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year 2 neuro - Robbie > Pathology of Brain Tumours > Flashcards

Pathology of Brain Tumours Flashcards

1
Q

What is meant by intracranial pressure?

A

The cranium is a hard, rigid, closed box and for pressure to be stable there must be (within certain limits) the correct amount of braintissure/blood/CSF

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2
Q

There are thick tough fibrous sheets inside that keep the brain in place, what is A and what is B?

A

A - falx cerebri

B - tentorium cerebelli

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3
Q

Can the brain go through the falx cerebri?

A

Brain cannot go through falx, but can go round edge

e.g. if pressurised

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4
Q

Can the brain go through the skull?

A

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

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5
Q

What is the consistency of the brain like?

A

Brain is soft – like a jelly – so it can move easily

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6
Q

What are the 2 main types of causes for raised intracranial pressure?

A

localised lesions

generalised pathology

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7
Q

What are some examples of localised lesions that may be the cause of raised intracranial pressure?

A

Haemorrhage (if localised called a haematoma)

Tumour

Abscess

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8
Q

What are some examples of generalised pathology that may be the cause of raised intracranial pressure?

A

Oedema post traums

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9
Q

Localised lesions = __________________ in head = SOL

A

Localised lesions = Space Occupying Lesions in head = SOL

  • Tumours
  • Bleeding (haematoma)
  • Abscess
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10
Q

What are the effects of intracranial space occupying lesions? (SOL)

A

As the amount of tissue increases, intracranial pressure rises

Cause internal shift (herniation) between the 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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11
Q

Image showing Tentorial (uncal) herniation

A
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12
Q

Image showing Cerebellar tonsillar herniation

A

Crush important nuclei like respiratory and cardiac centres and you die

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13
Q

What does swelling and shifting of brain tissue lead to?

A

Swelling and shift = localised ischaemia

Tumours squeeze nearby tissue and cause local ischaemia

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14
Q

Pressur eon the brian has consequences, what are symptoms and signs seen?

A

squeeze on the cortex and brainstem = morning headaches and sickness - very important symptom

squeeze on the optic nerve = papilloedema (seen on fundoscopy of the eye)

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15
Q

As pressure on the brain increases, what symtpoms may be seen?

A

Pupillary dilation - Squeeze and stretch on cranial nerve 3

Falling Glasgow coma scale - Squeeze on cortex and brainstem

Brain stem death – squeezing downwards of cerebellum into foramen magnum with crushing of brainstem

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16
Q

What are different types of intracranial tumours?

A

Central nervous system:

  • Primary tumours
  • Secondary (metastatic tumours)

Other intracranial tumours:

  • Cells originating outside brain and spinal cord (eg meningioma)
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17
Q

What are the 2 different classifications of intracranial tumours?

A

Primary (benign and malignat)

Metastatic malignancy (rare in children)

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18
Q

How are primary intracranial tumors named?

A

by resembelence of the cell of origin

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19
Q

What is a tumour of glial cells called?

A

gliomas (glioblastoma, astrocytoma, oligodendroglioma, ependymoma)

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20
Q

What is a tumour of embyronic neural calls called?

A

medulloblastoma

Nerve cell tumours are rare so tends to be embryonic neural cells as adults ones don’t change and divide and tend to be cell cycled block so only primitive neurons can form tumours

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21
Q

What is a tumour of arachnoidal calls called?

A

meningioma

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22
Q

What is a tumour of nerve sheath calls called?

A

Schwannoma, neurofibroma

23
Q

What is a tumour of the pituitary gland called?

A

adenoma

24
Q

What is the tumour of lymphoid cells called?

A

lymphoma

25
Q

What is a tumour of capillary vessels called?

A

haemangioblastoma

26
Q

Where may a intracranial metastatic malignancy originate from?

A

Breast, lung, kidney, colon, melanoma

27
Q

What are tumour of brain cells?

A

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

Embryonic neural cells – medulloblastoma

28
Q

What are tumours of cells surrounding or originate outside the brain?

A

Arachnoidal cell – meningioma

Nerve sheath cell – Schwannoma, neurofibroma

Pituitary gland - adenoma

Lymphoid cell – lymphoma

Capillary vessels - haemangioblastoma

29
Q

What are malignant intracranial tumours?

A

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

30
Q

What are intracranial childhood malignant tumours?

A

Embryonic neural cells – medulloblastoma

31
Q

Where is the site of central nervous system tumours?

A

adults - majority run above tentorium

children - majority below tentorium

32
Q

What do gliomas resemble?

A

Resemble cells of glial differentiation

33
Q

What are the structures of gliomas?

A

Diffuse edges – not encapsulated

34
Q

Are gliomas malignant and do they metastasise?

A

Malignant but do not metastasise outside the CNS

Cannot get through the blood brain barrier

35
Q

Glioma - resemble cells of glial differentiation, whata re some exmaples?

A

Astrocytes = astrocytoma (including glioblastoma - very malignant type of astrocytoma)

Oligodendrocytes = oligodendroglioma

Ependymal cells = ependymoma

36
Q

What is an astrocyte?

A

astrocyte = ‘star’ shaped cell

long processes support other cells structually and biochemically

37
Q

What are the 2 types of astrocytoma?

A
  1. Low grade astrocytoma
  2. Glioblastoma
38
Q

What is an astrocytoma – low grade?

A

Bland cells on microscopy (similar to normal astrocytes)

Grow very slowly

39
Q

What is a glioblastoma?

A

most malignant astrocytoma (high grade on microscopy) = glioblastoma (sometimes called glioblastoma multiforme)

40
Q

What are glioblastoma cells like?

A

Cellular, atypical tumour, with necrosis under microscope

Grow quickly - often present as large tumours

41
Q

What is a medulloblastoma?

A

Tumour of primitive neuroectoderm (primitive neural cells)

Sheets of small undifferentiated cells

Children especially effected

Posterior fossa, especially brainstem

42
Q

What is a meningioma?

A

form “arachnocytes” - cells that make up the coverings of the brain

They are slow growing and are often resectable

43
Q

Are meningiomas benign or metastatic?

A

“Benign” – do not metastasise – but can be locally aggressive and can invade the skull

44
Q

What do meningiomas look like on microscopy?

A

bland cells forming small groups, sometimes with calcification

45
Q

What are nerve sheath tumours?

A

Around peripheral nerves – intracranial and extracranial

Schwannoma is one example

Normal schwann cells wrap around peripheral nerves and form electrical insulation

46
Q

8th vestibulocochlear nerve schwannoma, often called ‘____________’ at angle between pons and cerebellum

A

8th vestibulocochlear nerve schwannoma, often called ‘Acoustic neuroma’ at angle between pons and cerebellum

47
Q

What is an acoustic neuroma?

A

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

Causes unilateral deafness

Benign lesion but removal technically difficult as often wedged right up against the brain stem and near lots of very important structures

48
Q

What is a pituitary adenoma?

A

Benign tumour of pituitary in pituitary fossa

Often secrete a pituitary hormone

Grow superiorly and impinge on optic chiasma – visual signs

49
Q

What are the signs of a pituitary adenoma?

A

Grow superiorly and impinge on optic chiasma – visual signs

50
Q

What is a CNS lymphoma?

A

High grade neoplasm

Usually diffuse large B-cell lymphoma

Often deep and central site in brain - difficult to biopsy

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

Generally do not spread outside of CNS

51
Q

What is a haemangioblastoma?

A

tumour of blood vessels

space occupying

may bleed

most often in cerebellum

52
Q

Are secondary tumours common or rare and what type of tumour are they commonly?

A

common

mostly carcinomas

53
Q

What is the histology of secondary tumours like?

A

like the histology of the primary tumour

year 2 neuro - Robbie (48 decks)

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