Brain Neoplasms


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Brain Neoplasms

  1. 1. 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
  2. 2. 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
  3. 3. 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
  4. 4. Incidence of IntracranialIncidence 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%
  5. 5. Incidence of PrimaryIncidence 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%
  6. 6. Frequent brain tumorsFrequent brain tumors Meningioma Astrocytoma/glioblastoma Oligodendroglioma Ependymoma Medulloblastoma Schwannoma/neurofibroma Phakomatosis
  7. 7. MeningiomaMeningioma Arachnoid cells origin Attached to dura, subdural Common sites Changes in cranium Hyperostosis Invasion Microscopic: whorls and psammoma bodies
  8. 8. GliomasGliomas Astrocytes- astrocytomas – Fibrillary – Pilocytic Oligodendrocytes- oligodendrogliomas Ependyma- ependymomas
  9. 9. AstrocytomaAstrocytoma ss Adults: Childhood: Supratentorial Solid Malignant Infratentorial Cystic Benign
  10. 10. 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).
  11. 11. 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
  12. 12. 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)
  13. 13. 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
  14. 14. Rosenthal fiber definitionRosenthal fiber definition Dense, eosinophilic fibers within cytoplasmic processes of astrocytes. Correspond to aggregate accumulation of intermediate filaments in these processes.
  15. 15. OligoOligo dendrdendr ogliooglio mamaSlow growing tumor Potentially malignant Calcifications
  16. 16. Tumors inTumors in VentriclesVentricles 1. Ependyma: Ependymoma 2. Choroid Plexus: Papilloma
  17. 17. 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
  18. 18. Primitive neuroectodermal tumorsPrimitive neuroectodermal tumors Neuroblastoma- cerebral hemispheres Medulloblastoma- cerebellum Ependymoblastoma- ventricles Pineoblastoma- pineal region
  19. 19. MedulloblastomaMedulloblastoma Origin: primitive neuroectodermal cells Age: 1st decade of life Site: vermis of cerebellum May cause hydrocephalus Subarachnoid dissemination
  20. 20. 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
  21. 21. Brain Tumors:Brain Tumors: MicroscopicMicroscopic Meningioma Whorls and psammoma bodies Glioblastoma Pseudopalisades Oligodendroglioma Mosaic/poached-egg Ependymoma Perivascular pseudorosettes Medulloblastoma Rosettes
  22. 22. TT uu mm oo rr ss oo ff NN ee rr 1. Schwannoma viii Cranial nerve (Acoustic sch.) Spinal roots, posterior Peripheral nerves 2. Neurofibroma Spinal Roots, rare Peripheral nerves 3. Malignant variants Rare
  23. 23. 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
  24. 24. 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.
  25. 25. 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
  26. 26. PP hh aa kk oo mm aa tt oo ss ii ss (( 1. Neurofibromatosis (von Recklinghausen's dis.) 2. Tuberous Sclerosis 3. Sturge-Weber disease (Encephalofacial Angiomatosis) 4. von Hippel-Lindau Disease 5. Neurocutaneous Melanosis
  27. 27. 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
  28. 28. 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
  29. 29. VeniceVenice