Neoplasia of the Brain

Question 1

Most common primary tumour mets in brain?

Answer 1

Lung

Question 2

Common tumours to metastasise in brain

Answer 2

Lung 
Breast 
Kidney 
Melanoma
Colon

Question 3

Which of these presents as multiple mets?

Answer 3

Lung and Melanomas - multiple mets.

Breast, kidney & colon - single mets.

Question 4

Vestibular Schwannoma - What % of Intracranial tumours?

Answer 4

5% of IC tumours

90% of cerebellopontine angle tumours.

Question 5

S and S

Answer 5

Hearing loss (unilateral)
Balance issues 
Vertigo
Tinnitus (unilateral)
                                                         - CN8

Absent corneal reflex - CN5

Facial palsy - CN7

Question 6

Bilateral vestibular schwannoma

Answer 6

Neurofibromatosis type 2.

Question 7

Investigations

Answer 7

MRI with gadolinium enhanced

Audiogram

Question 8

Management

Answer 8

Refer to ENT - urgently
Often slow, benign and initially observed.
Radiation, surgery or observation.

Question 9

Most common type of primary Brain tumour, associated with poor prognosis.

Answer 9

Glioblastoma

Question 10

1. ) Glioblastoma CT scan findings:
2. ) Disruption of blood/brain barrier causes:
3. ) Histology:

Answer 10

1. ) Solid tumour, central necrosis, with rim that is enhanced on contrast.
2. ) Vasogenic Oedema.
3. ) Pleomorphic tumour cells border necrotic areas

Question 11

Glioblastoma Treatment?

Answer 11

Treatment is surgical with postoperative chemotherapy and/or radiotherapy.
Dexamethasone is used to treat the oedema.

Question 12

Second most common primary brain tumour?

Malignant or benign?

What tissue do they arise form?

Answer 12

Meningioma

Usually benign

Come from the dura mater of the meninges.

Question 13

Meningioma histology:

Answer 13

Spindle cells in loops.

Psammoma bodies

Question 14

Meningioma Ix and tx?

Answer 14

MRI

Observe
Radiotherapy
Surgical Resection

Question 15

Other tumours:

1. ) Pilocytic astrocytoma
2. ) Medulloblastoma
3. ) Craniopharyngioma

Answer 15

1.) The most common primary brain tumour in children

Histology: Rosenthal fibres (corkscrew eosinophilic bundle)

2.) A medulloblastoma is an aggressive paediatric brain tumour.

Histology: Small, blue cells. Rosette pattern of cells with many mitotic figures

3.) It is common in children, but can present in adults also. It may present with hormonal disturbance, symptoms of hydrocephalus or bitemporal hemianopia.

• Histology: Derived from remnants of Rathke pouch

Ix - Pituitary profile and MRI.

Treatment with Surgery, with or without post surgery radiotherapy.