Presentation1.pptx, supratentorial brain tumour

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Presentation1.pptx, supratentorial brain tumour

  1. 1. Extra-axial Neoplasms Meningiomas account for 15% of all intracranial tumors and are the most common extra-axial tumor. They originate from the dura or arachnoid and occur in middle-aged adults. Women are affected twice as often as men. Meningiomas are well-differentiated, benign, and encapsulated lesions that indent the brain as they enlarge. They grow slowly and may be present for many years before producing symptoms. The histologic picture shows cells of uniform size that tend to form whorls or psammoma bodies. The parasagittal region is the most frequent site for meningiomas, followed by the sphenoid wings, parasellar region, olfactory groove, cerebello-pontine angle, and rarely the intraventricular region. Meningiomas often induce an osteoblastic reaction in the adjacent bone, resulting in a characteristic focal hyperostosis. They are also hypervascular, receiving their blood supply predominantly from dural vessels.
  2. 2. Meningioma: CT Imaging 􀂄􀂄 Non-Contrast – Sharply Circumscribed – Homogeneous – Hyperdense (+/- Ca++) 􀂄􀂄 NOT from psammoma bodies ! – Broad Dural Surface – Bone Changes (Hyperostosis) 􀂄􀂄 Enhanced CT – Homogeneous Enhancement Meningioma: Vasogenic Edema 􀂄􀂄 VASCULAR – parasitization of MCA, etc. – compression of cortical aa./vv. 􀂄􀂄 COMPRESSIVE TRAUMA 􀂄􀂄 SECRETORY EFFECT 􀂄􀂄 “TRANSCORTICAL FLOW” – Close apposition of tumor to brain – Thinned cortex – +/- infiltration of brain – Fluid gradient from meningioma into brain
  3. 3. Dural Tail 􀂄􀂄 Curvilinear enhancement 􀂄􀂄 “dural flair” 􀂄􀂄 First reported w/meningioma 􀂄􀂄 First reported to be neoplastic invasion 􀂄􀂄What is it REALLY? – Thickening of the dura – Vasocongestion of the dura – Edema of the dura Prevalence of "dural tail sign" Rokni-Yazdi H, Sotoudeh H. Eur J Radiol. 2006 Oct;60(1):42-5. 􀂄􀂄 22/98 patients (22.44%) of intracranial masses had "dural tail sign“ – 18 meningiomas – 2 pituitary adenomas – 1 primary cerebral lymphoma 􀂄􀂄 The "dural tail sign" had a sensitivity of 58.6% and specificity of 94.02% in diagnosis of meningioma.
  4. 4. Anterior falcine meningioma
  5. 5. “En plaque” Meningioma
  6. 6. Multiple Meningioma
  7. 7. Intraventricular meningioma
  8. 8. Optic nerve sheath meningioma right optic nerve mimicking optical glioma.
  9. 9. Hemangiopericytoma 􀂄􀂄 Syn: “angioblastic meningioma” 􀂄􀂄 Cell of Origin – perivascular pericyte of Zahn and/or Zimmerman 􀂄􀂄WHO 2-3 􀂄􀂄< 1% of primary CNS 􀂄􀂄 M 1.4:1 F 􀂄􀂄 Age – 40’s 􀂄􀂄 Dural based, bone destruction, lobulated HEMANGIOPERICYTOMA (HPC) 􀂄􀂄 Narrow dural base (“Mushrooming”) 􀂄􀂄No Hyperostosis 􀂄􀂄No Calcification in tumor 􀂄􀂄Lobulated (not hemispheric) 􀂄􀂄 Internal Signal Voids (on MRI) – irregular and multiple 􀂄􀂄 Hypervascular on Angio – irregular patterns
  10. 10. Intracerebral lymphoma
  11. 11. Intracerebral lymphoma
  12. 12. Pilocytic astrocytoma
  13. 13. ASTROCYTOMA, SUBEPENDYMAL GIANT CELL IN TUBEROUS SCLEROSIS
  14. 14. ASTROCYTOMA, SUBEPENDYMAL GIANT CELL IN TUBEROUS SCLEROSIS
  15. 15. Pleomorphic xanthoastrocytoma
  16. 16. Pleomorphic xanthoastrocytoma
  17. 17. Pleomorphic xanthoastrocytoma
  18. 18. Diffuse astrocytoma
  19. 19. Diffuse astrocytoma
  20. 20. Anaplastic Astrocytoma
  21. 21. Anaplastic astrocytoma
  22. 22. Glioblastoma multiforme
  23. 23. Glioblastoma multiforme
  24. 24. Glioblastoma multiforme
  25. 25. Glioblastoma multiforme
  26. 26. Multicenteric glioma 7.5% of glioblastomas
  27. 27. oligodendroglioma
  28. 28. Oligodendroglioma
  29. 29. Oligodendroglioma
  30. 30. Gangliocytoma
  31. 31. Ganglioglioma
  32. 32. Ganglioglioma
  33. 33. Central neurocytoma
  34. 34. Central neurocytoma
  35. 35. Thank You.

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