Tumours of the Nervous system Flashcards
What are some features of tumours in the CNS?
Neurological deficit
Motor weakness
Headache
Seizures
What are the neurological signs associated with Frontal lobe tumours?
Personality changes, increased aggresion, irritation, apathy, unilateral weakness, loss of smell, difficulty walking, vision & speech problems
What are the neurological signs associated with Temporal lobe tumours?
memory loss, language deficits, forgetting words, seizures
What are the neurological signs associated with parietal lobe tumours?
intellect, thought reasoning, sensation, hearing, memory, Difficulty speaking / understanding Problems reading/writing Loss of feeling in part of the body
What are the neurological signs associated with occipital lobe tumours?
Issues with sight
Describe the type of headache that presents in tumours?
Worse in the morning; wakes them up with coughing / leaning forward.
May be associated with vomiting OR symptoms like tension HA / migraine!
How is tumours diagnosed in the CNS?
CT/MRI scan
What is the most common primary tumour in adults?
Glioblastoma multiforme
Describe the appearance of Glioblastoma multiforme on imaging?
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).
Describe the appearance of Glioblastoma multiforme on Histology?
Pleomorphic tumour cells border necrotic areas
What is the treatment for Glioblastoma Multiforme?
Surgical with postoperative chemotherapy and/or radiotherapy.
Dexamethasone is used to treat the oedema.
What type of tumour is Glioblastoma multiforme?
Astrocytoma
What is the prognosis of Glioblastoma multiforme?
Very fast growing - poor prognosis of 1 year.
What is the second most common primary brain tumour in adults?
Meningioma
Describe the histology of Meningioma?
Spindle cells in concentric whorls and calcified psammoma bodies
Where do meningiomas arise?
Dura mater of the meninges and cause symptoms by compression rather than invasion.
Are meningiomas benign or malignant?
benign, extrinsic tumours of the central nervous system
What is a vestibular schwannoma (acoustic neuroma)?
Benign tumour arising from the eighth cranial nerve (vestibulocochlear nerve).
Bilateral vestibular schwannomas are asssociated with what condition?
Neurofibromatosis type 2
What are the signs of vestibular schwannomas?
Hearing loss, facial nerve palsy (due to compression of the nearby facial nerve) and tinnitus
What is the histology of vestibular schwannomas seen?
Antoni A or B patterns are seen. Vero cay bodies (acellular areas surrounded by nuclear palisades)
What is the most common primary brain tumour in children?
Pilocytic astrocytoma
What is the histology seen in Pilocytic astrocytoma?
Rosenthal fibres (corkscrew eosinophilic bundle)
What is a medulloblastoma?
Aggressive paediatric brain tumour that arises within the infratentorial compartment. It spreads through the CSF system.
What is the histology seen in medulloblastoma?
Small, blue cells. Rosette pattern of cells with many mitotic figures
What is an Ependymoma?
Commonly seen in the 4th ventricle – ependymal cells are columnar epithelial cells of the CNS that line the ventricles.
What is the histology seen in Ependymoma?
perivascular pseudo rosettes bodies.
What is a major sign of ependymoma?
hydrocephalus
What is a oligodendroma?
Benign, slow-growing tumour common in the frontal lobes, oligodendrocytes produce myelin in the CNS.
What is the histology seen in Oligodendroma
Calcifications with ‘fried-egg’ appearance
Are oligodendromas benign or malignant?
Benign
What is a Hemangioblastoma?
Vascular tumour of the cerebellum – cerebellar signs
What condition is associated with the development of Hemangioblastoma?
Von Hippel-Lindau syndrome
What is the histology seen with Hemangioblastoma?
Foam cells and high vascularity
What is a pituitary adenoma?
benign tumours of the pituitary gland - secretory (producing a hormone in excess) or non-secretory.
What is Von Hippel-Lindau syndrome?
rare genetic disorder with multisystem involvement. Visceral cysts and benign tumours with potential for malignant transformation.
What is a microadenoma?
Smaller than 1cm
What is a macroadenoma?
Larger than 1cm
What are the signs of a pituitary adenoma?
Hormone excess (e.g. Cushing’s due to ACTH, acromegaly due to GH) bitemporal hemianopia
What visual defect is associated with a pituitary adenoma?
Bitemporal hemianopia
What investigations are done for pituitary adenomas?
Pituitary blood profile and MRI.
What treatments are done for pituitary adenomas?
Hormonal or surgical (e.g. transsphenoidal resection).
What is the most common paediatric supratentorial tumour?
Craniopharyngioma
What is a craniopharyngioma?
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.
What are the features of craniopharyngioma?
Hormonal disturbance, symptoms of hydrocephalus or bitemporal hemianopia.
What investigations are done for craniopharyngiomas?
pituitary blood profile and MRI
What treatments are done for craniopharyngiomas?
Surgical with or without postoperative radiotherapy.
