Intracranial Neoplasms

Question 1

what is an extra-axial tumour

Answer 1

lesions that are external to the brain parenchyma

Question 2

what is the most common type of extra-axial tumour

Answer 2

meningioma

Question 3

what are features of meningioma tumours

Answer 3

usually benign tumors that arise from residual mesenchymal cells in the meninges

Question 4

what are other extra-axial tumours

Answer 4

pituitary adenoma
craniopharyngioma
choroid plexis papilloma
acoustic neuroma (vestibular schwannoma)

Question 5

what is a key fact about epidemiology of primary brain tumours

Answer 5

2nd most common seen in children

Question 6

what are common Sx of a presentation of tumour

Answer 6

progressive neurological deficit
motor weakness
headache
seizure
vomiting 
mental changes
papilloedema

Question 7

what is headaches, vomiting, mental changes and seizures a sign of

Answer 7

increased ICP

Question 8

what does blockage of CSF flow lead to

Answer 8

hydrocephalus

Question 9

headache can only occur with raised ICP - true or false

Answer 9

false

can occur without raised ICP

Question 10

what are worrying features of a headache

Answer 10

worse in morning; wakes them up
worse on lying down
worse with coughing/leaning forward 
worse on walking
associated with vomiting
gets better with vomiting

Question 11

what do neurological signs depend on

Answer 11

tumour location

Question 12

what is the frontal lobe responsible for

Answer 12

thought
reasoning
behaviour
memory

Question 13

what is pre central gyrus responsible for

Answer 13

movement

Question 14

what is post central gyrus responsible for

Answer 14

sensory

Question 15

what is the temporal love responsible for

Answer 15

behaviour
memory
hearing & vision pathways
emotion

Question 16

what is the parietal lobe responsible for

Answer 16

intellect
thought
reasoning
memory

Question 17

what are the types of neuroepithelial tissue

Answer 17

Astrocytes
Oligodendroglial cells
Ependymal cells/ choroid plexus
Neuronal cells
Pineal cells
Embryonic

Question 18

what are the 4 gradings of astrocytic tumours

Answer 18

I - Pilocytic astrocytoma

II - Diffuse/Low grade astrocytoma

III - Anaplastic astrocytoma

IV- Glioblastoma

Question 19

what are features of grade I astrocytomas

Answer 19

truly benign

slow growing

Question 20

who commonly gets a grade I astrocytoma

Answer 20

children

young adults

Question 21

what is the most common type of a grade I astrocytoma

Answer 21

pilocytic astrocytoma

Question 22

what areas of the brain are pilocytic astrocytomas seen

Answer 22

optic nerve
hypothalamic gliomas
cerebellum
brainstem

Question 23

Tx option for pilocytic astrocytoma

Answer 23

surgery

Question 24

what are the sub types of Grade II astrocytomas (low grade)

Answer 24

fibrillary astrocytoma (most common)
protoplasmic astrocytoma, gemistrocytic astrocytoma.

Question 25

where do low grade astrocytomas often affect

Answer 25

temporal lobe | posterior frontal lobe anterior parietal lobe

Question 26

where are the peak incidence for grade II astrocytomas

Answer 26

20-45y/o and 6-12y/o

Question 27

what is the common presentation of grade II astrocytomas

Answer 27

seizures | headaches

Question 28

what are poor prognostic factors for grade II astrocytomas

Answer 28

- age >50 - focal deficit (e.g. seizures) - short duration of symptoms - raised ICP - altered consciousness - enhancement on contrast studies

Question 29

Tx for grade II astrocytoma

Answer 29

surgery +/- radiation

Question 30

what is the median survival for anaplastic astrocytomas/grade III

Answer 30

2 years

Question 31

when do grade III tumours commonly occur

Answer 31

40-50 y.o | older than low grade astrocytoma and younger than glioblastoma

Question 32

anaplastic astrocytomas can progress into glioblastoma - true or false

Answer 32

true

Question 33

what is the most common adult primary intracranial tumour

Answer 33

Glioblastoma multiforme

Question 34

when is the peak age for a grade IV/glioblastoma

Answer 34

65-75 y/o

Question 35

what is Glioblastoma multiforme associated with

Answer 35

NF type I | Turcot Syndrome

Question 36

how does Glioblastoma multiforme spread

Answer 36

via white matter tracking/CSF pathways particularly the corticospinal tract and corpus callosum

Question 37

what is the corpus callosum

Answer 37

links the cerebral cortex of the left and right cerebral hemisphere

Question 38

what is a glioma spreading to the callosum sometimes called

Answer 38

butterfly glioma”

Question 39

1st line treatment of grade IV

Answer 39

surgery +/- chemo or radiotherapy

Question 40

what are the 2 most common forms of glial tumours

Answer 40

Astrocytomas Oligodendroglial tumours

Question 41

what is the epidemiology of oligodendroglial tumours

Answer 41

- another type of glial tumour - less common and account for 20% of glial tumours - seen at age 25-45y/o and 6-12y/o

Question 42

where do oligodendroglial tumours commonly affect

Answer 42

the frontal lobe

Question 43

how to oligodendroglial tumours appear

Answer 43

greyish-pink

Question 44

how are subarachnoid accumulations in oligodendroglial tumours described as looking

Answer 44

toothpaste morphology

Question 45

what can help pathologist distinguish oligodendroglial tumours from astrocytomas

Answer 45

oligodendroglial tumours have: - cysts - peripheral calcification - peritumoural haemorrhage

Question 46

what are collision tumours

Answer 46

mix of oligodendroglial cells and astrocytic cells

Question 47

what is the first line treatment for oligodendroglial tumours

Answer 47

Chemotherapy | are very chemosensitive

Question 48

what can meningiomas originate from

Answer 48

arachnoid cap cells of the meninges

Question 49

what are features of meningiomas

Answer 49

- most common extra-axial tumour - usually benign - rarely malignant or invade brain tissue - produce Sx by compressing underling brain

Question 50

what are meningiomas associated with

Answer 50

breast cancer | NF II

Question 51

what are the 2 macroscopic forms of meningioma

Answer 51

globuse | meningioma en plaque

Question 52

how do globuse meningioma apprear

Answer 52

rounded, well defined dural masses, looks like a fried egg (most common presentation)

Question 53

how do meningioma en plaque appear

Answer 53

carpet or sheet-like lesions that infiltrate the dura and invade the bone with extensive regions of dural thickening.

Question 54

where are common locations for meningiomas

Answer 54

parasagittal, convexity, sphenoid, intra-ventricular

Question 55

what Sx might be seen in meningiomas

Answer 55

headaches cranial nerve neuropathies paresis change in mental status majority are asymptomatic

Question 56

what is 1st Ix for meningioma

Answer 56

MRI head

Question 57

what are the types of nerve sheath tumours

Answer 57

Vestibular Schwannomas Neurofibromas Malignant peripheral nerve sheath tumours (MPST)

Question 58

where are Vestibular Schwannomas commonly seen

Answer 58

Cerebellopontine angle.

Question 59

what causes Vestibular Schwannomas/acoustic neuromas

Answer 59

benign tumour of schwann cells in the vestibular portion of CN VII

Question 60

what should be suspected in bilateral Vestibular Schwannomas/acoustic neuromas

Answer 60

NF type II

Question 61

what reflex is loss in Vestibular Schwannomas/acoustic neuromas

Answer 61

corneal reflex

Question 62

Sx of Vestibular Schwannomas/acoustic neuromas

Answer 62

``` hearing loss; asymmetrical commonly; (SNHL) dizziness facial numbness tinnitus loss of equilibrium ```

Question 63

Ix of Vestibular Schwannomas/acoustic neuromas

Answer 63

1st - audiogram | 2nd - contrast MRI

Question 64

Tx of Vestibular Schwannomas/acoustic neuromas

Answer 64

1 - focused radiation or surgery

Question 65

what is the most common germ cell tumour

Answer 65

germinomas