Tumours of the Nervous system

Question 1

What are some features of tumours in the CNS?

Answer 1

Neurological deficit
Motor weakness
Headache
Seizures

Question 2

What are the neurological signs associated with Frontal lobe tumours?

Answer 2

Personality changes, increased aggresion, irritation, apathy, unilateral weakness, loss of smell, difficulty walking, vision & speech problems

Question 3

What are the neurological signs associated with Temporal lobe tumours?

Answer 3

memory loss, language deficits, forgetting words, seizures

Question 4

What are the neurological signs associated with parietal lobe tumours?

Answer 4

intellect, thought reasoning, sensation, hearing, memory, Difficulty speaking / understanding Problems reading/writing Loss of feeling in part of the body

Question 5

What are the neurological signs associated with occipital lobe tumours?

Answer 5

Issues with sight

Question 6

Describe the type of headache that presents in tumours?

Answer 6

Worse in the morning; wakes them up with coughing / leaning forward.

May be associated with vomiting OR symptoms like tension HA / migraine!

Question 7

How is tumours diagnosed in the CNS?

Answer 7

CT/MRI scan

Question 8

What is the most common primary tumour in adults?

Answer 8

Glioblastoma multiforme

Question 9

Describe the appearance of Glioblastoma multiforme on imaging?

Answer 9

Solid tumours with central necrosis and a rim that enhances with contrast

Disruption of the blood-brain barrier and therefore are associated with vasogenic oedema (cerebral oedema).

Question 10

Describe the appearance of Glioblastoma multiforme on Histology?

Answer 10

Pleomorphic tumour cells border necrotic areas

Question 11

What is the treatment for Glioblastoma Multiforme?

Answer 11

Surgical with postoperative chemotherapy and/or radiotherapy.

Dexamethasone is used to treat the oedema.

Question 12

What type of tumour is Glioblastoma multiforme?

Answer 12

Astrocytoma

Question 13

What is the prognosis of Glioblastoma multiforme?

Answer 13

Very fast growing - poor prognosis of 1 year.

Question 14

What is the second most common primary brain tumour in adults?

Answer 14

Meningioma

Question 15

Describe the histology of Meningioma?

Answer 15

Spindle cells in concentric whorls and calcified psammoma bodies

Question 16

Where do meningiomas arise?

Answer 16

Dura mater of the meninges and cause symptoms by compression rather than invasion.

Question 17

Are meningiomas benign or malignant?

Answer 17

benign, extrinsic tumours of the central nervous system

Question 18

What is a vestibular schwannoma (acoustic neuroma)?

Answer 18

Benign tumour arising from the eighth cranial nerve (vestibulocochlear nerve).

Question 19

Bilateral vestibular schwannomas are asssociated with what condition?

Answer 19

Neurofibromatosis type 2

Question 20

What are the signs of vestibular schwannomas?

Answer 20

Hearing loss, facial nerve palsy (due to compression of the nearby facial nerve) and tinnitus

Question 21

What is the histology of vestibular schwannomas seen?

Answer 21

Antoni A or B patterns are seen. Vero cay bodies (acellular areas surrounded by nuclear palisades)

Question 22

What is the most common primary brain tumour in children?

Answer 22

Pilocytic astrocytoma

Question 23

What is the histology seen in Pilocytic astrocytoma?

Answer 23

Rosenthal fibres (corkscrew eosinophilic bundle)

Question 24

What is a medulloblastoma?

Answer 24

Aggressive paediatric brain tumour that arises within the infratentorial compartment. It spreads through the CSF system.

Question 25

What is the histology seen in medulloblastoma?

Answer 25

Small, blue cells. Rosette pattern of cells with many mitotic figures

Question 26

What is an Ependymoma?

Answer 26

Commonly seen in the 4th ventricle – ependymal cells are columnar epithelial cells of the CNS that line the ventricles.

Question 27

What is the histology seen in Ependymoma?

Answer 27

perivascular pseudo rosettes bodies.

Question 28

What is a major sign of ependymoma?

Answer 28

hydrocephalus

Question 29

What is a oligodendroma?

Answer 29

Benign, slow-growing tumour common in the frontal lobes, oligodendrocytes produce myelin in the CNS.

Question 30

What is the histology seen in Oligodendroma

Answer 30

Calcifications with 'fried-egg' appearance

Question 31

Are oligodendromas benign or malignant?

Answer 31

Benign

Question 32

What is a Hemangioblastoma?

Answer 32

Vascular tumour of the cerebellum – cerebellar signs

Question 33

What condition is associated with the development of Hemangioblastoma?

Answer 33

Von Hippel-Lindau syndrome

Question 34

What is the histology seen with Hemangioblastoma?

Answer 34

Foam cells and high vascularity

Question 35

What is a pituitary adenoma?

Answer 35

benign tumours of the pituitary gland - secretory (producing a hormone in excess) or non-secretory.

Question 36

What is Von Hippel-Lindau syndrome?

Answer 36

rare genetic disorder with multisystem involvement. Visceral cysts and benign tumours with potential for malignant transformation.

Question 37

What is a microadenoma?

Answer 37

Smaller than 1cm

Question 38

What is a macroadenoma?

Answer 38

Larger than 1cm

Question 39

What are the signs of a pituitary adenoma?

Answer 39

``` Hormone excess (e.g. Cushing’s due to ACTH, acromegaly due to GH) bitemporal hemianopia ```

Question 40

What visual defect is associated with a pituitary adenoma?

Answer 40

Bitemporal hemianopia

Question 41

What investigations are done for pituitary adenomas?

Answer 41

Pituitary blood profile and MRI.

Question 42

What treatments are done for pituitary adenomas?

Answer 42

Hormonal or surgical (e.g. transsphenoidal resection).

Question 43

What is the most common paediatric supratentorial tumour?

Answer 43

Craniopharyngioma

Question 44

What is a craniopharyngioma?

Answer 44

Solid/cystic tumour of the sella region that is derived from the remnants of Rathke’s pouch. It is common in children but can present in adults also.

Question 45

What are the features of craniopharyngioma?

Answer 45

Hormonal disturbance, symptoms of hydrocephalus or bitemporal hemianopia.

Question 46

What investigations are done for craniopharyngiomas?

Answer 46

pituitary blood profile and MRI

Question 47

What treatments are done for craniopharyngiomas?

Answer 47

Surgical with or without postoperative radiotherapy.