Pathology of Brain Tumours Flashcards
What are the thick tough fibrous sheets that keep the brain in place?
Falx cerebri
Tentorium cerebelli
Where does the spinal cord open through the skull?
Through the foramen magnum
Causes of raised ICP
Localised lesions - haemorrhage (haematoma if localised) - tumour - abscess Generalized pathology - e.g. oedema post trauma
What does SOL stand for?
Space occupying lesion
Examples of SOL in the head
Tumours
Bleeding (haematoma)
Abscess
Effects of intracranial SOLs
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)
What does swelling and shift of brain tissue lead to?
Localised ischaemia
Presentation of a squeeze on the cortex and brainstem
Morning headaches
Sickness
Presentation of a squeeze on the optic nerve
Papilloedema (on fundoscopy)
Presentation of a rising ICP
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
What does a subfalcine herniation lead to?
A midline shift - brain pushed away from the tumour
What type of herniation causes brainstem death?
Cerebellar Tonsillar Herniation
Types of intracranial tumours
CNS - primary - secondary (metastatic) Other - originating from outside brain and spinal cord e.g. meningioma
Examples of primary intracranial tumours
Gliomas Medulloblastoma Meningioma Schwannoma Neurofibroma Adenoma Lymphoma Haemangioblastoma
Types of gliomas
Glioblastoma
Astrocytoma
Oligodendroglioma
Ependyoma
What do gliomas originate from?
Glial cells
What do medulloblastomas originate from?
Embryonic neural cells
What do meningiomas originate from?
Arachnoidal cells
What do schwannomas and neurofibromas originate from?
Nerve sheath cells
What do adenomas arise from?
Pituitary gland
What do lymphomas arise from?
Lymphoid cells
What do hemangioblastomas arise from?
Capillary vessels
What cancers commonly metastasize to the brain?
Breast Lung Kidney Colon Melanoma
Are glial cell tumours (gliomas) malignant or benign?
Malignant
What are embryonic neural cell tumours (medulloblastomas)?
Childhood malignant tumours
Where are the majority of CNS tumours found in an adult?
Above the tentorium
Where are the majority of CNS tumours found in a child?
Below the tentorium
Features of gliomas
Resemble cells of glial differentiation
Diffuse edges
Not encapsulated
Malignant but do NOT metastasize outside of the CNS
Examples of gliomas resembling cells of glial differentiation
Astrocytes (astrocytoma)
Oligodendrocytes (oligodendroglioma)
Ependymal cells (ependymoma)
Main type of glioma
Astrocytoma
What is another name for astrocytoma?
Glioblastoma
Features of meningiomas
Benign Does not metastasise Can be locally aggressive and invade the skull Slow growing Often resectable
What is a pituitary adenoma?
Benign tumour of the pituitary in the pituitary fossa
How does pituitary adenoma grow?
Superiorly
Impinge on the optic chiasma
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)
Where do people most often get hemangioblastoma?
Cerebellum
What is a schwannoma around the 8th CN called?
Acoustic neuroma
Presentation of acoustic neuroma
Unilateral deafness
How are brain tumours classified?
Tissue of origin
Location
Primary or secondary (metastatic)
Grading
What is the second most common brain tumour after glioma?
Meningioma
Who gets meningiomas?
40 - 70 y/o
F > M
Pathology of meningioma
Arise from arachnoidal cap cell type from arachnoid membrane
Usually non invasive
What are meningiomas associated with?
NF-2
Where can meningiomas be located?
Parasagittal region
Sphenoid wing
Parasellar region
Presentation of meningioma
Asymptomatic
Symptomatic
- focal or generalised seizure or gradually worsening neurological deficit
Investigations of meningioma
CT
MRI
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
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
Spectrum of astrocytomas ranges from what to what?
Benign to malignant
What is an astrocytoma a type of?
Glioma
What is a benign type of astrocytoma called?
Low grade pilocytic astrocytoma
What is a type of malignant astrocytoma called?
High grade astrocytoma / Glioblastoma multiforme
Who gets diffuse low grade astrocytomas?
Young adults
Locations of diffuse low grade astrocytomas
Widely infiltrate surrounding tissue
- Frontal region
- subcortical white matter
Presentation of diffuse low grade astrocytomas
Seizures
Headache
Slowly progressive neurological deficits
What is seen on CT with a diffuse low grade astrocytoma?
Well circumscribed
Non enhancing
Hypodense
Isodense lesion
What is the most common type of primary brain tumour in adults?
High grade astrocytoma / glioblastoma
Who gets glioblastomas?
40 - 60 y/os
M > F