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Yr2 Neuro MA > Pathology of brain tumours > Flashcards

Pathology of brain tumours Flashcards

1
Q

What are the main causes of raised intracranial pressure?

A

Space occupying (localized lesions):

  • Bleeding - Haemorrhage (Haematoma if localized)
  • Tumour
  • Abscess

Generalized pathology such as:

  • Cerebral oedema post-trauma
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2
Q

Space occupying lesions can cause the brain to shift (herniate) within the skull

What are the types of herniation?

A

Cingulate

Central

Uncal

Cerebellotonsilar

Upward

Transcalvarial

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3
Q

Identify the types of brain herniation on the diagram below

A
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4
Q

What is a subfalcine herniation?

A

when brain tissue is displaced under the falx cerebri - the fold of dura mater down the longitudinal fissure

The cingulate herniation is a Subfalcine herniation

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5
Q

What is the effect of cerebellar tonsillar herniation?

A

Brainstem death

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6
Q

What are the structures indicated by red arrows?

A

Falx cerebri (top)

Tentorium cerebelli (bottom 2)

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7
Q

How can tumours cause ischaemia of brain tissue?

A

Tumours squeeze nearby tissue and cause local ischaemia

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8
Q

Describe the signs & symptoms associated with rising intracranial pressure

A

Morning headaches & sickness - Squeezing of cortex & brainstem

Papilloedema - Squeezing of Optic nerve

*At very high ICPs:*

Pupillary dilation - Squeezing of CN III

Falling GCS score - “ “ Cortex & brainstem

Brainstem death - Uncal/Cerebellotonsillar herniation through the foramen magnum

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9
Q

Aside from primary and secondary (metastasis) tumours of the CNS - how else can intracranial tumours form?

A

Tumours that arise from Cells originating outside brain and spinal cord (eg meningioma) - but are still within the cranium

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10
Q

Primary intracranial tumours are classed depending on their cells of origin

A

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

Embryonic neural cells – medulloblastoma

Arachnoidal cell – meningioma

Nerve sheath cell – Schwannoma, neurofibroma

Pituitary gland - adenoma

Lymphoid cell – lymphoma

Capillary vessels - haemangioblastoma

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11
Q

What are the types of tumour that arise from/in brain tissue?

A

Gliomas (glial cell tumours):

  • glioblastoma
  • astrocytoma
  • oligodendroglioma
  • ependymoma

Medulloblastoma (embryonic neural cell tumour)

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12
Q

What types of intracranial tumours originate from cells surrounding or outside the brain?

A

Meningiomas - arachnoidal cell tumour

Schwannoma, neurofibroma - Nerve sheath cells

Adenomas - pituitary gland tumour

Lymphoma - lymphoid cell tumour

Haemangioblastoma - Capillary vessel tumour

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13
Q

What types of intracranial tumours are malignant (cancerous)?

A

All gliomas:

  • Glioblastoma
  • Astrocytoma
  • Oligodendroglioma
  • Ependymoma

Medulloblastoma - Childhood malignant tumour

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14
Q

As a general rule - how does the location of tumours tend to differ in adults and children?

A

Adults - above tentorium

Children - below tentorium

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15
Q

What cells give rise to each type of glioma?

A

Astrocytes –> astrocytoma (including glioblastoma)

Oligodendrocytes –> oligodendroglioma

Ependymal cells –> Ependyomas

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16
Q

Are gliomas able to metastasize?

A

Yep - but do not metastasise outside the CNS

17
Q

Are gliomas encapsulated or non-encapsulated?

A

Non-encapsulated

Gliomas have diffuse edges

18
Q

There are lots of types of astrocytoma - however - what are the 2 main types?

A

Low-grade astrocytoma:

  • Slow growing, least malignant

Glioblastoma:

  • Fast-growing, most malignant
    • Often presents as large tumour
  • Necrosis around tumour
19
Q

How do the 2 main types of astrocytoma differ under a microscope?

A

Low-grade astrocytoma:

  • Cells look a lot like normal astrocytes
    • (Small star-like cells with one nucleus)
  • Grow slowly

Glioblastoma:

  • Cellular, atypical tumour - with necrosis
  • Cells have multiple nuclei or wonky shaped nuclei
  • Fast-growing
20
Q

What type of tumour is shown here?

A

Meningioma

21
Q

What is a medulloblastoma?

A

A tumour of the primitive neuroectoderm (primitive neural cells)

Affects children & sometimes adults

Sheets of undifferentiated cells

Tumours are found in the posterior fossa - commonly in/around the brainstem

22
Q

What is a meningioma?

A

A Benign tumour that forms in the meninges - specifically from the arachnocytes around the brain

It is slow-growing but can be locally aggressive - and can directly invade the skull

Often resectable

23
Q

Where are meningiomas found?

A

In the meninges - typically around the brain

Only a small proportion of meningiomas are in the spinal cord

They can also be found in places they directly invade - ie the Skull

24
Q

What has caused the lesion shown here?

A

The meningioma has caused a depression in the cerebral hemisphere

25
Q

Describe what microscopy of a meningioma would show

A

Microscopy will show bland cells forming small groups

± calcification (which is sometimes called a psammoma)

26
Q

What are the types of nerve sheath tumours?

A

Schwannoma - of Schwann cells in the PNS

Oligodendroglioma - of O.cytes in the CNS

27
Q

What is an Acoustic neuroma?

A

A very specific type of Schwannoma

Schwannoma of the Vestibularcochlear (CN VIII) nerve - located at the cerebellopontine angle

Although it is benign - it is difficult to resect

Acoustic neuroma causes unilateral deafness

28
Q

What type of tumour is circled?

What are the arrows pointing to?

A

An acoustic neuroma (a type of schwannoma)

The arrows point to the cerebellum - the right is pretty wilted

29
Q

What is this ting

A

Pituitary adenoma

Funnily enough, it comes from the pituitary glands

Large well-circumscribed mass protruding upwards from base of skull

30
Q

What type of cells are most commonly associated with CNS lymphoma?

A

Usually diffuse large B-cell lymphoma

High-grade neoplasm

31
Q

Why is it difficult to biopsy CNS lymphoma?

A

Lymphoma is often deep and central in the brain

Thus It is hard to reach for biopsy

It also does not typically spread out from the CNS

32
Q

Why is it difficult to treat CNS lymphoma?

A

The drugs can’t cross the blood-brain barrier

33
Q

What is a haemangioblastoma?

A

A tumour that arises in the capillaries in the brain - most commonly in the cerebellum

They are space-occupying (thus may restrict blood flow) - and may bleed (Haematoma etc etc)

34
Q

What is the most common type of secondary tumour found in the brain?

A

Carcinomas

Commonly from the lungs, breast, kidneys…

This is fairly common in adults- but secondary tumours rare in children

35
Q
A

Yr2 Neuro MA (35 decks)

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