Pathology of Brain Tumours

Question 1

What must be true for pressure to be stable?

Answer 1

For pressure to be stable must be (within certain limits) correct amount of brain tissue/blood/CSF

Question 2

What keeps the brain in place?

Answer 2

There are thick tough fibrous sheets inside that keep the brain in place

• Falx cerebri
• Tentorium cerebelli

Question 3

What is the opening to the spinal cord called?

Answer 3

Foramen magnum

Question 4

How can the brain move around the falx?

Answer 4

Brain cannot go through falx, but can go round edge

Question 5

The brain cannot go through the skull, but can move down through…

Answer 5

Foramen magnum

Question 6

What localise lesions can raise intracranial pressure?

Answer 6

• Haemorrhage
• Tumour
• Abscess

Question 7

What generalised pathology can raise intracranial pressure?

Answer 7

Oedema post trauma

Question 8

What is a localised haemorrhage called?

Answer 8

Haematoma

Question 9

What are localised lesions also known as?

Answer 9

Space occupying lesions (SOL)

Question 10

What are the effects of SOL?

Answer 10

• Amount of tissue increases
• Raises intra cranial pressure
• Cause internal shift (herniation) between the intracranial spaces

Question 11

What internal shift can SOL cause?

Answer 11

• Right-left or left-right
• Cerebrum moves inferiorly over edge of tentorium (uncal herniation)
• Cerebellum moves inferiorly into foramen magnum (coning)

Question 12

What are the different types of brain herniation?

Answer 12

• Cingulate
• Central
• Uncal
• Cerebrotonsillar
• Upward
• Transcalvarial

Question 13

What types of shift is subfalcine herniation?

Answer 13

Midline shift

Question 14

What happens in tentorial (uncal) herniation?

Answer 14

• Brain herniates inferiorly at side of tentorium

- Aqueduct is crushed and narrow

Question 15

What type of herniation results in brainstem death?

Answer 15

Cerebellar tonsillar herniation

Question 16

What occurs in cerebellar tonsil herniation?

Answer 16

Tonsils move inwards and downwards and crush brainstem

Question 17

What does swelling and shift cause?

Answer 17

Localised ischaemia

Question 18

What are the signs and symptoms of increased intracranial pressure?

Answer 18

• Squeeze on cortex and brainstem: morning headaches and sickness
• Squeeze on optic nerve: papilloedema

Question 19

What stages occur as pressure increases?

Answer 19

• Pupillary dilation
• Falling GCS
• Brain stem death

Question 20

Why do pupils dilate with increased pressure?

Answer 20

Squeeze and stretch on cranial nerve 3

Question 21

Why does the GCS fall with increasing pressure?

Answer 21

Squeeze on cortex and brainstem

Question 22

Why does brain stem death occur with increasing pressure?

Answer 22

Squeezing downwards of cerebellum into foramen magnum with crushing of brainstem

Question 23

What are the 2 types of classification of tumours within the CNS?

Answer 23

• Primary tumours

- Secondary (metastatic tumours

Question 24

Other than CNS tumours what other intracranial tumours can occur?

Answer 24

Cells originating outside brian and spinal cord(eg meningioma)

Question 25

Give examples of primary intracranial tumours.

Answer 25

- Gliomas (glioblastoma, astrocytoma, oligodendroglioma, ependymoma) - Medullablastoma - Meningioma - Schwannoma, neurofibroma - Adenoma - Lymphoma - Haemangioblastoma

Question 26

What metastatic malignancies can occur in the brain?

Answer 26

- Breast - Lung - Kidney - Colon - Melanoma

Question 27

Who is brain metastatic disease rare in?

Answer 27

Children

Question 28

Give examples of glial cell tumours.

Answer 28

Gliomas (glioblastoma, astrocytoma, oligodendroglioma, ependymoma)

Question 29

Give an example of embryonic neural cell tumours.

Answer 29

Medullablastoma

Question 30

Give examples of nerve sheath tumours.

Answer 30

- Scwhannoma | - Neurofibroma

Question 31

Give an examples of an Arachnoidal cell tumour

Answer 31

Meningioma

Question 32

Give an example of a pituitary gland tumour

Answer 32

Adenoma

Question 33

Give an example of a lymphoid cell tumour.

Answer 33

Lymphoma

Question 34

Give an example of a capillary vessel tumour.

Answer 34

Haemangioblastoma

Question 35

What intracranial tumours are derived from brain cells?

Answer 35

- Gliomas | - Medullablastomas

Question 36

What intracranial tumours are derived from cells surrounding or originating outside the brain?

Answer 36

- Meningiomas - Scwhannoma - Neurofibroma - Adenoma - Lymphoma - Haemangioblastoma

Question 37

What intracranial tumours are malignant?

Answer 37

- Gliomas | - Medullablastomas

Question 38

Where do most CNS tumours occur in adults?

Answer 38

Majority above tentorium

Question 39

Where do most CNS tumours occur in children?

Answer 39

Majority below tentorium

Question 40

What do gliomas resemble?

Answer 40

Resemble cells of glial differentiation

Question 41

What is the macroscopic appearance of gliomas?

Answer 41

Diffuse edges – not encapsulated

Question 42

Gliomas are malignant but what do the not do?

Answer 42

Malignant but do not metastasise outside the CNS

Question 43

What are tumours derived from astrocytes called?

Answer 43

Astrocytoma

Question 44

What are tumours derived from oligodendrocytes called?

Answer 44

Oligodendroglioma

Question 45

What are tumours derived from ependymal cells called?

Answer 45

Ependymoma

Question 46

What do astrocytes look like?

Answer 46

- Star shaped cells | - Long processes support other cells structurally and biochemically

Question 47

Give 2 examples of types of astrocytoma.

Answer 47

- Low grade astrocytoma | - Glioblastoma

Question 48

What do low grade astrocytoma's look like on microscopy?

Answer 48

Bland cells on microscopy (similar to normal astrocytes)

Question 49

How fast do low grade astrocytomas grow?

Answer 49

Very slowly

Question 50

What is the most malignant astrocytoma?

Answer 50

Glioblastoma

Question 51

What is another name for glioblastoma?

Answer 51

Glioblastoma multiforme

Question 52

How doe glioblastomas appear on microscopy?

Answer 52

Cellular, atypical tumour, with necrosis under microscope

Question 53

How fast do glioblastomas grow?

Answer 53

Grow quickly – often present as large tumours

Question 54

What is a medullablastoma?

Answer 54

Tumour of primitive neuroectoderm (primitive neural cells)

Question 55

Who are usually affected by medullablastomas?

Answer 55

Children

Question 56

Where are medullablastomas usually located?

Answer 56

Posterior fossa, especially brainstem

Question 57

How do medulloblastoma look?

Answer 57

Sheets of small undifferentiated cells

Question 58

What are meningiomas derived from?

Answer 58

From “arachnocytes” – cells that make up the coverings of the brain

Question 59

What type of tumours are meningioma's?

Answer 59

Benign: they do not metastasie

Question 60

How can meningioma's cause damage?

Answer 60

They are locally aggressive and can invade the skull

Question 61

How fast do meningiomas grow?

Answer 61

Slow growing

Question 62

How are meningiomas often treated?

Answer 62

Often resectable

Question 63

How do meningiomas appear on microscopy?

Answer 63

Bland cells forming small groups which whorl around each other resembling an arachnoid granulation, sometimes with calcification

Question 64

What is the calcification sometimes present in meningiomas called?

Answer 64

The calcification is sometimes called psammoma (from ‘grain of sand’) body formation

Question 65

Where do nerve sheath tumours occur?

Answer 65

Around peripheral nerves – intracranial and extracranial

Question 66

What do normal Schwann cells do?

Answer 66

Normal schwanncells wrap around peripheral nerves and form electrical insulation

Question 67

What is an acoustic neuroma?

Answer 67

8th vestibulocochlear nerve schwannoma, at angle between pons and cerebellum

Question 68

How do acoustic neuromas present?

Answer 68

Unilateral deafness

Question 69

What type of tumours are acoustic neuromas?

Answer 69

Benign lesions but technically difficult to remove

Question 70

What type of tumour is a pituitary adenoma?

Answer 70

Benign

Question 71

Where are pituitary adenomas located?

Answer 71

Pituitary fossa

Question 72

What do pituitary adenomas often secrete?

Answer 72

Often secrete a pituitary hormone

Question 73

How do pituitary adenomas grow?

Answer 73

Grow superiorly and impinge on optic chiasma resulting in visual signs

Question 74

Why are CNS lymphomas difficulty biopsy?

Answer 74

Often deep and central site in brain

Question 75

Why are CNS lymphomas difficult to treat?

Answer 75

Difficult to treat as drug do not cross blood-brain barrier

Question 76

What do CNS lymphomas generally not do?

Answer 76

Generally do not spread outside of CNS

Question 77

What are CNS lymphomas?

Answer 77

- High grade neoplasm | - Usually diffuse large B-cell lymphoma

Question 78

What is a Haemangioblastoma?

Answer 78

Space occupying tumour of blood vessels

Question 79

Where are Haemangioblastoma usually found?

Answer 79

Cerebellum

Question 80

What complication may Haemangioblastoma result in?

Answer 80

They may bleed

Question 81

What are most secondary tumours?

Answer 81

Carcinomas

Question 82

What is the histological appearance of a secondary tumour?

Answer 82

Histology is that of the primary tumour