Pathology of brain tumour

2021-01-30 12:00 AM

Some mild to severe focal neurological signs, such as paralysis of a particular cranial nerve, weakness in limbs, memory loss or decreased vision may also suggest brain tumour.

 

Outline

Brain tumour is a conventional term called by clinical physicians to refer to tumour in the skull because actually tumour in brain tissue only account for over 50% of tumour in the skull. There is also meningeal tumour, tumour originating from blood vessels ... Before, brain tumour was diagnosed after autopsies. Bennet and Gotli were the first two authors to have definitive diagnosis and surgery to remove brain tumour (1984), and in the following years many authors published more and more brain tumour.

Regarding the frequency it is thought that one in every 20,000 people in the world has a brain tumour, according to Kiegsfield's report, the general brain tumour in all ages is 4.2 to 5.4 / 100,000 people in 1 year. Brain tumour compared with tumour in the body accounted for 5.8%.

Increased intracranial pressure

The most common feature of brain tumour is increased intracranial pressure including increased volume of the tumour, increased volume due to cerebral oedema, and stagnation of cerebrospinal fluid. The prolonged increase in intracranial pressure easily affects the brain organization and cranial nerves leading to changes in brain organization manifesting dysfunction of the brain and then changes to the brain entity.

Cerebrospinal fluid

There is always a balanced process of cerebrospinal fluid production and depletion and relatively constant quantity so that intracranial pressure is less likely to change. If the reproductive and absorption process is disturbed or there is a compression on the cerebrospinal fluid channels, it will cause stagnation and lead to increased intracranial pressure.

Increase in volume and location of the tumour

The increase in tumour volume and location plays a key role in increasing intracranial pressure especially as the tumour grows and with the closer the cerebrospinal fluid to the pathway and when comparing tumour size and location. then it was still found that the tumour's location was related to the cerebrospinal fluid pathway. In fact, contributed more to the increase in intracranial pressure.

Cerebral oedema

Also, a factor causing increased intracranial pressure was identified on CT Scanner (1981) Kazner based on X-ray images to divide tumour, divided into 3 levels of oedema.

Oedema level I: Edge oedema up to 2cm around the tumour.

Level II oedema: oedema around the tumour 2cm or more, may occupy up to half of the hemisphere.

Grade III oedema: Oedema spread more than half of the cerebral hemisphere, even oedema to the opposing brain hemisphere.

Classify

People classify brain tumour according to organization, by embryological origin and recently from 1971 to 1976 there have been many conferences in Switzerland of neuroscientists around the world that have given the organizational classification. current international central nervous system tumour.

According to embryonic origin

Neurodermal polyps

Medulloblastoma.

Spongioblastoma.

Oligodendroglioma.

Astrocytoma và Astroblastoma.

Glioblastoma multiforme.

Paraglioma.

Mesodermal tumour

Meningiomas

Blood tumour.

Epithelial tumour.

Epidermal tumour

Craniopharyngioma.

Hypophysenadenoma.

Mixed U

Epidermoid.

Teratoma.

Cholesteatoma.

According to international learning organization: announced in 1979

I. Tumour from the neuroderma

Astrocytes

Branched glioma

Myeloma

Papilloma of the choroid plexus

Nematode cell tumour

Nematode fibroids

Nerve cell tumour

- Nervous nodules

- Glioma of the nerve ganglion

- Nerve lymphoma

Less differentiated tumour and embryonic tumour

- Glioblastoma

Myeloblastoma

Malignancy degree


II II I

I

I-III IV

I

I-II III

IV IV

II. Tumour arise from the nerve membrane

Neurinoma

Nervous fibroids

 


I I

III. The tumour arise from the meningeal and embryonic organization

Branched glioma

 

 

I

Myeloma

Fibrosarcoma

III-IV

III-IV

IV. Primary malignant lymph nodes

III-IV

V. Tumour arise from blood vessels

I

BECAUSE. Tumour from embryonic cells

Membrane sarcoma

Teratoma

 

II-III I

VII. Other real neoplasms and similar processes

Graniopharyngioma

Lipoma

 


I I

VIII. Neoplasms of the following drugs

Adenoma pituitary

Adenocarcinoma hypophyses

 


I I

III

Clinical symptoms

In the clinical examination, the problem of detecting and diagnosing brain tumour is also based on the equipment conditions of medical facilities in developed countries when clinically there are signs of suspicion of brain tumour, people build up Modern diagnostic means such as CT Scanner or IRM. This work is very fast, simple but highly effective in optimal imaging, the size position is very clear and an assessment of the nature of the tumour is also quite accurate. In Vietnam, the examination of clinical symptoms still plays an important role in order to have a more accurate diagnosis.

Seizures are neurological cues suggesting brain tumour in about 40% of cases.

Some mild to severe focal neurological signs, such as paralysis of a particular cranial nerve, weakness in limbs, memory loss or decreased vision may also suggest brain tumour.

Intracranial hypertension syndrome with diffuse headache nausea, vomiting, fundoscopy with visual papillary oedema are valuable symptoms when thinking of brain tumour.

It is found that 80-90% of patients with brain tumour have a local or general headache. Local headaches are explained by mechanical factors pressing into the cranial nerves or the venous sinuses, causing a reflex to constrict the blood vessels of the brain and meninges. Bruns and Busep suggest that generalized headache is due to increased intracranial pressure, the stimulation of receptors is achieved through increased intracranial pressure, so when ventricular puncture or anti-oedema drug administration is painful. head has better. It has also been demonstrated that if ventricular effusion causes only one ventricular dilatation, the headache also manifests itself as a lateral migraine (Wolff and Agdubr).

However, clinically, there are also cases of brain tumour that have no headache for a very long time, headaches can be severe or very vague with unknown location of pain. The characteristic of headaches in brain tumour is that pain is frequent and tends to increase, arising from strong emotions, coughing, when helping patients sit up too hard, and pain increases or decreases, sometimes dependent and personal. first position.

Vomiting: In 65-68% of cases, vomiting is indicative of increased intracranial pressure. Vomiting in the brain tumour is characterized by sudden vomiting, vomiting is not associated with meals, and there is no sign of pre-vomiting abdominal pain. In the posterior fossa brain tumour, the most frequent, the tentative tumour are the least common, dizziness may be associated with vomiting and nausea and also in the skull tumour in the posterior fossa.

Oedema of the optic nerve: Oedema or atrophy of the optic spine is an objective symptom when increased intracranial pressure puts pressure on the vessels of the optic nerve leading to venous stasis and papillary oedema. Papillary oedema will lead to atrophy of the optic spine, so it is necessary to examine and detect the syndrome of increased intracranial pressure early to avoid complications of the eye.

Diagnostic symptoms determined

The tumour on the tent

Frontal lobe tumour:

Loss of memory and attention, a common psychosis manifestation in frontal lobe brain tumour is a characteristic symptom that often presents with irritability or laughter without excuse and sometimes roughness, possibly losing their sense of smell. and atrophy of the optic nerve. In the anterior part of the frontal lobe can affect number III, IV, V nerves; may lose motor language if the tumour is behind the frontal lobe.

Parietal lobe tumour:

The characteristic manifestations of parietal lobe tumour are sensory and motor disturbances, decreased sensation, tactile sensation, loss of spatial positioning, and motor disorders are often discreet.

Temporal lobe tumour:

If the tumour presses on the back hook, it will cause delusions, hallucinations and hallucinations, and language disorders. Some patients exhibit aphasia with damage to the posterior temporal lobe and lower parietal lobe, and they lose the ability to name objects correctly. If the cyst in the base of the skull presses on the optic nerve causing the eyelids to collapse, dilating the pupils.

Occipital brain tumour:

In manifestation of visual impairment, if the cerebellar enlargement is stretched and pushed down, the symptoms of the cerebellum appear that may lose corneal reflex and damage VI.

Occipital lobe tumour is less common than at other sites. Intracranial hypertension syndrome usually manifests early because of compression in the brain drain. For diagnosis can be based on increased intracranial pressure syndrome and secret cerebellar syndrome.

Ventricular tumour

In the III and IV ventricles, the typical symptoms are headaches and severe pain, manifested early increased intracranial pressure nausea, popular oedema. Usually obstructs the cerebrospinal pathways and causes ventricular effusion. Less common is for lateral ventricular tumour.

Pituitary tumour:

Accounting for 7.7-9.5% of all brain tumour (Burdnco and Elsberg) 98% of pituitary tumour are anterior lobe tumour, endocrine disorders are the basic symptom of pituitary adenoma including:

Genital dysphoria-obesity.

Big fingertips and giant symptoms.

Visual disturbances: Depending on the location of the tumour compared to the visual interference.

Lymphoma:

Classified as congenital tumour, is a tumour on the pituitary. They are referred to as pituitary adenomas in the literature. There are 4 possible cranial tumours:

Most likely skull tumour.

Cystic cranial tumour.

Cranasal calcification.

Most often mixed skull tumour of the three types above.

Clinical manifestations: Headache, visual impairment, sleep disturbance, excessive eating, drinking a lot, urinating a lot, increased intracranial pressure, endocrine disorders, obesity, hypogonadism.

Posterior fossa (under the tent)

Angioplasty of the cerebellum:

Limited by the cerebellum, upper part of the cerebellum and lateral part of the brain. If the tumour grows to the cerebellar hemisphere with little pressure on the brain and brain, the surgery is relatively simple, but if the tumour is mainly developed towards the brain and brain, it will damage the blood vessels. The brain is pressurized and thus completely removing the tumour is very difficult. Common tumour in the corner of the cerebellum:

Auditory nerve tumour (VIII cord tumour), the disease is more common in women than men.

Meningitis develops on the shore above the rocky bone.

Symptoms of cerebellar angular tumour: Tinnitus, dizziness, hearing loss. If there is numbness on the face and tongue, the tumour is compressing the V-wire.

Cerebellar tumour:

May be found in the worm lobe or in the hemisphere of the cerebellum.

Symptoms: Headache, increasing trend Syndrome of apparent increased intracranial pressure, nausea and vomiting.

Gait disorder, unsteady walking, staggering due to balance disorder, illness or falling on the u side.

Tumour of the cranial nerves

Including optic nerve tumour, visual interference, hearing nerves.

Subclinical symptoms

X-ray of the skull

Cranial imaging can show increased intracranial pressure, spaced joints, finger imprints, noting that the increase in intracranial pressure is 6 months or more, the above signs are valid . In addition, there can be visual changes in the pituitary such as pituitary erosion and calcium loss due to long-term increased intracranial pressure. For cranial tumour can see that the tumour is completely calcified. Bone resorption can be seen in the VIII cord tumour, causing the inner ear to widen and change the margin on the rock bone. Meningeal tumour can also eat cranial defects.

EEG

EEG can detect delta and beta waves in a certain area if combined with the correct clinical symptoms can help us diagnose the brain tumour.

Supersonic

Ultrasound of the midline, if there is a movement of the midline from 1-1.5cm, is valid for diagnosis. Two-way ultrasound, also known as the Doppler effect, is used in the diagnosis of encephalopathy in neonates with a cleft lip, the two-way ultrasound method is convenient and inexpensive in diagnosing brain tumour in children.

For adults, one cranial cavity can be used for diagnosis as above.

Brain angiography

This is a means of diagnosing brain tumour in the 1970s, first made by Egas Monis in 1927 through two paths from the inner carotid artery (CAG) and vertebral artery (VAG).

In addition, cerebral artery was also taken using Seldinger technique (1953) by inserting a needle into the femoral artery and inserting the cathéter into the vertebral artery. 

The proliferation and thrust of blood vessels in the brain are indirect images of mass displacement.

Computerized tomography

Computer imaging allows to determine the location and size of the brain tumour organization according to S.Wende, in 3750 cases of brain tumour, the diagnosis of brain tumour is correct in up to 80% of cases. In which, meningioma correctly diagnosed 84% of cases of these tumour.

Magnetic resonance imaging (IRM)

Locate the location of the brain tumour.

Evaluate 3-dimensional correlation of lesions with neighbouring organizations.

The principles of treatment

Includes the following steps: Surgery, radiation, chemicals.

Surgery

The goal of surgery is to remove the tumour and not damage the healthy brain tissue. However, whether the goal is achieved or not depends on whether the tumour is shallow or deep, whether the tumour has a clear limit or not. Relevance to the tumour, tumour mass and speciality of the surgeon. Thanks to computed tomography and surgical microscopy one can remove the tumour more thoroughly. However, not all types of tumour can be completely removed, the meningeal tumour has a clear limit but sometimes only partially removed.

Brain tumour in the deep, in the brain, brain stem, in the large blood vessels, in the base of the skull, removing the tumour will be very difficult because it is near the respiratory centre, cardiovascular and difficult to stop bleeding.

Radiation treatment

Radiation rays are firstly used to kill the remaining malignant cells after resection or malignant tumour in the deep that people only have minimal surgery Stereotaxy with the results of disease anatomy. It is also used to prevent benign or relatively benign tumour from recurring such as pituitary adenoma or Craniopharyngioma. In general, in the past years, the treatment of brain tumour with radiation has made significant progress due to the advancement of mechanical equipment. Especially since 2005, Hue University Hospital of Medicine and Pharmacy has used gamma knives to treat brain tumour, safely and effectively.

Chemical treatment

Currently, the results of chemotherapy are very encouraging, but for tumour of brain tissue, the prognosis has not changed significantly. It is recommended to use chemicals only in cases of rapidly growing malignancies, specifically for Glioblastoma, Astrocytoma grade III and IV. Many authors have suggested that the chemical resulted in better treatment.

There are several types of chemicals used in the treatment of brain tumour: Cyclophosphamide (Endoxan), 5 Fluoro-Uracyle (5FU), Methotrexate (Aethopterin), Vincristine (Oncovin), Mithramycin (Mithrancin), Doxorubicin (Adriamycin). .

Chemical used after radiation; both of these methods use the additional treatment after surgery.

Corticoid and immunotherapy have also been mentioned in brain tumour. The aim of corticosteroid therapy is to prevent cerebral oedema around tumour and immunotherapy is a treatment that remains in the research era.

In summary, for a benign brain tumour, the most effective treatment is radical resection, but it also depends on the anatomical site, the implications of tumour mass and function. Surgical malignant brain tumour attempts to maximize their mass with combined chemotherapy and radiation treatment to achieve greater efficiency.

Preventive

It is necessary to detect early symptoms suggesting of diseases in the brain region: prolonged headache, drowsiness, mental disorders ...

Grassroots health workers need to propagate in the community that when these signs appear, come to the health facility for medical examination.