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NEURO > Pathology of brain tumours > Flashcards

Pathology of brain tumours Flashcards

1
Q

what is needed for ICP to be stable

A

correct amount of brain tissue, blood, CSF

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2
Q

what keep the brain in place within the skull

A

thick tough fibrous sheets

  • Falx cerebri
  • Tentorium cerebelli
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3
Q

where does the spinal cord leave the skull

A

foramen magnum

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4
Q

how can the brain move in relation to the falx and skull

A

cannot go through falx but can go around the edge

cannot go through the skull but can move down through the foramen magnum

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5
Q

what can cause raised ICP

A

localised lesions

  • haemorrhage (haematoma)
  • tumour
  • abscess

generalised pathology
- oedema post trauma

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6
Q

what are localised lesions in the head known as

A

SOL - space occupying lesions

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7
Q

how do SOL raise ICP

A

amount of tissue increases

causes internal shift (herniation) between intracranial spaces

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8
Q

what are the 6 types of brain herniation

A
  1. cingualate - cingulate gyrus pushed under falx, RL, LR
  2. central - cerebrum pushed down
  3. uncal - cerebrum moves inferiorly over edge of tentorium
  4. cerebellotonsillar - tonsils move inwards and downwards and crush brainstem, down through foramen magnum
  5. upward - cerebellum moves up
  6. transcalvarial - out through skull fracture
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9
Q

what herniation is the cause of brainstem death

A

cerebellotonsillar

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10
Q

what herniation can narrow and crush the cerebral aqueduct

A

uncal

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11
Q

what can swelling and shift lead to

A

local ischaemia

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12
Q

what are the symptoms of squeeze on the cortex and brainstem

A

morning headache and sickness

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13
Q

what are the symptoms of squeeze on the optic nerve

A

papilloedema - seen on fundoscopy

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14
Q

what pressure causes pupillary dilation

A

squeeze and stretch on cranial nerve 3

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15
Q

what pressure causes a fall in the GCS

A

squeeze on cortex and brainstem

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16
Q

what pressure causes brainstem death

A

squeezing downwards of cerebellum into foramen magnum crushing of the brainstem

17
Q

what are the different groupings of intracranial tumours

A

CNS

  • primary
  • secondary (metastatic)

other intracranial
- cells originating outside the brain and spinal cord

18
Q

where do secondary metastatic brain tumours usually come from

A

breast, lung, kidney, colon, melanoma

19
Q

what are intracranial tumours that occur from brain cells (CNS tumours)

A

Glial cells – gliomas
MALIGNANT

Embryonic neural cells – medulloblastoma
CHILDHOOD MALIGNANT

20
Q

what are intracranial tumours that occur from cells surrounding or originating outside the brain

A

Arachnoidal cell – meningioma

Nerve sheath cell – Schwannoma, neurofibroma

Pituitary gland - adenoma

Lymphoid cell – lymphoma

Capillary vessels - haemangioblastoma

21
Q

where do CNS tumours most commonly occur in adults and children respectively

A

adults - above the tentorium

children - below the tentorium

22
Q

what are the characteristics of gliomas

A

resemble cells of glial differentiation

diffuse edges but NOT encapsulated

malignant but do NOT metastasise outside the CNS

23
Q

what are the three types of gliomas

A

Astrocytoma
- resemble astrocytes

Oligodendroglioma
- resemble oligodendrocytes

Ependymoma
- resemble ependymal cells

24
Q

what are the two main forms of astrocytoma

A

low grade astrocytoma

glioblastoma - most malignant

25
Q

how is low grade astrocytoma defined on microscopy

A

bland cells - similar to normal star shaped astrocytes

small cell, small nucleus

grow very slowly

26
Q

how is glioblastoma defined on microscopy

A

cellular, atypical tumour with necrosis

large cell with multiple irregular nuclei

grow quickly - often present with large tumours

27
Q

how is medulloblastoma defined on microscopy

A

from embryonic neural cells - sheets of small undifferentiated cells

28
Q

where are medulloblastoma usually found

A

posterior fossa, especially the brainstem

children

29
Q

what are meningiomas

A

from arachnocytes - the cells that make the coverings of the brain

benign and do NOT metastasise

BUT can be locally aggressive and invade the skull

30
Q

how are meningioma defined on microscopy

A

bland cells forming small groups, sometimes with calcification

slow growing

often resectable

31
Q

what is schwannoma

A

a type of nerve sheath tumour

normal schwann cells wrap around peripheral nerves and form electrical insulation

32
Q

what is an example of a schwannoma

A

8th vestibulocochlear nerve schwannoma
= acoustic neruoma

causes unilateral deafness

benign lesion but technically difficult to remove

found at the angle of the pons and cerebellum

33
Q

what is a pituitary adenoma

A

benign tumour in the pituitary fossa

often secretes a pituitary hormone

can impinge on the optic chiasma = visual signs

34
Q

what is CNS lymphoma

A

a high grade neoplasm

often diffuse large B-cell lymphoma

don’t spread outside CNS

35
Q

why is CNS lymphoma difficult to biopsy and treat

A

biopsy - often deep and central in the brain

treatment - drugs do not cross the blood brain barrier

36
Q

what is a haemangioblastoma

A

tumour of blood vessels

space occupying

may bleed

most often in the cerebellum

37
Q

what are some characteristics of secondary metastatic tumours

A

mostly carcinoma

common

histology = that of the primary tumour

NEURO (51 decks)

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