Childhood brain tumors

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  • These tumors show low cellularity, low proliferative and mitotic activity, and rarely metastasize or undergo malignant transformation. (grade 1) Pilomyxoidastrocytoma (PMA) is a recently defined variant of pediatric low-grade astrocytoma. (PMAs) have been found to have different histologic features and more aggressive than pilocyticastrocytomas. (Diffuse) The brain stem and spinal cord are the next most frequently affected sites.
  • Anaplasticastrocytoma
  • Childhood brain tumors

    1. 1. Childhood Brain Tumors<br />NabilahbintiDato’ Ayob<br />060100814<br />
    2. 2. Astrocytoma<br />Astrocytoma is the most common brain tumor, accounting for more than half of all primary CNS malignancies.(Peads)<br />Originate in glial-cells: called astrocytes.<br />Astrocytomascome in four major subtypes:<br />Juvenile pilocyticastrocytoma (grade 1)<br />Fibrillary/diffuse astrocytoma (grade 2)<br />Anaplasticastrocytoma (grade 3)<br />Glioblastomamultiforme (grade 4)<br />Most cases occur in the first decade of life Peak age at 5-9 years. <br />
    3. 3. Astrocytoma<br />Pilocyticastrocytomasarise throughout the neuraxis, but preferred sites  optic nerve, optic chiasm / hypothalamus, thalamus and basal ganglia, cerebral hemispheres, cerebellum, and brain stem. <br />Diffuse astrocytomasmay arise in any area of the CNS but most commonly  cerebrum, particularly the frontal and temporal lobes. <br />Anaplasticastrocytoma arises in the same locations as diffuse astrocytomas, with a preference for the cerebral hemispheres increased cellularity, marked mitotic activity, and a tendency to infiltrate through neighboring tissue. <br />
    4. 4. Astrocytoma<br />Glioblastomamultiformesubcortical white matter of the cerebral hemispheres. Combined frontotemporal location with infiltration into the adjacent cortex, basal ganglia, and contralateral hemisphere is typical.<br />Glioblastoma most frequent  brain stem in children. These tumors are highly cellular, with high proliferative and mitotic activity. <br />
    5. 5. Juvenile pilocyticastrocytoma of the cerebellum (MRI).<br />Supratentorial glioblastoma multiforme(MRI)<br />
    6. 6. T2-weighted image of a diffuse intrinsic pontineglioma.<br />Grade 2 diffuse astrocytoma<br />
    7. 7. Medulloblastoma<br />Medulloblastoma is the most common malignant brain tumor in children, accounting for 10-20% of primary CNS neoplasms and approximately 40% of all posterior fossatumors  Highly invasive embryonalneuroepithelialtumor<br />Cerebellartumor arising predominantly from the cerebellarvermis<br />Morphologically similar tumors arising in the pineal region are termed pineoblastomas, and those arising in other CNS locations are called primitive neuroectodermaltumors (PNETs)<br />
    8. 8. Medulloblastoma<br />The tumor may spread contiguously, to the cerebellar peduncle and/or the floor of the fourth ventricle<br />anteriorly, to the brainstem<br />Inferiorly, to the cervical spine<br />Superiorly, above the tentorium. <br />It also may spread via the CSF intracranially or to the leptomeninges and spinal cord. <br />
    9. 9. A cross-section of medulloblastoma (PNET) sitting in the cerebellum<br />MRI showing a medulloblastoma of the cerebellum.<br />
    10. 10. Ependymoma<br />Ependymoma neoplasm composed of glial cells that have differentiated along ependymallines.<br />Most common  Ependymallining of the ventricles (most often the floor, roof, or lateral recesses of the fourth ventricle) but it also arises in the filumterminale and the central spinal canal.<br />3rd most common brain tumor in children, accounting for approximately 10% of primary CNS neoplasms<br /> Tends to invade locally, even if histological appearance is benign. <br />Approximately 90% of tumors are intracranial, with as many as 70% occurring in the posterior fossa.<br />
    11. 11. Anaplasticependymoma of the lateral ventricle in an 8-week-old girl with hydrocephalus<br />Ependymoma of the 4th ventricle (CT-contrast)<br /> - Ventricular enlargement<br />
    12. 12. Craniopharyngioma<br />Craniopharyngiomashistologicallybenign neuroepithelial tumors that are predominately observed in children aged 5-10 years. <br />These tumors arise from squamous cell embryologic rests found along the path of the primitive adenohypophysis and craniopharyngeal duct.<br />Pediatric craniopharyngiomas are believed to arise from cellular remnants of the Rathke pouch, which is an embryologic structure that forms both the infundibulum and anterior lobe of the pituitary gland.<br />
    13. 13. Note that the lesion is sharply demarcated and smoothly contoured. This fluid-filled mass is consistent with a typical craniopharyngioma.<br />Image demonstrates a cystic lesion in the typical location of a craniopharyngioma.<br />
    14. 14. Choroid plexus papillomas<br />Choroid plexus papillomas may arise wherever a choroid plexus exists. In all age groups, the sites at which choroid plexus papillomas occur, in order of frequency, are the lateral ventricles (43%), fourth ventricle (39%), third ventricle (10%), and cerebellopontine angle (8%).<br />Of all choroid plexus papillomas, 20% occur in patients younger than 1 year old, and 85% occur in those younger than 10 years old.<br />On gross pathologic examination, choroid plexus papillomas appear as lobulated, encapsulated masses.<br />
    15. 15. Shows intense heterogeneous enhancement extension into the third ventricle.<br />Demonstrates  enhancing lateral ventricular mass(CT).<br />
    16. 16. A germ cell tumor/Germinoma<br />Arises from primitive developing cells that form in the embryo and may otherwise become the reproductive system.<br />Most commonly found in the pineal and suprasellar regions.<br />Approximately 2 percent of all pediatric brain tumors. Half of it occur in young people (10-20 y.o)<br />
    17. 17. Mass in the epiphysialarea<br />These are typical localisations, the lesions crawl along the floor of the 3rd ventricle.<br />

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