Brain Tumors

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Brain Tumors

  1. 1. Brain TumorsBrain Tumors Maria RountreeMaria Rountree
  2. 2. Most common types of brain tumorsMost common types of brain tumors  The most common childhood tumors are:The most common childhood tumors are:  1. Astrocytoma1. Astrocytoma  2. Medulloblastoma2. Medulloblastoma  3. Ependymoma3. Ependymoma  The most common adult tumors are:The most common adult tumors are:  1. Metastatic brain tumors from lung, breast, melanoma, and1. Metastatic brain tumors from lung, breast, melanoma, and other cancersother cancers  2. Glioblastoma Multiforme2. Glioblastoma Multiforme  3. Anaplastic (Malignant) Astrocytoma3. Anaplastic (Malignant) Astrocytoma  4. Meningioma4. Meningioma
  3. 3. Incidence of brain tumorsIncidence of brain tumors  Annual incidence ~15–20 cases per 100,000 people.Annual incidence ~15–20 cases per 100,000 people. Annual incidence primary brain cancer in children isAnnual incidence primary brain cancer in children is about 3 per 100,000.about 3 per 100,000.  Leading cause of cancer-related death in patientsLeading cause of cancer-related death in patients younger than age 35.younger than age 35.  Primary brain tumors /secondary ~ 50/50Primary brain tumors /secondary ~ 50/50  ~17,000 people in the United States are diagnosed with~17,000 people in the United States are diagnosed with primary cancer each year. Secondary brain cancerprimary cancer each year. Secondary brain cancer occurs in 20–30% of patients with metastatic disease.occurs in 20–30% of patients with metastatic disease.
  4. 4. Clinical Presentation of brain tumorsClinical Presentation of brain tumors  HeadachesHeadaches  SeizuresSeizures  Nausea & vomitingNausea & vomiting  Loss of consciousnessLoss of consciousness  Cognitive dysfunctionCognitive dysfunction  Neurological dysfx- weakness, sensory loss, aphasia,Neurological dysfx- weakness, sensory loss, aphasia, visual spatial dysfunctionvisual spatial dysfunction
  5. 5. Cognitive dysfunctionCognitive dysfunction  Includes memory problem, mood or personalityIncludes memory problem, mood or personality disordersdisorders  It is the presenting symptom in 30-35% of patients withIt is the presenting symptom in 30-35% of patients with brain metastasis.brain metastasis.  Patients symptoms often subtle, complain of fatigue,Patients symptoms often subtle, complain of fatigue, urge to sleep and loss of interest in daily activities.urge to sleep and loss of interest in daily activities. Confused with depression.Confused with depression.  Consider neuroimaging in patients who present withConsider neuroimaging in patients who present with new onset of depressive symptoms or without obviousnew onset of depressive symptoms or without obvious cause.cause.
  6. 6. Case:Case:  76 yo old female presented with increased irritability76 yo old female presented with increased irritability with her family, sleeplessness and reckless spending.with her family, sleeplessness and reckless spending.  PMH: HTN, breast cancerPMH: HTN, breast cancer  PE, labs –wnlPE, labs –wnl  MSE notable for loud rapid speech, flight of ideas, noMSE notable for loud rapid speech, flight of ideas, no delusions or hallucinationsdelusions or hallucinations  CT revealed a 3 cm intraventricular lesionCT revealed a 3 cm intraventricular lesion  Meningioma was removed and sxs slowly abatedMeningioma was removed and sxs slowly abated
  7. 7. Brain Meningioma CTBrain Meningioma CT
  8. 8. Meningioma MRI /T2Meningioma MRI /T2
  9. 9. Figure 1a. CT scan showing an astrocytic lesion (arrows), one of the glial tumors, in the left frontal lobe. Figure 1b. Intraoperative photograph of exposed brain tumor showing the pale lesion pouting out of the brain surface after opening the overlying dura. Figure 1c. Photomicrograph of a smear preparation showing astrocytic hypercellularity (more cells than normal) and nuclear pleomorphism (abnormal variability of the nuclei in cells), in keeping with a malignant astrocytoma.
  10. 10. Neuroimaging of brain tumorsNeuroimaging of brain tumors  Major diagnostic modality. Useful for preoperativeMajor diagnostic modality. Useful for preoperative planningplanning  The diagnosis of a primary brain tumor is best made byThe diagnosis of a primary brain tumor is best made by cranial MRI. This should be the first test obtained in acranial MRI. This should be the first test obtained in a patient with signs or symptoms suggestive of anpatient with signs or symptoms suggestive of an intracranial mass. The MRI scan should always beintracranial mass. The MRI scan should always be obtained both with and without contrast materialobtained both with and without contrast material (gadolinium).(gadolinium).  MRI superior to CT scan for evaluating meninges,MRI superior to CT scan for evaluating meninges, subarachnoid space, posterior fossa and defining thesubarachnoid space, posterior fossa and defining the vascular abnormality of the lesionvascular abnormality of the lesion
  11. 11. NeuroimagingNeuroimaging  High-grade or malignant gliomas appear as contrast-High-grade or malignant gliomas appear as contrast- enhancing mass lesions, which arise in white matter andenhancing mass lesions, which arise in white matter and are surrounded by edemaare surrounded by edema  Multifocal malignant gliomas are seen in ~ 5% ofMultifocal malignant gliomas are seen in ~ 5% of patients.patients.  Low-grade gliomas typically are nonenhancing lesionsLow-grade gliomas typically are nonenhancing lesions that diffusely infiltrate brain tissue and may involve athat diffusely infiltrate brain tissue and may involve a large region of brain. Low-grade gliomas are usuallylarge region of brain. Low-grade gliomas are usually best appreciated on T2-weighted MRI scans.best appreciated on T2-weighted MRI scans.
  12. 12. NeuroimagingNeuroimaging  A contrast-enhanced CT scan may be used if MRI isA contrast-enhanced CT scan may be used if MRI is unavailable. CT may be false-negative in patients with aunavailable. CT may be false-negative in patients with a low-grade tumor and can have significant artifactlow-grade tumor and can have significant artifact through the posterior fossa, which may obscure a lesionthrough the posterior fossa, which may obscure a lesion in this area.in this area.  Calcification, which may suggest the diagnosis of anCalcification, which may suggest the diagnosis of an oligodendroglioma, is often better appreciated on CToligodendroglioma, is often better appreciated on CT than on MRI.than on MRI.  CT useful if there is a question of bone or vascularCT useful if there is a question of bone or vascular involvement, or for detecting mets to skull base. Also,involvement, or for detecting mets to skull base. Also, in ER situation or if MRI is contraindicated.in ER situation or if MRI is contraindicated.
  13. 13. Radiologic features of metastaticRadiologic features of metastatic diseasedisease -Multiple lesions -Localization at the grey-white junction -More circumscribed margins -Relatively large amount of edema compared to size of lesion
  14. 14. SourcesSources  Wen, Patrick Y. Overview of Brain Metastases.Wen, Patrick Y. Overview of Brain Metastases. UptoDate version 13.3.UptoDate version 13.3.  Wong, Eric T. Clinical presentation andWong, Eric T. Clinical presentation and diagnosis of brain tumors. UptoDate versiondiagnosis of brain tumors. UptoDate version 13.3.13.3.  Ma, Julie. Mania Resulting from Brain Tumor.Ma, Julie. Mania Resulting from Brain Tumor. Clinical Vignette UCLA Department ofClinical Vignette UCLA Department of Medicine.Medicine.

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