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Adult CNS Tumors Neurology
- 1. Primary CNS Tumors of Adults BY SHANNON LARATONDA, MHS
- 2. Epidemiology Half of all brain and spinal cord tumors are metastatic The most frequent primary CNS tumors are glioblastoma multiforme and meningiomas Primary malignant CNS tumors account for 2- 3% of all cancer deaths in the U.S.
- 3. Clinical manifestations Headache – often worse at night or early morning Seizures – tumors involving cerebral cortex Mental changes – deficits in memory, concentration, reasoning Focal neurological symptoms are related to involvement of specific brain regions Symptoms related to increased ICP are due to the presence of a space-occupying mass w/in the cranial cavity, blockage of CSF flow, and peritumoral edema
- 4. Primary Versus Metastatic Tumors Primary Poorly circumscribed Usually single Location varies according to specific type Metastatic Well circumscribed Often multiple Usually located at the junction between gray and white matter
- 5. Primary Adult CNS Tumors Glioblastoma multiforme (Grade IV astrocytoma) Meningioma Hemangioblastoma Schwannoma Oligodendroglioma Pituitary Adenoma
- 6. Glioblastoma multiforme (Grade IV astrocytoma The most common CNS primary malignancy in adults Most common location is white matter in the centrum semiovale Characteristic histopath. feature is an area of necrosis surrounded by rows of neoplastic cells (pseudopalisading necrosis) Aggressive tumors – poor prognosis, 1 yr. median survival Originate from astrocytes and immunoreact w/ GFAP Has a tendency to cross the midline by involving the corpus callosum – “butterfly glioma”
- 7. Glioblastoma multiforme http://images.radiopaedia.org/images/940/67dcac388ad1cc69f7252e9ab44516.jpg Head CT and MRI w/ contrast are best initial tests for any form of IC mass lesion
- 8. Meningioma Common, typically benign Originates from meningothelial cells of the arachnoid Women more than men Attach to dura and push underlying brain w/o invasion Composed of spindle shaped cells w/ indistinct borders; arranged in whorls or fascicles Psammoma bodies are frequent Rx: resection and/or radiosurgery
- 10. Hemangioblastoma Most often cerebellar Assoc. w/ Von Hippel-Lindau syndrome when found w/ retinal angiomas Can produce EPO causing secondary polycythemia Closely arranged, thin walled capillaries w/ minimal interleaving parenchyma Benign, generally non-invasive Rx: surgical excision
- 12. Schwannoma Originates from schwann cells of cranial or spinal nerves Most frequent location is on the 8th CN at the cerebellopontine angle Classical presentation of tinnitus and loss of hearing Good prognosis after surgical resection or treated w/ stereotactic radiosurgery Bilateral acoustic schwannomas are pathognomonic of NF Type 2 The neoplastic cells are immunoreactive with S-100 protein
- 14. Oligodendroglioma Most often in frontal lobes white matter 30-50 year old patients Often manifests w/ seizures Relatively rare, slow growing, 5-10 year survival Tend to recur after surgery and eventually degenerate into high-grade gliomas over time Neoplastic cells similar to oligodendroglia w/ pronounced perinuclear halo
- 16. Pituitary Adenoma Most commonly prolactinoma Manifests w/ bitemporal hemianopia due to pressure on optic chiasm Hyper or hypo-pituitarism are sequelae Monomorphic neoplastic cells
- 18. References Le, T., Bhushan, V., & Sochat, M. (2014). First Aid for the USMLE Step 1: Adult primary brain tumors. McGraw-Hill Education New York, NY. Sanchez, H. and Barone, J. (2011). Kaplan Medical USMLE Step 1 Pathology: CNS Pathology. Kaplan Publishing. New York, NY. Fischer, C. (June 2015). Master the Boards USMLE Step 2 CK: Oncology. Kaplan Publishing. New York, NY.