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Nervous System > The Pathology of intracranial tumours > Flashcards

The Pathology of intracranial tumours Flashcards

1
Q

what is meant by intracranial pressure?

A

Cranium is a hard, rigid, closed box

For pressure to be stable must be (within certain limits) correct amount of brain tissue/blood/CSF

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2
Q

what must be considered anatomically in relation to intr cranial pressure?

A

There are thick tough fibrous sheets inside that keep the brain in place
Falx cerebri
Tentorium cerebelli

Opening to spinal cord
Foramen magnum

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3
Q

can brain go through the falx cerebri?

A

Brain cannot go through falx, but can go round edge

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4
Q

can 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 are localised lesion causes of raised intra-cranial pressure?

A

Haemorrhage (if localised called a haematoma)
Tumour
Abscess

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6
Q

what are generalised pathologies causing raised intra-cranial pressure?

A

Oedema post trauma

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7
Q

what are space occupying lesions in the head?

A

Tumours
Bleeding (haematoma)
Abscess

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8
Q

what effect do space occupying lesions have in the cranium?

A

Amount of tissue increases
Raises intra cranial pressure
Cause internal shift (herniation) between the intracranial spaces

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9
Q

how can the brain internally shift?

A

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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10
Q

what is tentorial herniation?

A

Uncal herniation of temporal lobe over the tentorium

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11
Q

what is coning?

A

Cerebellotonsillar (‘tonsillar’) herniation of brain stem through foramen magnum

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12
Q

Subfalcine (= under falx) herniation =

A

midline shift

Falx (falcine membrane) pushed over to side

Cingulate gyrus is pushed over to side and herniates underneath falx = subfalcine herniation

Lateral ventricle is crushed flat and displaced downwards

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13
Q

what effect does swelling and shift have?

A

localised ischaemia
Tumours squeeze nearby tissue and cause local ischaemia

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14
Q

what symptoms and signs does squeeze on cortex and brainstem have?

A

morning headaches and sickness

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15
Q

what symptoms and signs does squeeze on optic nerve have?

A

papilloedema (seen on fundoscopy of eye)

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16
Q

as intra cranial pressure increases what signs can be seen?

A

Pupillary dilation
Falling Glasgow coma scale
Brain stem death

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17
Q

what is pupillary dilation caused by?

A

Squeeze and stretch on cranial nerve 3

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18
Q

what is a falling glasgow coma scale caused by?

A

Squeeze on cortex and brainstem

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19
Q

what is brain stem death caused by?

A

squeezing downwards of cerebellum into foramen magnum with crushing of brainstem (patient is dead)

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20
Q

what types of intracranial tumours are within the CNS?

A

Primary tumours
Secondary (metastatic tumours)

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21
Q

what intracranial tumours are not found within the CNS?

A

Cells originating outside brain and spinal cord (eg meningioma)

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22
Q

what are different types of primary intracranial tumours (benign and malignant)?

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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23
Q

glial cells

A

gliomas (glioblastoma, astrocytoma, oligodendroglioma, ependymoma)

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24
Q

embryonic neural cells

A

medulloblastoma

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25
Q

arachnoudal cells

A

meningioma

26
Q

Nerve sheath cell

A

Schwannoma, neurofibroma

27
Q

Pituitary gland

A

adenoma

28
Q

lymphoid cell

A

lymphoma

29
Q

Capillary vessels

A

haemangioblastoma

30
Q

what type of malignancy is common in adults but rare in children?

A

Metastatic malignancy

Breast, lung, kidney, colon, melanoma

31
Q

which primary tumours are originated from brain cells?

A

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

Embryonic neural cells – medulloblastoma

32
Q

which primary tumours are originated from cells surrounding / outside the brain?

A

Arachnoidal cell – meningioma
Nerve sheath cell – Schwannoma, neurofibroma
Pituitary gland - adenoma
Lymphoid cell – lymphoma
Capillary vessels - haemangioblastoma

33
Q

which primary tumours are classed as malignant tumours?

A

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

34
Q

which primary tumour is a type of childhood malignant tumour?

A

Embryonic neural cells – medulloblastoma

35
Q

what is the location of CNS tumours in adults commonly?

A

Majority above tentorium

36
Q

what is the location of CNS tumours in children commonly?

A

Majority below tentorium

37
Q

how would you describe the diffuse edges of gliomas?

A

not encapsulated

38
Q

how is the malignancy of gliomas described metastasise wise?

A

Malignant but do not metastasise outside the CNS

39
Q

glial cells differentiate into…

A

astrocytoma

40
Q

oligodendrocytes differentiate into…

A

oligodendroglioma

41
Q

ependymal cells differentiate into…

A

ependymoma

42
Q

what are the different tyoes of gliomas?

A

Astrocytoma (main type)

43
Q

how is the shape of an astrocyte described?

A

‘Star’ shaped cell

Long processes support other cells
structurally and biochemically

44
Q

what are the different types of extremes of astrocytoma?

A

Low grade astrocytoma

Glioblastoma

[3. Many others……..]

45
Q

how are cells on microscopy described in low grade astrocytoma?

A

Bland cells on microscopy (similar to normal astrocytes)
Grow very slowly

small cells with single nucleus

46
Q

how are cells on microscopy described in high grade astrocytoma

A

glioblastoma

large tumour with necrosis

47
Q

what is a gliobastoma?

A

Cellular, atypical tumour, with necrosis under microscope

Grow quickly – often present as large tumours

Large cell with multiple nuclei / single nucleus

48
Q

what is medulloblastoma?

A

Tumour of primitive neuroectoderm (primitive neural cells)

Sheets of small undifferentiated cells
Children especially
Posterior fossa, especially brainstem

49
Q

what is meningioma?

A

From “arachnocytes” – cells that make up the coverings of the brain

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

slow growing / often resectable

50
Q

what is the location of meningioma most commonly?

A

Meningioma is usually attached to the meninges and pushes into the brain but does not usually invade it

51
Q

what does microscopy of a meningioma show?

A

Microscopy – bland cells forming small groups, sometimes with calcification

Small groups of cells whorl around each other, resembling an arachnoid granulation

The calcification is sometimes called a psammomabody (from ‘grain of sand’)

52
Q

what are nerve sheath tumours?

A

Around peripheral nerves – intracranial and extracranial

53
Q

what is an example of a nerve sheath tumour?

A

Schwannoma

54
Q

how do normal schwann cells present?

A

Normal schwann cells wrap around peripheral nerves and form electrical insulation

55
Q

what is 8th vestibulocochlear nerve schwannoma known as?

A

‘Acoustic neuroma’ at angle between pons and cerebellum

56
Q

what are symptoms of acoustic neuroma?

A

Unilateral deafness

Benign lesion but removal technically difficult

57
Q

how is a pituitary adenoma described?

A

Benign tumour of pituitary in pituitary fossa
Often secrete a pituitary hormone
Grow superiorly and impinge on optic chiasma – visual signs

58
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
Generally do not spread outside of CNS

59
Q

what is a haemangioblastoma?

A

Tumour of blood vessels
Space occupying
May bleed
Most often in cerebellum

60
Q

how are secondary tumours described?

A

Mostly carcinomas
Common
Histology = that of the primary tumour

Nervous System (40 decks)

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