cns neoplasm dr. raid jastania, frcpc assistant professor, faculty of medicine, umm alqura...

CNS Neoplasm

Dr. Raid Jastania, FRCPCAssistant Professor, Faculty of

Medicine, Umm Alqura UniversityVice Dean, Faculty of Dentistry

Reference and Contact

• Robbins Basic Pathology• http://www.pathoma.com/

• Jastania@hotmail.com• http://uqu.edu.sa/staff/ar/4180114

Before We Start:

• 50 year old female presented with personality change, aggressive behaviour, persistent headache and confusion.

• She was referred to neurology clinic. Clinical assessment: no neurological deficit. CT scan of brain showed contrast enhanced lesion of 4 cm in the left frontal lobe with surrounding edema.

Before We Start:

• What is the diagnosis? Explain• How does cancer (neoplasm) develop?• What are the criteria of Malignancy?

At the end of the lecture you will be able to:

• List the most common neoplasms of the CNS.

• Explain the “cell of origin” of common CNS neoplasms.

• Explain the criteria of “malignancy/Benignity” in CNS neoplasms and the WHO grading system.

• Compare the pathological features of Astrocytoma, oligodendrogioma, ependymoma, meningioma and Medulloblstoma.

• List the most common metastatic tumors of the brain.

At the end of the lecture you will be able to:

• List the most common neoplasms of the CNS.

• Explain the “cell of origin” of common CNS neoplasms.

• Explain the criteria of “malignancy/Benignity” in CNS neoplsms and the WHO grading system.

• Compare the pathological features of Astrocytoma, oligodendrogioma, ependymoma, meningioma and Medulloblstoma.

• List the most common metastatic tumors of the brain.

CNS Neoplasm• 10-17 / 100,000 intracranial• 1-2 / 100,000 intraspinal• 50% Metastatic• Common primary CNS tumors:

• Glioblastoma Multiforme (GBM)• Astrocytoma• Oligodentroglioma• Ependymoma• Meningioma• Medulloblastoma• ?? Glioma

At the end of the lecture you will be able to:

• List the most common neoplasms of the CNS.

• Explain the “cell of origin” of common CNS neoplasms.

• Explain the criteria of “malignancy/Benignity” in CNS neoplsms and the WHO grading system.

• Compare the pathological features of Astrocytoma, oligodendrogioma, ependymoma, meningioma and Medulloblstoma.

• List the most common metastatic tumors of the brain.

Cells in the CNS

• Neuron / Ganglion• Glial Cells– Astrocyte– Oligodendrocyte– Ependymal cell– Meningothelial cell– ?Primitive cell– Schwann cell

At the end of the lecture you will be able to:

• List the most common neoplasms of the CNS.

• Explain the “cell of origin” of common CNS neoplasms.

• Explain the criteria of “malignancy/Benignity” in CNS neoplasms and the WHO grading system.

• Compare the pathological features of Astrocytoma, oligodendrogioma, ependymoma, meningioma and Medulloblstoma.

• List the most common metastatic tumors of the brain.

Malignancy Criteria

• What are the features of Malignancy?

Malignancy Criteria

• What are the features of Malignancy?– Rapid rate of growth– Invasion– Anaplasia– Metastasis

• What about:– The brain contains critical/vital structures!– Metastasis of primary brain tumors is Rare– Pattern of growth: diffuse, pushing, infiltrative

WHO Grading System

• Grades:– Grade 1– Grade 2– Grade 3– Grade 4

• Criteria for grading:– Atypia, cellularity,

pleomorphism– Necrosis– Vascular proliferation– Mitotic activity

At the end of the lecture you will be able to:

• List the most common neoplasms of the CNS.

• Explain the “cell of origin” of common CNS neoplasms.

• Explain the criteria of “malignancy/Benignity” in CNS neoplasms and the WHO grading system.

• Compare the pathological features of Astrocytoma, oligodendrogioma, ependymoma, meningioma and Medulloblstoma.

• List the most common metastatic tumors of the brain.

Astrocytoma

• 80% of adult primary brain tumors

• 4th -6th decade• Cerebral hemisphere• Seizure, headache, focal

neurological deficit• Grades: 2, 3, 4• Mean survival: 5 years

Oligodendroglioma• 5-15% of Glioma• 4th -5th decade• Seizure• Cerebral hemisphere, white

matter• Better prognosis than

astrocytoma• Mean survival: 5-10y• Heterozytosity of

Chromosome 1p 19q with good response to chemotherapy

Glioblastoma Multiforme

• Grade 4 Astrocytoma• Grade 4

Oligodendroglioma

Ependymoma

• Arise next to ependymal surface

• Near fourth ventricle• In children and adult• Neurofibromatosis

type2• CSF spread• Prognosis variable

Medulloblastoma

• Children• Cerebellum• Undifferentiated, high

grade• Radiosensitive• 75% 5 year survival

Meningioma• Benign tumor• Adults• Arise from meningothelial cells• Vague, non localizing symptoms• Neurofibromatosis type2

At the end of the lecture you will be able to:

• List the most common neoplasms of the CNS.

• Explain the “cell of origin” of common CNS neoplasms.

• Explain the criteria of “malignancy/Benignity” in CNS neoplasms and the WHO grading system.

• Compare the pathological features of Astrocytoma, oligodendrogioma, ependymoma, meningioma and Medulloblstoma.

• List the most common metastatic tumors of the brain.

Metastasis

• Carcinoma: lung, breast, melanoma, kidney, GI

• Sharply demarcated• At gray-white matter

junction

At the end of the lecture you will be able to:

• List the most common neoplasms of the CNS.

• Explain the “cell of origin” of common CNS neoplasms.

• Explain the criteria of “malignancy/Benignity” in CNS neoplasms and the WHO grading system.

• Compare the pathological features of Astrocytoma, oligodendrogioma, ependymoma, meningioma and Medulloblstoma.

• List the most common metastatic tumors of the brain.

Further questions and readings

• What other neoplasms occur in the CNS

• What are the clinical presentations of CNS neoplasms?

• What is paraneoplastic syndromes?

• What is neurofibromatosis, Von Hippel-Lindau disease

• How do we teat CNS neoplasms?