Space occupying lesions Flashcards
What is the most common primary brain tumour in adults?
Glioblastoma
What are the presenting features of glioblastoma?
- Signs of raised ICP (headaches etc)
- Seizures
- Focal neurological deficits
What is the typical appearance of glioblastoma on imaging?
- Solid tumour (irregular in shape + size) with central necrosis surrounded by a rim that enhances with contrast
- Vasogenic oedema (due to disruption of BBB)
What is the typical histopathological appearance of glioblastomas?
Pleomorphic tumour cells border necrotic areas
What is the management of glioblastomas?
Surgical removal with post-operative chemotherapy ± radiotherapy
Dexamethasone for oedema
What is the 2nd most common primary tumour is adults?
Meningioma
What are the presenting features of meningiomas?
- Mostly asymptomatic
- Seizures
- Focal neurological signs (i.e. depends on location of the tumour)
Where in the cranium do meningiomas typically occur?
- Falx cerebri
- Superior sagittal sinus
- Skull base
From which type of cells do meningiomas arise?
Arise from the arachnoid cap cells of the meninges
What is the histopathological appearance of meningiomas?
Spindle cells in concentric whorls and calcified psammoma bodies
What is the management of meningiomas?
- Observation
- Radiotherapy
- Surgical resection
What are the presenting features of vestibular schwannomas?
- Sensorineural hearing loss
- Tinnitus
- Dizziness/vertigo
- Sometimes CN V and VII palsies
What is the most common location for vestibular schwannomas to develop?
Cerebellopontine angle
Which condition are vestibular schwannomas classically associated with?
Neurofibromatosis type 2
Describe the histopathological appearance of vestibular schwannomas?
- Antoni A or B patterns
- Verocay bodies (acellular areas surrounded by nuclear palisades)
What is the management of vestibular schwannomas?
- Observation
- Radiotherapy
- Surgical resection
What is the most common primary brain tumour of childhood?
Pilocytic astrocytoma
What are the presenting features of pilocytic astrocytomas?
DANISH:
- Dysdiadochokinesis
- Ataxia
- Nystagmus
- Intention tremor
- Slurred/staccato speech
- Hypotonia
- Features of raised ICP
Describe the histopathological appearance of pilocytic astrocytomas.
Rosenthal fibres (corkscrew eosinophilic bundle)
What is the management of pilocytic astrocytomas?
Surgical resection + chemotherapy
What are the presenting features of ependymoma?
Raised ICP (headaches, papilloedema, N+V)
Where in the cranium do ependymomas most commonly occur?
4th ventricle
Describe the histopathological appearance of ependymomas.
Perivascular pseudorosettes
What is the management for ependymomas?
Surgical resection + chemotherapy
What are the presenting features of an oligodendroma?
- Seizures
- Focal neurological deficits
- Personality changes (location in frontal lobe)
Where in the cranium do oligodendromas typically occur?
Frontal lobe
Describe the histopathological appearance of oligodendromas.
Calcifications with ‘fried-egg’ appearance
What is the management of oligodendromas?
- Watchful waiting
- Benign and slow-growing therefore intervention is rarely needed
How do pituitary microadenomas present?
Asymptomatic
How do pituitary macroadenomas present?
- Hypopituitarism
- Headache
- Bitemporal hemianopia (upper quadrant > lower quadrant)
What is the management of pituitary adenomas?
Trans-sphenoidal surgical resection
Which brain tumour of childhood is the most malignant?
Medulloblastoma
Which part of the cranium do medulloblastomas typically occur?
Infratentorial compartment
What is the histopathological appearance of medulloblastomas?
- Small blue cells
- Rosette pattern of cells with many mitotic figures
What is the management of medulloblastomas?
Surgical resection + chemotherapy
What is the most common paediatric supratentorial tumour?
Craniopharyngioma
What are the presenting features of craniopharyngiomas?
- Hormonal disturbance
- Symptoms of hydrocephalus/raised ICP
- Bitemporal hemianopia
(lower quadrant > upper quadrant)
Describe the cellular origin of craniopharyngiomas.
Solid/cystic tumours of the sellar region that are derives from the remnants of Rathke’s pouch
What is the management of craniopharyngiomas?
Surgical resection ± post-operative radiotherapy
What brain tumour is commonly associated with von Hippel-Lindau syndrome?
Haemangioblastoma
