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nervous system > Pathology of Brain Tumour > Flashcards

Pathology of Brain Tumour Flashcards

1
Q

Causes of raised ICP?

A

Localised (Space Occupying) Lesions

  • Haemorrhage or haematoma
  • Tumour
  • Abscess

Also Oedema post trauma

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2
Q

Types of herniation due to raised ICP?

A

Internal Shift or Herniation:

  • Right-left e.g. subfalcine herniation (cingulate gyrus herniates under falx)
  • Uncal Herniation (cerebrum moves down over tentorium)
  • Coning (Cerebellum, mainly tonsils, moves into foramen magnum)
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3
Q

What happens to tissue around a tumour?

A

Ischaemia due to the squashing effect of the tumour

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4
Q

Early signs of a raising ICP?

A

Morning Headaches and vomiting from cortex/brainstem compression

Papilloedema & Visual Disturbance from pressure on optic nerve

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5
Q

What other signs appear as ICP increases?

A
  • Pupillary Dilation from stretch on III
  • 6th nerve palsy
  • Focal Neurological Deficits
  • Falling GCS from pressure on Cortex/brainstem
  • Brain Stem Death from coning
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6
Q

Intracranial tumours can be divided into 3 major categories?

A
  • Primary CNS tumours
  • Secondary (Metastatic) CNS tumours
  • Cells from outside CNS e.g. Meningioma
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7
Q

What are the classes of Primary tumours?

A

These Ones are CNS tumours and are malignant:

  • Gliomas (many types based on specific glial cell)
  • Medulloblastoma (Embryonic Neural Cells)

These are the ones originating outside the brain:

  • Meningioma (Arachnoid)
  • Schwannoma/Neurofibroma (nerve sheath(
  • Adenoma (Pituitary)
  • Lymphoma
  • Haemanioblastoma (Capillaries)
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8
Q

What cancers commonly metastasise to the brain?

A
  • Breast
  • Lung
  • Kidney
  • Colon
  • Melanoma
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9
Q

where anatomically in the brain would you find tumours?

A

Adults - Above Tentorium

Children - Mainly below Tentorium

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10
Q

Describe Gliomas?

A

Originate from Glial Cells e.g. Astrocytoma or Glioblastoma

They have no capsule so diffuse edges
They are malignant but do not metastasise outside the CNS

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11
Q

What cell do glioblastomas and astrocytomas originate from?

A

Both from Astrocytes

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12
Q

Whats the difference between a glioblastoma and an astrocytoma?

A

Both originate from astrocytes & are malignant

Astrocytomas:

  • Bland mostly normal cells
  • Low Grade tumour
  • Grows very slowly

Glioblastoma:

  • Cellularly Atypical (multiple or irregular nuclei)
  • Grows very quickly
  • Shows necrosis microscopically
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13
Q

What does a medulloblastoma originate from?

A

Primitive Neuroectoderm (primitive Neural cells)

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14
Q

Describe a medulloblastoma?

A
  • Forms sheets of small undifferentiated cells

- Malignant

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15
Q

Where and in who do medulloblastomas appear?

A
  • Mostly in children

- In Posterior Fossa especially around the brainstem

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16
Q

Describe the growth of a meningioma?

A

Originates in arachnocytes

They’re benign so no metastases but may invade skull or crush brain

Grows slowly making it often resectable

17
Q

how does a meningioma appear microscopically?

A

Bland cells in small groups +/- calcification

They tend to resemble a normal arachnoid granulation

18
Q

What do we call the calcifications of a meningioma?

A

Psammoma body formation

19
Q

Give one major example of a schwannoma?

A

VIII nerve Schwannoma (Acoustic Neuroma)

Generally at angle of Pons & Cerebellum

20
Q

What are the consequences of an Acoustic

Neuroma?

A
  • Unilateral Deafness
  • Benign lesion very difficult to remove

Can also put pressure on facial nerve

21
Q

What does a pituitary adenoma do?

A
  • Impinge on optic chiasm

- Pituitary hormone secretion

22
Q

What makes up a CNS lymphoma?

A

Diffuse Large B-cell lymphoma

23
Q

Consequences of haemangioblastoma?

A

Space occupying and may bleed

24
Q

What makes up most secondary tumours in the brain?

A

Carcinomas

25
Q

Clinical Presentation of Intracranial Tumours?

A
  • Symptoms/signs of raised ICP
  • Focal Neurological Deficits
  • Seizures (in lesions of cerebral cortex, think tumour in an adult onset seizure)
  • CSF obstruction (Hydrocephalus)
26
Q

How would we investigate a suspected Intracranial Tumour?

A
  • History/exam
  • CT/MRI
  • PET scan
  • Biopsy
  • Check for sources of secondary tumour e.g. CXR/AXR/PXR
27
Q

What are the goals of Intracranial tumour management?

A
  • Diagnosis of benign vs malignant
  • Improve quality of life (reducing symptoms and neurological deficits)
  • Prolonging life expectancy
28
Q

What treatments are available for Intracranial Tumours?

A
  • Chemo/radiotherapy
  • Corticosteroids (reduces ICP from oedema)
  • Anti-epileptics to prevent seizures
  • Analgesia
  • Anti-emetics

Surgery

  • Either as complete resection
  • Or debulking to reduce symptoms/ICP
29
Q

Whats the prognosis for meningioma?

A

Usually surgically resectable

May need anticonvulsants

30
Q

Prognosis for Gliomas?

A

Astrocytomas have a long life expectancy

Glioblastoma Multiformes have a 1yr survival avg.

nervous system (51 decks)

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