brain neoplasms
TRANSCRIPT
Brain Neoplasms:Brain Neoplasms:General ConsiderationsGeneral Considerations
1. Comprise: 10% of all tumors
2. Most common childhood neoplasms
3. Peak incidence at 5th decade
4. Supratentorial tumors in adults
5. Infratentorial tumors in childhood
Brain Neoplasms:Brain Neoplasms: General ConsiderationsGeneral Considerations
6. Different tumors in different ages 7. Primary tumors infiltrative, metastatic well-demarcated 8. Intraneural seeding occur, but no extraneural metastasis 9. Produce neurologic symptoms by size, location, invasiveness, and secondary effects
Varieties of brain tumorsVarieties of brain tumors
Meninges: meningioma, hemangiopericytoma Astrocytes: astrocytoma (various types) Oligodendrocytes: oligodendroglioma Ventricles: ependymoma, choroid plexus papilloma,
colloid cyst Vascular: hemangioblastoma Primitive cells: germinoma, medulloblastoma,
neuroblastoma, pineoblastoma, retinoblastoma Neuronal: ganglioglioma, gangliocytoma Pituitary: adenoma, craniopharyngioma Nerves: schwannoma, neuroblastoma
Incidence of Intracranial Incidence of Intracranial GliomasGliomas
(All ages)(All ages)
Glioblastomas
Astrocytomas
Ependymomas
Medulloblastomas
Oligodendrogliomas
Choroid plexus papillomas
Colloid cysts
55.0%
20.5%
6.0%
6.0%
5.0%
2.0%
2.0%
Incidence of Primary Incidence of Primary IntraspinalIntraspinal
Intramedullary GliomasIntramedullary Gliomas
Ependymomas
Astrocytomas (grades 1 and 2)
Glioblastomas (Astrocytomas grades 3 and 4)
Oligodendrogliomas
Other tumors
63.0%
24.5%
7.5%
3.0%
2.0%
Frequent brain tumorsFrequent brain tumors
Meningioma Astrocytoma/glioblastoma Oligodendroglioma Ependymoma Medulloblastoma Schwannoma/neurofibroma Phakomatosis
MeningiomaMeningioma
Arachnoid cells originAttached to dura, subduralCommon sitesChanges in cranium Hyperostosis Invasion
Microscopic: whorls and psammoma bodies
GliomasGliomas
Astrocytes- astrocytomas– Fibrillary– Pilocytic
Oligodendrocytes- oligodendrogliomas Ependyma- ependymomas
AstrocytomaAstrocytomass
Adults:
Childhood:
SupratentorialSolidMalignant
InfratentorialCysticBenign
Adult vs childhood astrocytomasAdult vs childhood astrocytomas
Adult: fibrillary. Grading varies from low grade malignancy to one of most malignant brain tumor.
Childhood: pilocytic. Very low grade tumor (benign).
Fibrillary astrocytomasFibrillary astrocytomas
Grossly solid Common in cerebral hemispheres Low grade in young, higher grade in older Grading
– astrocytoma (low grade)– Anaplastic astocytoma– glioblastoma multiforme
Fibrillary astrocytoma: microscopicFibrillary astrocytoma: microscopic
Low grade- hypercellularity, pleomorphism Anaplastic- as above plus mitosis, vascular
endothelial proliferation Glioblastoma multiforme- as above plus
necrosis and pseudopalisades. Grossly variegated appearance (multiforme)
Pilocytic astrocytomaPilocytic astrocytoma
Common in childhood Most slow growing of the gliomas Sites: cerebellum, around III V., optic nerve Grossly cystic with mural nodule Microscopic
– elongated hair-like (pilo) elongated cells– Rosenthal fibers
Rosenthal fiber definitionRosenthal fiber definition
Dense, eosinophilic fibers within cytoplasmic processes of astrocytes.
Correspond to aggregate accumulation of intermediate filaments in these processes.
OligoOligodendrdendroglioogliomamaSlow growing tumor
Potentially malignant
Calcifications
Tumors in Tumors in VentriclesVentricles
1. Ependyma: Ependymoma
2. Choroid Plexus: Papilloma
EpendymomasEpendymomas
Arise from ependymal lining- ventricles and central canal of spinal cord
Common in childhood 4th V. common in cerebrum Most common tumor of spinal cord
parenchyma in adult Microscopic
– perivascular pseudorosettes– ependymal rosettes
Primitive neuroectodermal tumorsPrimitive neuroectodermal tumors
Neuroblastoma- cerebral hemispheres Medulloblastoma- cerebellum Ependymoblastoma- ventricles Pineoblastoma- pineal region
MedulloblastomaMedulloblastoma
Origin: primitive neuroectodermal cells Age: 1st decade of life Site: vermis of cerebellum May cause hydrocephalus Subarachnoid dissemination
Histologic patterns: definitionsHistologic patterns: definitions
Whorls: onion-skinning pattern of tumor cells Psammoma bodies: laminated calcium Pseudopalisading: lining up of the tumor cells
around a central necrotic area Palisade: lining up of tumor cells around their
own cytoplasmic processes. No necrosis. Pseudorosette: tumor cells around blood
vessels, cells equidistant from vessel walls. Rosettes: tumor cells around central lumen or
fibrillary area of cellular processes
Brain Tumors: Brain Tumors: MicroscopicMicroscopic
Meningioma Whorls and psammoma bodiesGlioblastoma PseudopalisadesOligodendroglioma Mosaic/poached-eggEpendymoma Perivascular pseudorosettesMedulloblastoma Rosettes
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1. Schwannoma viii Cranial nerve (Acoustic sch.) Spinal roots, posterior Peripheral nerves
2. Neurofibroma Spinal Roots, rare Peripheral nerves
3. Malignant variants Rare
Peripheral nerve tumorsPeripheral nerve tumors
Schwannoma Schwann cells Compress the nerve trunk Encapsulated Easily resectable without
nerve damage Microscopic:
– Antony A and B fibers– Verocay bodies
Neurofibroma Schwann cells, neurites,
fibroblasts Fusiform and involves
nerve trunk Not encapsulated Not resectable without
sacrificing nerve Micro- Intermingled cells
with wavy nuclei
Metastatic brain tumorsMetastatic brain tumors
Most common brain tumor in adults. Common primary sites: melanoma, lung,
breast, GI tract, kidney. Most are in cerebrum (MCA territory). In gray-white junctions due to rich capillarity Discrete, globoid, sharply demarcated
tumors. Amenable to surgical resection. Single or multiple. Brain edema frequent.
Phakomatosis: definitionPhakomatosis: definition
Phakos (Greek): lentil mole or freckle. Neurologic abnormalities combined with
defects of skin or retina, explained by their common ectodermal origin.
Involvement of visceral organs
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1. Neurofibromatosis (von Recklinghausen's dis.)
2. Tuberous Sclerosis
3. Sturge-Weber disease (Encephalofacial Angiomatosis)
4. von Hippel-Lindau Disease
5. Neurocutaneous Melanosis
NeurofibromatosisNeurofibromatosis
1. Dominant inheritance
2. Multiple neurofibromas Central - CNS peripheral nerves
3. Increased incidence of: meningioma glioma schwannoma - bilateral VIII N.
4. Cafe-au-lait (melanosis) in skin
5. Elephantiasis: increased connective tissue
Tuberous SclerosisTuberous Sclerosis
1. Dominant inheritance
2. Clinical triad: seizures mental retardation adenoma sebaceum
3. Retinal hamartoma (phakoma)
4. Tubers in cerebral cortex
5. Subependymal giant cell astrocytoma
6. Hamartomas in other organs: heart, kidney
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