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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
What are embryonic neural cell tumours (medulloblastomas)?
Childhood malignant tumours
26
Where are the majority of CNS tumours found in an adult?
Above the tentorium
27
Where are the majority of CNS tumours found in a child?
Below the tentorium
28
Features of gliomas
Resemble cells of glial differentiation Diffuse edges Not encapsulated Malignant but do NOT metastasize outside of the CNS
29
Examples of gliomas resembling cells of glial differentiation
Astrocytes (astrocytoma) Oligodendrocytes (oligodendroglioma) Ependymal cells (ependymoma)
30
Main type of glioma
Astrocytoma
31
What is another name for astrocytoma?
Glioblastoma
32
Features of meningiomas
``` Benign Does not metastasise Can be locally aggressive and invade the skull Slow growing Often resectable ```
33
What is a pituitary adenoma?
Benign tumour of the pituitary in the pituitary fossa
34
How does pituitary adenoma grow?
Superiorly | Impinge on the optic chiasma
35
Features of a CNS Lymphoma
High grade neoplasm Usually diffuse large B-cell lymphoma Often deep and central site in the brain (difficult to biopsy)
36
Where do people most often get hemangioblastoma?
Cerebellum
37
What is a schwannoma around the 8th CN called?
Acoustic neuroma
38
Presentation of acoustic neuroma
Unilateral deafness
39
How are brain tumours classified?
Tissue of origin Location Primary or secondary (metastatic) Grading
40
What is the second most common brain tumour after glioma?
Meningioma
41
Who gets meningiomas?
40 - 70 y/o | F > M
42
Pathology of meningioma
Arise from arachnoidal cap cell type from arachnoid membrane Usually non invasive
43
What are meningiomas associated with?
NF-2
44
Where can meningiomas be located?
Parasagittal region Sphenoid wing Parasellar region
45
Presentation of meningioma
Asymptomatic Symptomatic - focal or generalised seizure or gradually worsening neurological deficit
46
Investigations of meningioma
CT | MRI
47
What does meningioma look like on CT?
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
48
What does meningioma look like on MRI?
Isotense with grey matter on T1 images | Enhance with contrast - often with enhancing dural trail extending from the tumour attachment
49
Spectrum of astrocytomas ranges from what to what?
Benign to malignant
50
What is an astrocytoma a type of?
Glioma
51
What is a benign type of astrocytoma called?
Low grade pilocytic astrocytoma
52
What is a type of malignant astrocytoma called?
High grade astrocytoma / Glioblastoma multiforme
53
Who gets diffuse low grade astrocytomas?
Young adults
54
Locations of diffuse low grade astrocytomas
Widely infiltrate surrounding tissue - Frontal region - subcortical white matter
55
Presentation of diffuse low grade astrocytomas
Seizures Headache Slowly progressive neurological deficits
56
What is seen on CT with a diffuse low grade astrocytoma?
Well circumscribed Non enhancing Hypodense Isodense lesion
57
What is the most common type of primary brain tumour in adults?
High grade astrocytoma / glioblastoma
58
Who gets glioblastomas?
40 - 60 y/os | M > F
59
How may a glioblastoma arise?
De novo | From a low grade glioma
60
Pathology of glioblastoma
Tumour infiltrates along white matter tract and can cross the corpus callosum Can look like a butterfly lesion
61
Prognosis of glioblastoma
Very malignant | Poor prognosis
62
Location of glioblastoma
Frontal and temporal lobes | Basal ganglia
63
Presentation of glioblastoma
Seizures Headache Slowly progressive neurological deficits
64
Mean onset of an oligodendroglioma
40 y/o
65
What do oligodendrogliomas arise from?
Myelin
66
Features of oligodendroglioma
Characteristic "fried egg" appearance | Slow growing
67
Location of oligodendroglioma
Superficially in frontal lobes
68
Presentation of oligodendroglioma
Seizures most common Headache Slowly progressive neurological deficits
69
What does an oligodendroglIoma look like on CT?
Well circumscribed, hypodense lesions with heavy calcification Cystic degeneration is common but haemorrhage and oedema are uncommon
70
What does CNS lymphoma cause?
Increased ICP | Brain destruction
71
What cancers commonly spread to the brain?
Melanoma Renal cell Choriocarcinoma
72
A schwannoma is unilateral in what % of cases?
90%
73
When are bilateral lesions seen with schwannomas?
Almost exclusively in NF2
74
What can pineal germinoma cause and why?
Obstructive hydocephalus | Due to aqueduct stenosis
75
What can a brainstem glioma cause?
Locked in syndrome
76
What is the only known risk factor for a brainstem glioma?
NF1
77
Who is low grade pilocytic astrocytomas mostly common in?
Young children
78
What is a hemangioblastoma characterised by?
Abundant capillary blood vessels
79
What is a hemangioblastoma assosiated with?
Retinal lesions
80
What do intra-axial gliomas originate from?
Glial cells
81
Types of gliomas
``` Astrocytoma (grade I and III) Anaplastic astrocytoma (III) Glioblastoma multiforme (IV) ```
82
Survival of glioblastoma multiforme
8 - 10 months
83
Where do ependymomas arise from?
Lining of the ventricle
84
What is a ependymoma?
Benign tumour which causes obstruction of CSF
85
Where is ependymoma most commonly found?
4th ventricle
86
Median age of diagnosis of ependymoma
5 y/o
87
What is the second commonest tumour in children?
Medulloblastoma
88
What is a medulloblastoma highly sensitive to?
Radiotherapy
89
Who is CNS lymphoma common in?
Immunocompromised patients e.g. transplant, AIDs
90
Survival of CNS lymphoma
1 - 4 years
91
Treatment of CNS lymphoma
Chemotherapy | Radiation/decadron
92
Where do extra-axial tumours arise from?
Supporting structures on the CNS
93
Examples of extra-axial tumourd
``` Meningioma Metastatic Acoustic neuroma (schwannoma) Pituitary adenoma Neurofibroma ```
94
Examples of intra-axial tumours
``` Gliomas Oligodendroglioma Ependymomas Medulloblastoma CNS lymphoma ```
95
Features of meningioma
Slow growing Attached to meninges Usually benign
96
What usually causes mets to cause a extraaxial tumour?
Lung Breast Kidney GI
97
Where do you find an acoustic neuroma?
CN VIII
98
Is an acoustic neuroma benign or malignant?
Benign
99
How is a pituitary adenoma classified?
Hormone secretion | Location
100
Types of prolactin secreting pituitary adenomas
Microadeoma | Macroadenoma
101
What level of serum prolactin indicates a prolactin secreting tumour?
> 500Mu/L
102
Presentation of a microprolactinoma
``` Hyperprolactinaemia Gallactorrhoea Amenorrhoea Impotence Infertility in males ```
103
Presentation of a pituitary adenoma
May cause hyperprolactinaemia May cause growth hormone deficiency May present with endocrine abnormalities May present with bilateral temporal heminaopia
104
Presentation of growth hormone deficiency in childhood
Dwarfism Slow / absent growth Absent / delayed sexual development Cephalofacial disproportion
105
Presentation of adulthood GH deficiency
``` Increased body fat Decreased muscle mass Decreased bone density - increased risk of fractures - impaired glucose tolerance ```
106
Inheritance of neurofibroma
Autosomal dominant
107
What are neurofibromas attached to?
Nerve
108
Are neurofibromas benign or malignant?
Benign
109
When do neurofibromas occur?
Childhood / early adolescence
110
Treatment of neurofibroma
Surgery | Radiation
111
What does the presentation of a brain tumour depend on?
Location Size Type
112
Presentation of brain tumours
``` Cerebral oedema Increased ICP Focal neurological deficits Obstruction of flow of CSF Pituitary dysfunction Papilloedema ```
113
Presentation of cerebral tumours
``` 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
Presentation of brainstem tumours
``` Hearing loss (acoustic neuroma) Facial pain and weakness Dysphagia Decreased gag reflex Nystagmus Hoarseness Ataxia Dysarthria ```
115
Definition of ataxia
Loss of muscle contraction
116
Definition of dysarthria
Speech muscle disorder
117
What do cerebellar tumours cause?
Disturbances in coordination and equilibrium
118
What do pituitary tumours cause?
Endocrine dysfunction Visual deficits Headache
119
Presentation of frontal lobe tumours
``` Inappropriate behaviour Personality changes Inability to concentrate Impaired judgement Memory loss Headache Expressive aphasia Motor dysfunctions ```
120
Presentation of parietal lobe tumours
Sensory deficits - paraesthesia - loss of 2 pt discrimination - visual field defects
121
Presentation of temporal lobe tumours
``` Psychomotor seizures Temporal lobe judgement Behaviour Hallucinations Visceral symptoms No convulsions Loss of consciousness ```
122
Presentation of occipital lobe tumours
Visual disturbances
123
Investigations of brain tumour
``` CT with/without contrast MRI with/without contrast Plain films Myelography PET scan LP/CSF analysis ```
124
What investigation is mostly used widely for the investigation /diagnosis of brain tumours?
CT
125
What is the most preferred investigation for the follow up of most brain tumours?
MRI
126
Treatment of brain tumours
``` Steriods Surgical treatment - resection - biopsy - craniotomy - sterotaxis surgery - transsphenoidal - endoscopic ```
127
Post op complications of brain surgery
``` Increased ICP Haematoma Hypovolaemic shock Atelectasis Pulmonary oedema Meningitis Fluid and electrolyte imbalances (ADH) Wound infection Seizures CF leak Oedema ```
128
What type of cells are sensitive to radiation?
Cells that rapidly divide (e.g. brain tumours) and normal tissue too
129
Types of radiation
External beam radiation Stereotactic radiosurgery (gamma, inax, cyberknife) Interstitial brachytherapy
130
Considerations that need to be taken with radiotherapy
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
What does chemotherapy do?
Slows cell growth
132
How are chemotherapy drugs administered?
PO IV Intrathecal routes
133
Examples of chemotherapy drugs
``` Temozolomide (temodar) CCNU BCNU Cisplatin Etoposide ```
134
Acute side effects of chemotherapy
``` Oral mucositis Bone marrow suppression Fatigue Hair loss Nausea/vomiting Anxiety Peripheral neuropathy ```
135
What is used to treat N + V?
Anti emetics
136
What % of cancer patients develop brain metastases?
10 - 15%
137
Another name for vestibular schwannoma
Acoustic neuroma
138
Classical presentation of acoustic neuroma
Vertigo Hearing loss Tinnitus Absent corneal reflex
139
What CNs can be affected in acoustic neuroma?
CN VIII CN V CN VII
140
Presentation of CN VIII if affected in acoustic neuroma?
Vertigo Unilateral sensorineural hearing loss Unilateral tinnitus
141
Presentation of CN V if affected in acoustic neuroma
Absent corneal reflex
142
Presentation of CN VII if affected in acoustic neuroma
Facial palsy
143
When are bilateral acoustic neuromas seen?
NF2
144
Treatment of acoustic neuromas
Observed initially as benign and slow growing Radiotherapy Surgery
145
Investigation of acoustic neuroma
MRI of cerebellopontine angle | Audiometry
146
What is the most common primary cancer responsible for brain metastases?
Lung

Neuro Pathology (21 decks)

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