isotense with grey matter on T1 images

Enhance with contrast - often with enhancing dural trail extending from the tumour attachment

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49
Q

Spectrum of astrocytomas ranges from what to what?

A

Benign to malignant

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50
Q

What is an astrocytoma a type of?

A

Glioma

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51
Q

What is a benign type of astrocytoma called?

A

Low grade pilocytic astrocytoma

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52
Q

What is a type of malignant astrocytoma called?

A

High grade astrocytoma / Glioblastoma multiforme

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53
Q

Who gets diffuse low grade astrocytomas?

A

Young adults

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54
Q

Locations of diffuse low grade astrocytomas

A

Widely infiltrate surrounding tissue

  • Frontal region
  • subcortical white matter
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55
Q

Presentation of diffuse low grade astrocytomas

A

Seizures
Headache
Slowly progressive neurological deficits

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56
Q

What is seen on CT with a diffuse low grade astrocytoma?

A

Well circumscribed
Non enhancing
Hypodense
Isodense lesion

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57
Q

What is the most common type of primary brain tumour in adults?

A

High grade astrocytoma / glioblastoma

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58
Q

Who gets glioblastomas?

A

40 - 60 y/os

M > F

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59
Q

How may a glioblastoma arise?

A

De novo

From a low grade glioma

60
Q

Pathology of glioblastoma

A

Tumour infiltrates along white matter tract and can cross the corpus callosum
Can look like a butterfly lesion

61
Q

Prognosis of glioblastoma

A

Very malignant

Poor prognosis

62
Q

Location of glioblastoma

A

Frontal and temporal lobes

Basal ganglia

63
Q

Presentation of glioblastoma

A

Seizures
Headache
Slowly progressive neurological deficits

64
Q

Mean onset of an oligodendroglioma

65
Q

What do oligodendrogliomas arise from?

66
Q

Features of oligodendroglioma

A

Characteristic “fried egg” appearance

Slow growing

67
Q

Location of oligodendroglioma

A

Superficially in frontal lobes

68
Q

Presentation of oligodendroglioma

A

Seizures most common
Headache
Slowly progressive neurological deficits

69
Q

What does an oligodendroglIoma look like on CT?

A

Well circumscribed, hypodense lesions with heavy calcification
Cystic degeneration is common but haemorrhage and oedema are uncommon

70
Q

What does CNS lymphoma cause?

A

Increased ICP

Brain destruction

71
Q

What cancers commonly spread to the brain?

A

Melanoma
Renal cell
Choriocarcinoma

72
Q

A schwannoma is unilateral in what % of cases?

73
Q

When are bilateral lesions seen with schwannomas?

A

Almost exclusively in NF2

74
Q

What can pineal germinoma cause and why?

A

Obstructive hydocephalus

Due to aqueduct stenosis

75
Q

What can a brainstem glioma cause?

A

Locked in syndrome

76
Q

What is the only known risk factor for a brainstem glioma?

77
Q

Who is low grade pilocytic astrocytomas mostly common in?

A

Young children

78
Q

What is a hemangioblastoma characterised by?

A

Abundant capillary blood vessels

79
Q

What is a hemangioblastoma assosiated with?

A

Retinal lesions

80
Q

What do intra-axial gliomas originate from?

A

Glial cells

81
Q

Types of gliomas

A 
Astrocytoma (grade I and III)
Anaplastic astrocytoma (III)
Glioblastoma multiforme (IV)
82
Q

Survival of glioblastoma multiforme

A

8 - 10 months

83
Q

Where do ependymomas arise from?

A

Lining of the ventricle

84
Q

What is a ependymoma?

A

Benign tumour which causes obstruction of CSF

85
Q

Where is ependymoma most commonly found?

A

4th ventricle

86
Q

Median age of diagnosis of ependymoma

87
Q

What is the second commonest tumour in children?

A

Medulloblastoma

88
Q

What is a medulloblastoma highly sensitive to?

A

Radiotherapy

89
Q

Who is CNS lymphoma common in?

A

Immunocompromised patients e.g. transplant, AIDs

90
Q

Survival of CNS lymphoma

A

1 - 4 years

91
Q

Treatment of CNS lymphoma

A

Chemotherapy

Radiation/decadron

92
Q

Where do extra-axial tumours arise from?

A

Supporting structures on the CNS

93
Q

Examples of extra-axial tumourd

A 
Meningioma
Metastatic
Acoustic neuroma (schwannoma)
Pituitary adenoma
Neurofibroma
94
Q

Examples of intra-axial tumours

A 
Gliomas
Oligodendroglioma
Ependymomas
Medulloblastoma
CNS lymphoma
95
Q

Features of meningioma

A

Slow growing
Attached to meninges
Usually benign

96
Q

What usually causes mets to cause a extraaxial tumour?

A

Lung
Breast
Kidney
GI

97
Q

Where do you find an acoustic neuroma?

98
Q

Is an acoustic neuroma benign or malignant?

99
Q

How is a pituitary adenoma classified?

A

Hormone secretion

Location

100
Q

Types of prolactin secreting pituitary adenomas

A

Microadeoma

Macroadenoma

101
Q

What level of serum prolactin indicates a prolactin secreting tumour?

102
Q

Presentation of a microprolactinoma

A 
Hyperprolactinaemia
Gallactorrhoea
Amenorrhoea
Impotence
Infertility in males
103
Q

Presentation of a pituitary adenoma

A

May cause hyperprolactinaemia
May cause growth hormone deficiency
May present with endocrine abnormalities
May present with bilateral temporal heminaopia

104
Q

Presentation of growth hormone deficiency in childhood

A

Dwarfism
Slow / absent growth
Absent / delayed sexual development
Cephalofacial disproportion

105
Q

Presentation of adulthood GH deficiency

A 
Increased body fat
Decreased muscle mass 
Decreased bone density 
- increased risk of fractures
- impaired glucose tolerance
106
Q

Inheritance of neurofibroma

A

Autosomal dominant

107
Q

What are neurofibromas attached to?

108
Q

Are neurofibromas benign or malignant?

109
Q

When do neurofibromas occur?

A

Childhood / early adolescence

110
Q

Treatment of neurofibroma

A

Surgery

Radiation

111
Q

What does the presentation of a brain tumour depend on?

A

Location
Size
Type

112
Q

Presentation of brain tumours

A 
Cerebral oedema
Increased ICP
Focal neurological deficits
Obstruction of flow of CSF
Pituitary dysfunction 
Papilloedema
113
Q

Presentation of cerebral tumours

A 
Headache
Vomiting unrelated to food intake 
Changes in visual fields and acuity 
Hemiparesis or hemiplegia 
Hypokinesia
Decreased tactile discrimination 
Seizures
Changes in personality or behaviour
114
Q

Presentation of brainstem tumours

A 
Hearing loss (acoustic neuroma)
Facial pain and weakness
Dysphagia 
Decreased gag reflex
Nystagmus 
Hoarseness 
Ataxia 
Dysarthria
115
Q

Definition of ataxia

A

Loss of muscle contraction

116
Q

Definition of dysarthria

A

Speech muscle disorder

117
Q

What do cerebellar tumours cause?

A

Disturbances in coordination and equilibrium

118
Q

What do pituitary tumours cause?

A

Endocrine dysfunction
Visual deficits
Headache

119
Q

Presentation of frontal lobe tumours

A 
Inappropriate behaviour
Personality changes
Inability to concentrate
Impaired judgement 
Memory loss
Headache 
Expressive aphasia
Motor dysfunctions
120
Q

Presentation of parietal lobe tumours

A

Sensory deficits

  • paraesthesia
  • loss of 2 pt discrimination
  • visual field defects
121
Q

Presentation of temporal lobe tumours

A 
Psychomotor seizures
Temporal lobe judgement
Behaviour
Hallucinations 
Visceral symptoms
No convulsions 
Loss of consciousness
122
Q

Presentation of occipital lobe tumours

A

Visual disturbances

123
Q

Investigations of brain tumour

A 
CT with/without contrast
MRI with/without contrast 
Plain films
Myelography 
PET scan
LP/CSF analysis
124
Q

What investigation is mostly used widely for the investigation /diagnosis of brain tumours?

125
Q

What is the most preferred investigation for the follow up of most brain tumours?

126
Q

Treatment of brain tumours

A 
Steriods
Surgical treatment
- resection 
- biopsy 
- craniotomy 
- sterotaxis surgery 
- transsphenoidal 
- endoscopic
127
Q

Post op complications of brain surgery

A 
Increased ICP
Haematoma
Hypovolaemic shock 
Atelectasis
Pulmonary oedema 
Meningitis
Fluid and electrolyte imbalances (ADH)
Wound infection 
Seizures
CF leak 
Oedema
128
Q

What type of cells are sensitive to radiation?

A

Cells that rapidly divide (e.g. brain tumours) and normal tissue too

129
Q

Types of radiation

A

External beam radiation
Stereotactic radiosurgery (gamma, inax, cyberknife)
Interstitial brachytherapy

130
Q

Considerations that need to be taken with radiotherapy

A

Skin burns and reddened skin from beam of radiation
Corticosteriods are given during radiation to control cerebral oedema
Radiation necrosis may occur after treatments are completed; may need to be surgically removed

131
Q

What does chemotherapy do?

A

Slows cell growth

132
Q

How are chemotherapy drugs administered?

A

PO
IV
Intrathecal routes

133
Q

Examples of chemotherapy drugs

A 
Temozolomide (temodar)
CCNU 
BCNU 
Cisplatin 
Etoposide
134
Q

Acute side effects of chemotherapy

A 
Oral mucositis 
Bone marrow suppression 
Fatigue 
Hair loss
Nausea/vomiting
Anxiety 
Peripheral neuropathy
135
Q

What is used to treat N + V?

A

Anti emetics

136
Q

What % of cancer patients develop brain metastases?

137
Q

Another name for vestibular schwannoma

A

Acoustic neuroma

138
Q

Classical presentation of acoustic neuroma

A

Vertigo
Hearing loss
Tinnitus
Absent corneal reflex

139
Q

What CNs can be affected in acoustic neuroma?

A

CN VIII
CN V
CN VII

140
Q

Presentation of CN VIII if affected in acoustic neuroma?

A

Vertigo
Unilateral sensorineural hearing loss
Unilateral tinnitus

141
Q

Presentation of CN V if affected in acoustic neuroma

A

Absent corneal reflex

142
Q

Presentation of CN VII if affected in acoustic neuroma

A

Facial palsy

143
Q

When are bilateral acoustic neuromas seen?

144
Q

Treatment of acoustic neuromas

A

Observed initially as benign and slow growing
Radiotherapy
Surgery

145
Q

Investigation of acoustic neuroma

A

MRI of cerebellopontine angle

Audiometry

146
Q

What is the most common primary cancer responsible for brain metastases?

Neuro Pathology (21 decks)

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