The pathology of intracranial tumours

Question 1

3 space occupying lesions causing raised ICP

Answer 1

haemorrhage - haematoma
tumour
abscess

Question 2

Generalised pathology causing raised ICP

Answer 2

oedema post trauma

Question 3

What happens following a SOL?

Answer 3

amount of tissue increases
raised ICP
cause internal shift/herniation between intracranial spaces

Question 4

3 types of internal shift due to SOL

Answer 4

Right-left or left-right
uncal herniation
coning

Question 5

What is uncal herniation?

Answer 5

cerebrum moves inferiorly over edge of tentorium

Question 6

What is coning?

Answer 6

cerebellum moves inferiorly into foramen magnum

Question 7

What is a subfalcine herniation?

Answer 7

cingulate gyrus pushed side and herniated under falx

Question 8

What happens to brain, falx, midline and lateral ventricle in subfalcine herniation?

Answer 8

pushed away from tumour
lateral ventricle crushed flat and displaced downwards
midline shift

Question 9

What happens to aqueduct in uncal herniation?

Answer 9

crushed and narrow

Question 10

What is cerebellar tonsillar herniation the cause of?

Answer 10

brain stem death

Question 11

What happens in cerebellar tonsillar herniation?

Answer 11

tonsils move inwards and downwards and crush brainstem

Question 12

When tumours squeeze nearby tissue what occurs?

Answer 12

ischaemia

Question 13

Symptoms of squeezing on cortex and brainstem

Answer 13

morning headaches

sickness

Question 14

Sign of squeezing on optic nerve

Answer 14

papilloedema - fundoscopy

Question 15

As ICP increases what happens and why?

Answer 15

pupillary dilation - CN 3
falling GCS - cortex and brainstem
brainstem death - crush brainstem

Question 16

Example of intracranial tumour arising outwith brain and spinal cord

Answer 16

meningioma

Question 17

Common cancers to metastasise to brain

Answer 17

breast, colon, kidney, lung, melanoma

Question 18

Difference in usual site of CNS tumours in adults and children

Answer 18

tentorium - adults above and children below

Question 19

What do gliomas resemble?

Answer 19

cells of glial differentiation

Question 20

2 features of gliomas

Answer 20

not encapsulated

do not spread outwith CNS

Question 21

Appearance of low grade astrocytoma

Answer 21

bland cells and grow very slowly

Question 22

Glioblastoma appearance

Answer 22

cellular, atypical, tumour, necrosis

grow quick and large tumours

Question 23

What is medulloblastoma a tumour of?

Answer 23

primitive neuroectoderm

Question 24

Where is medulloblastoma usually located?

Answer 24

posterior fossa - brainstem

Question 25

What type of people do medulloblastoma usually occur in?

Answer 25

children

Question 26

What are menigiomas derived from?

Answer 26

arachnocytes

Question 27

Describe a meningioma

Answer 27

slow growing and resectable
attached to meninges and depress cerebrum
do not metastasise but can be locally invasive and can invade skull

Question 28

Microscopy of meningioma features

Answer 28

bland cells forming small groups

calcification

Question 29

What is an acoustic neuroma?

Answer 29

8th cranial nerve schwannoma

Question 30

Where is an acoustic neuroma found within the brain?

Answer 30

angle between pons and cerebellum

Question 31

Symptom of acoustic neuroma

Answer 31

unilateral deafness

Question 32

Is an acoustic neuroma malignant or benign?

Answer 32

benign

Question 33

What is a pituitary adenoma?

Answer 33

benign tumour of pituitary in pituitary fossa

Question 34

What signs can occur from a pituitary adenoma?

Answer 34

visual - press on optic chiasm

Question 35

Why are CNS lymphoma hard to biopsy and treat?

Answer 35

deep in brain

blood-brain barrier

Question 36

Haemangioblastoma

Answer 36

tumour of blood vessels

Question 37

Haemangioblastoma - site

Answer 37

cerebellum

Question 38

Histology of secondary tumours

Answer 38

same as that of primary