Brain cancer

Question 1

most adult tumours are ____tentorial whereas the majority of childhood tumours are ____tentorial

Answer 1

supra (adult)

infra (child)

Question 2

commonest form of brain tumour?

Answer 2

metastases

Question 3

T/F: brain metastases are often not treatable with surgical intervention

Answer 3

true - often multiple

Question 4

commonest primary tumour in adults?

prognosis?

Answer 4

glioblastoma multiforme

poor prongosis (~1yr)

Question 5

appearance of glioblastoma multiforme on imaging?

Answer 5

central necrosis

rim that enhances with contrast

Question 6

histology of glioblastoma multiforme?

Answer 6

pleomorphic tumour cells border necrotic areas

multiforme > pleomorhpic

Question 7

treatment of glioblastoma multiforme?

Answer 7

surgical with post-op chemo and/or radiotherapy. Dexamethasoen to treat the oedema

Question 8

2nd commonest primary brain tumour in adults

Answer 8

meningioma

Question 9

Meningiomas

1) typically BENIGN/ MALIGNANT
2) INTRINSIC/ EXTRINSIC tumours of the CNS
3) arise from the ___ mater
4) T/F: cause symptoms by invasion
5) typically located where?

Answer 9

1) benign
2) extrinsic
3) dura
4) false - by compression
5) falx cerebri, superior sagittal sinus, convexity (surface), skull base

Question 10

histology of meningioma?

Answer 10

Spindle cells in concentric whorls and calcified psammoma bodies (psaMMoMa > MeningioMa)

Question 11

Vestibular schwannoma (prev acoustic neuroma)

1) benign tumour arising from which CN?
2) often located where
3) presentation?

Answer 11

1) VIII
2) cerebellopontine angle
3) hearing loss, tinnitus, facial nerve palsy

Question 12

what condition is associated with B/L vestibular shwannomas

Answer 12

NFT2

B/L > 2

Question 13

histology of vestibular schwannomas?

Answer 13

Antoni A or B patterns 
Verocay bodies (acellular areas surrounded by nuclear palisades)

V erocay > V estibular

Question 14

most common primary brain tumour in children?

Answer 14

pilocytic astrocytoma

Question 15

histology of pilocytic astrocytoma?

Answer 15

Rosenthal fibres (corkscrew eosinophilic bundle)

Question 16

an aggressive paediatric brain tumour that arises within the infratentorial compartment and spreads through the CSF system

Answer 16

Medulloblastoma

Question 17

treatment of medulloblastoma?

Answer 17

Surgical resection + chemo

Question 18

histology of medulloblastoma?

Answer 18

small, blue cells. Rosette pattern with many mitotic figures.

Question 19

Ependymoma

1) commonly located where
2) may cause what complication
3) histology

Answer 19

1) commonly in 4th ventricle
2) hydrocephalus
3) perivascular pseudorosettes

Question 20

Oligodendroma

1) benign, slow growing tumour in the ____ lobes
2) histology?

Answer 20

1) frontal
2) calcifications with ‘fried egg’ appearance

(imagine the O’s as fried eggs)

Question 21

Haemangioblastoma

1) vascular tumour of the ____
2) associated with what syndrome?
3) histology?

Answer 21

1) cerebellum
2) von Hippel-Lindau
3) foam cells and high vascularity

Question 22

T/F: Pituitary adenomas are benign tumours of the pituitary gland

Answer 22

true

Question 23

micro- vs macro- pituitary adenoma?

Answer 23

micro < 1cm

marco >1cm

Question 24

visual defect in pituitary adenoma and why?

Answer 24

bitemporal hemianopia

due to the crossing nasal fibres

Question 25

Most common paediatric supratentorial tumour?

Answer 25

Craniopharyngioma

Question 26

Craniopharyngioma 1) tumour of the sellar region that's derived from where? 2) presentation? 3) treatment?

Answer 26

1) Rathke’s pouch 2) hormonal disturbance, hydrocephalus, bitemporal hemianopia 3) surgical removal +/- post-op radiotherapy

Question 27

headache red flag features?

Answer 27

constant pain worse at night worse on walking, coughing, staining, bending forward vomiting

Question 28

how to recognise papilloedema on fundoscopy?

Answer 28

Blurring of the optic disc margin Elevated optic disc (look for the way the retinal vessels flow across the disc to see the elevation) Loss of venous pulsation Engorged retinal veins Haemorrhages around optic disc Paton’s lines (retinal creases around the optic disc)

Question 29

most common cancers that metastasise to the brain?

Answer 29

``` lung (most common) breast bowel melanoma RCC ```

Question 30

3 types of glioma?

Answer 30

Astrocytoma (GM most common) Oligodendroglioma Ependymoma

Question 31

causes distruption of the BBB and therefore are associated with vasogenic oedema

Answer 31

glioblastoma multiforme