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Path 2022 > Histopath - Neuro > Flashcards

Histopath - Neuro Flashcards

1
Q

Only known environmental risk factor for CNS cancer

A

Previous radiotherapy to head and neck

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2
Q

Supratentorial tumour clinical features

A

Seizures
personality change
focal neuro deficit

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3
Q

Subtentorial tumour clinical features

A

Cerebellar signs
Long tract signs - hyperreflexia?
CN palsies

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4
Q

Craniotomy - indication, purpose

A

Debulking
Subtotal & complete resections
Remove as much tumour as (safely) possible

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5
Q

Open biopsy - indications, purpose

A

Inoperable but approachable tumours (~1cm)

Take sample - usually representative

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6
Q

Stereotactic biopsy - indications, purpose

A

If open biopsy not indicated, ~0.5cm tissue

Tissue may be insufficient

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7
Q

What components are assessed to give tumour grade

A

Proliferative activity
Cell differentiation
Necrosis
Genetic profile

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8
Q

Grading of CNS tumour

A

Grade 1 = benign
Grade 2 = >5 years
Grade 3 = <5 years
Grade 4 = <1 year

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9
Q

Diffuse gliomas - management

A

complete resection impossible due to direction of growth into CNS parenchyma

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10
Q

Genetics of diffuse gliomas

A 
Often have IDH1/2 mutations
H3 mutations (1%)
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11
Q

Genetics of circumscribed gliomas

A

> 90% have MAPK pathway mutations

  • BRAF
  • NF1
  • FGFR1
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12
Q

Most common tumour of children

A

Pilocytic astrocytoma (WHO grade 1)

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13
Q

Imaging: ‘well circumscribed cystic enhancing lesion’

What is it?

A

Pilocytic astrocytoma

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14
Q

Histology of pilocytic astrocyoma

A

Piloid ‘hairy’ cell
Rosenthal fibres
Low mitotic activity

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15
Q

Histology of astrocytoma

A

Low-moderate cellularity
Low mitotic activity
No vascular proliferation, necrosis

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16
Q

Most common glial cell tumour (glioma)

A

Glioblastoma

also most aggressive

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17
Q

Histology of glioblastoma

A

High cellularity
High mitotic activity
Micro vascular proliferation (neoangiogenesis)
Necrosis

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18
Q

MRI reports ‘extra-axial, isodense, contrast-enhancing’

What is it?

A

Meningioma

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19
Q

Histology of meningioma

A

Psammoma bodies

Calcifications

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20
Q

Most frequent CNS tumour in adults?

A

Metastases

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21
Q

Most frequent primaries that metastasise to CNS

A

Breast
Lung
Melanoma
Renal

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22
Q

Histology of Medulloblastoma

A

Homer-Wright rosettes

4 subtypes:

  • classic
  • nodular / desmoplastic
  • extensive nodularity
  • large cell anaplastic
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23
Q

Grade of medulloblastoma

A

All WHO grade 4

24
Q

Usual site of diffuse glioma

A

Supratentorial

25
Q

Usual site of circumscribed glioma

A

Posterior fossa

26
Q

Usual site of pilocytic astrocytoma (type of circumscribed glioma)

A

Cerebellar
Optic-hypothalamic
Brain stem

27
Q

Usual site of astrocytoma (diffuse glioma)

A

Cerebral hemispheres

28
Q

Subfalcine herniation

A

Singular cortex pushed under falx
Rare
Not acute

29
Q

Transtentorial (uncal) herniation

A

Raised ICP supratentorially

Medial temporal lobe pushed into posterior cranial fossa

30
Q

Tonsillar herniation

A

Global raised ICP
Cerebellum pushed through base of skull

Can cause cardio respiratory depression (via compression of brain stem)

31
Q

TIA future risk

A

1/3 of those with TIA get significant infarct within 5 years

32
Q

Non-traumatic intra-parenchymal haemorrhage - cause & location of bleed

A

HTN in majority of bleeds

Small intraparenchymal vessel rupture
Sub cortical region most common - esp basal ganglia

33
Q

Subarachnoid haemorrhage - cause & location of bleed

A

Rupture of Berry aneurysm

80% internal carotid artery bifurcation
20% within vertebro-basilar circulation

34
Q

Most common cause of stroke

A

Infarction - tissue death due to ischaemia (70-80%)

35
Q

Common sites of cerebral atherosclerosis

A

Carotid bifurcation

Basilar artery

36
Q

Most common site of embolic occlusion (causing stroke)

A

Middle of cerebral artery branches

37
Q

Origin of emboli causing stroke?

A

Heart

Other atherosclerotic plaques

38
Q

Signs of basal skull fracture

A

Otorrhoea, rhinorrhoea
Battle sign (mastoid bruising)
Periorbital bruising + swelling (Raccoon eyes)

39
Q

Contusion definition

A

Brain in collision with skull causing surface bruising

If Pia mater is torn –> ‘laceration’

40
Q

Areas of brains susceptible to contusion

A

Lateral surfaces of hemisphere

Inferior surfaces of frontal & temporal lobes

41
Q

Commonest cause of coma (when no bleed present)

A

Diffuse axonal injury

42
Q

Chronic Traumatic encephalopathy

A

Psych presentations in retired American footballers (emerging in rugby + football)

Tau pathology

43
Q

Histology of Prion disease

A

Prion protein deposits
Spongiform change
Pathological protein plaques in cerebellum

44
Q

Clinical features new Variant CJD

A

Patients <45 yrs old

Cerebellar ataxia
Dementia

Longer duration than CJD

45
Q

Histology of Alzheimer’s

A

Extracellular amyloid plaques
Neurofibrillary Tau tangles

+ same protein from plaques builds in vessels ‘cerebral amyloid angiopathy’

46
Q

Macroscopic changes in Alzheimer’s

A

Cerebral atrophy

Large ventricles
Severe shrinkage of hippocampus
Widening of sulci, thinning of gyri

47
Q

Braak staging of Alzheimer’s

A

I-III = medial temporal lobes

IV = wider spread throughout temporal lobes

V = peristriate cortex

VI = primary visual cortex

48
Q

What Braak stage are Alzheimer’s patients with Sx

A

stage III-IV

49
Q

Macroscopic Changes in Parkinson’s disease

A

Loss of dopaminergic neurons in substantia nigra –> loss of neuromelanin pigment

50
Q

Microscopic features of Parkinson’s disease

A 
Lewy bodies
Axonal processes (Lewy neurites)
51
Q

Diagnostic gold standard for Parkinson’s disease

A

Immunostaining for alpha synuclein

52
Q

Braak staging of Parkinson’s disease

A 
1 = dorsal motor nucleus of vagus (in dorsal medulla)
2 = pons
3 = substantia nigra
4 = cholinergic neurons
5 = frontal?
53
Q

What Braak stage are symptomatic Parkinson’s disease patient

A

Stage 3

54
Q

Other causes of Parkinsonism (besides Parkinson’s disease)

A

Multiple system atrophy - alpha synuclein deposited in glial cells (mainly oligodendrocytes)

Progressive supra nuclear palsy

Corticobasal degeneration

EPSE from psychiatric medication

55
Q

Macroscopic appearance of Pick’s disease

A

Fronto-temporal atrophy

56
Q

Microscopic appearance of Pick’s disease

A

Tau positive pick bodies
Marked gliosis
Neuronal loss
Balloon neurons

Path 2022 (12 decks)

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