The document discusses various benign brain neoplasms. It provides details on histopathological grading of benign vs malignant tumors. It then describes several specific benign brain tumor types including their imaging appearance and characteristics such as location, symptoms, age of presentation, treatment etc. The tumors discussed include meningioma, pituitary adenoma, craniopharyngioma, gliomas, nerve sheath tumors and others.

1. BENIGN NEOPLASM
BRAIN
DEPARTMENT OF RADIOLOGY
DR. HRITIK SHARMA
MD RADIOLOGIST

2. FOR THE PAST CENTURY, THE CLASSIFICATION OF BRAIN TUMORS HAS BEEN BASED LARGELY ON CONCEPTS OF HISTOGENESIS
THAT TUMORS CAN BE CLASSIFIED ACCORDING TO THEIR MICROSCOPIC SIMILARITIES WITH DIFFERENT PUTATIVE CELLS OF
ORIGIN AND THEIR PRESUMED LEVELS OF DIFFERENTIATION WHICH LEAD TO A LOT OF CONFUSION AND DOUBTS AMONG
PATHOLOGISTS.
DEIFINATION OF BENIGN BRAIN NEOPLASM ON HISTOPATHOLOGICAL BASIS WAS GRADE I AND GRADE II TUMORS (2007),
WHERE AS GREADE III AND IV WERE CONSIDERED AS MALGNANT.
THERE ARE NOT MANY CHANGES IN WHO HISTOLOGICAL GRADING IN 2016 UPDATE AS COMPARED TO 2007 CNS TUMOR,
ONLY A NEW CATEGORY “GRADE UNKNOWN” IS ADDED FOR DIFFUSE LEPTOMENINGEAL GLIONEURONAL TUMOR.
2007
THE CLASSIFICATION IS HISTOLOGICALLY
2016
THE CLASSIFICATION IS BASED ON GENETIC BASIS OF TUMORGENISIS
AND MOLECULAR MARKESR

3. 1. AGE
2. LOCALIZATION
INTRA AND EXTRA AXIAL
SUPRATENTORIAL AND INFRATENTORIAL
INTRA VENTRICULAR
WHAT COMPARTMENT (CP ALGLE, SKULL BASE)
MIDLINE CROSSING
3. CONTRAST ENHANCEMENT
4. CT AND MRI CHARACTERSTICS (Ca++, FAT, CYSTIC, ETC)
5. SOLITARY OR MULTIPLE
RADIOLOGICAL CLASSIFICATIONS CNS TUMORS

4. 2007

7.  WHO GRADE I
 WELL CIRCUMSCRIBED, SLOW GROWING, OFTEN CYST WITH MURAL NODULE
 LOCATION : CEBREBELLUM > OPTIC CHIASM > ADJACENT TO THIRD VENTRICLE > BRAIN STEM
 C/F : HEADACHE, VOMITING (MOST COMMON), ATAXIA
 PEAK AGE : 5-15 YRS
 SURVIVAL RATE : 20 YRS
 EPI: MOST COMMON PRIMARY BRAIN TUMOR IN CHILDREN
 MICRO: COMPACTED BIPOLAR CELLS WITH ROSENTHAL FIBERS
 DX: MEDULLOBLASTOMA, EPENDYMOMA, HEMANGIOBLASTOMA, GANGLIOGLIOMA
 MX: CEREBELLAR RESECTION FOLLOWED BY CHEMOTHERAPHY

8. CT IMAGING OF PILOCYTIC ASTROCYTOMA
NCCT CECT

9. MRI IMAGING OF PILOCYTIC ASTROCYTOMA
TIWI T2WI T1WIC+

10.  WHO GRADE 1
 BENIGN, SLOWGROWING GLIONURAL TUMOR ARISING NEAR FORAMEN OF MONRO, WELL
MARGINATED, SOLID MASSES OF APPROX 2-3 CM.
 C/F: HEADACHE, INCREASE ICT DUE TO OBSTRUCTION, LOC AND WORSENING EPILEPSY
 MEAN AGE: 11YRS OR DURING FIRST 2 DECADES
 MOST COMMON CNS NEOPLASM IN TUBEROUS SCLEROSIS COMPLEX (TSC)
 DX: CHOROID PLEXUS PAPPILOMA, SUBEPENDYMOMAL NODULE, SUBEPENDYMOMA.
 MX: SUCCESSFUL TREATMENTS REPORTED WITH RAPAMYCIN(EVEROLIMUS), SURGERY IS NO
LONGER NECESSARY IN MOST CASES

11. CT IMAGING OF SEGA
NCCT CECT

12. MRI IMAGING OF SEGA
T1WI T2WI FLAIR T1WIC+

13.  WHO GRADE II
 WELL DIFFERENTIATED, SLOW GROWING, DIFFUSELY INFILTRATING CORTICAL
AND SUBCORTICAL REGION
 MOST COMMON SITE IS FRONTAL LOBE>PARIETAL>TEMPORAL
 BEST DIAGNOSTIC CLUE: PARTIALLY CALCIFIED SUBCORTICAL/CORTICAL FRONTAL MASS
IN MIDDLE-AGED ADULT
 C/F: SEIZURES, HEADACHE, FOCAL NEUROLOGIC DEFICITS
 PEAK AGE: 4TH AND 5TH DECADE
 SURVIVAL TIME: APPROX 10 YRS.
 DX: LOW GRADE DIFFUSE ASTROCYTOMA, DNET, CENTRAL GANGLIOCYTOMA.
 MX: SURGICAL RESECTION IS THE PRIMARY TREATMENT FOLLOWED BY
CHEMOTHERAPHY.

14. CT IMAGING OF OLIGODENDROGLIOMA
NCCT CECT

15. MRI IMAGING OF OLIGODENDROGLIOMA
T1WI T2WI FLAIR T1WIC+ SWI

16.  WHO GRADE I
 BENIGN SLOW GROWING, ENHANCING LOBULATED (CAULIFLOWER-LIKE) MASS IN ATRIUM
OF LATERAL VENTRICLE
 MOST COMMON LOCATION TRIGONE OF LATERAL VENTRICLE > 4TH VENTRICLE.
 C/F: DIFFUSE HYDROCEPHALUS FROM CSF OVER PRODUCTION, MACROCRANIA, BULGING
FONTANELLE, VOMITING, HEADACHE, ATAXIA, SEIZURE
 PEAK AGE:1.5-3.5YRS. (MOST COMMON BRAIN TUMOR IN CHILDREN <1 YEAR OLD)
 CA++ IS COMMONLY SEEN IN 4TH VENTRICLE TUMORS
 DX: ATYPICAL CPP, CHOROID PLEXUS CARCINOMA, VILLOUS HYPERTROPHY OF CP.
 MX: SURGICAL RESECTION.

17. CT IMAGING OF CHOROID PLEXUS PAPILOMA
NCCT CECT

18. MRI IMAGING OF CHOROID PLEXUS PAPILOMA
T1WI T2WI FLAIR T1WIC+

19.  WHO GRADE I OR II
 WELL-DIFFERENTIATED, SLOWLY GROWING PARTIALLY CYSTIC, ENHANCING,
CORTICALLY BASED MASS IN CHILD/YOUNG ADULT
 MOST COMMON NEOPLASM TO CAUSE TEMPORAL LOBE EPILEPSY
 MOST COMMONLY SUPERFICIAL HEMISPHERES, TEMPORAL LOBE >FRONTAL
 3 MORPHOLOGICAL PATTERNS
 CIRCUMSCRIBED CYST WITH MURAL NODULE (MOST COMMON)
 SOLID TUMOR (OFTEN THICKENS, EXPANDS GYRI)
 INFILTRATING,POORLY DELINEATED MASS (UNCOMMON)
 CALCIFICATION IS COMMON
 DX: PLEOMORPHIC XANTHOASTROCYTOMA, DNET, PILOCYTIC ASTROCYTOMA
 MX: SURGICAL RESECTION , MAJORITY OF PATIENTS SEIZURE-FREE AFTER SURGERY

20. CT IMAGING OF GANGLIOGLIOMA
NCCT CECT CECT

21. MRI IMAGING OF GANGLIOLIOMA
T2WI T1WIC+ T1WIC+

22.  WHO GRADE I
 MIXED NEURONAL-GLIAL TUMOR.
 DEMARCATED, WEDGE-SHAPED/OVOID, CYSTIC/MULTICYSTIC CORTICAL MASS IN
YOUNG PATIENTS WITH LONG STANDING PARTIAL /COMPLEX SEIZURES
 MAY OCCUR IN ANY REGION OF SUPRATENTORIAL CORTEX, TEMPORAL LOBE IS
MOST COMMON
 CORTICAL MASS FREQUENTLY "POINTS" TOWARD VENTRICLE
 CALCIFICATION AND LEPTOMENINGEAL INVOLVEMENT ARE COMMON
 ADJACENT CORTICAL DYSPLASIA IS COMMON
 MICRO :HALLMARK = SPECIFIC GLIONEURONAL ELEMENT (SGNE)
 C/F:TEMPORAL LOBE EPILEPSY
 D/D: FOCAL CORTICAL DYSPLASIA, GANGLIOGLIOMA.
 MX: SURGICAL RESECTION USUALLY CURATIVE

23. CT IMAGING OF DNET
NCCT NCCT

24. MRI IMAGING OF DNET
T1WIC+ T2WI FLAIR

25.  WHO GRADE II
 WELL-DEMARCATED, INTRAVENTRICULAR, NEUROCYTIC NEOPLASM
LOCATED IN FORAMEN OF MONRO
 "BUBBLY"MASS IN FRONTAL HORN OR BODY OF LATERAL VENTRICLE
 PARENCHYMAL INVASION IS RARE
 MODERATELY VASCULAR, MAY CALCIFY, HEMORRHAGE RARE
 TYPICALLY ATTACHED TO SEPTUM PELLUCIDUM OR LATERAL VENTRICULAR WALL
 C/F: INCREASED ICP, HEADACHE, MENTAL STATUS CHANGES, VISUAL DISTURBANCES.
 AGE:YOUNG ADULTS…MEAN AGE:30 YRS.
 DX: SUBEPENDYMOMA, SUBEPENDYMAL GIANT CELL ASTROCYTOMA.
 MX: COMPLETE SURGICAL RESECTION IS TREATMENT OF CHOICE

26. CT IMAGING CENTRAL NEUROCYTOMA
NCCT CECT

27. MRI IMAGING CENTRAL NEUROCYTOMA
T1WI T2WI FLAIR T1WIC+ SWI

28.  WHO GRADE I
 SLOW GROWING WELL CIRCUMSCRIBED, ROUND, MASSES WITH INTRATUMORAL CYSTS IN
YOUNG ADULTS
 MAY MIMIC BENIGN PINEAL CYST
 CIRCUMSCRIBED PINEAL MASS THAT "EXPLODES” PINEAL CALCIFICATION PERIPHERALLY
 MOST COMMON C/F HEADACHE, PARINAUD SYNDROME (PARALYSIS OF UPWARD GAZE)
 MOST COMMON PINEAL PARENCHYMAL TUMOR.
 MEAN AGE 35-40 YRS.
 DX: PINEAL CYSTS, GERMINOMA, PINEAL PARENCHYMAL TUMOR OF INTERMEDIATE
DIFFERENTIATION.
 MX: SURGICAL EXCISION OR STEREOTACTIC BIOPSY IS PRIMARY TREATMENT

29. CT IMAGING OF PINEOCYTOMA
NCCT CECT

30. MRI IMAGING OF PINEOCYTOMA
T1WI T2WI FLAIR T1WIC+

31.  WHO GRADE I
 SLOW GROWING, NONINVASIVE, BENIGN, WELL-DIFFERENTIATED, INTRAVENTRICULAR
EPENDYMAL TUMOR, TYPICALLY ATTACHED TO VENTRICULAR WALL
 INCIDENTAL FINDING IN IMAGING.
 LOCATION: INFERIOR FOURTH VENTRICLE > FRONTAL HORNS LAT VENTRICLE.
 C/F:ASYMPTOMATIC
 AGE: MIDDLE AGED AND OLDER ADULTS, RARE IN CHILDREN
 D/D: EPENDYMOMA, CENTRAL NEUROCYTOMA, CHOROID PLEXUS PAPILLOMA.
 MX: CONSERVATIVE WITH SERIAL IMAGING IF SYMPTOMATIC SURGICAL RESECTION IS
CURATIVE IN MOST CASES

32. CT IMAGING OF SUBEPENDYMOMA
NCCT CECT CECT

33. MRI IMAGING OF SUBEPENDYMOMA
T1WI T2WI FLAIR T1WIC+

34. WHO GRADE II
SLOW-GROWING LOBULATED MASS IN BODY / INFERIOR 4TH VENTRICLE SOFTOR
"PLASTIC"TUMOR , ACCOMMODATES TO SHAPE OF VENTRICLE
SQUEEZES THROUGH FORAMEN OF MAGENDIE INTO CISTERNA MAGNA ± EXTENSION
THROUGH FORAMINA OF LUSCHKA INTO CPA CISTERNS
INFRATENTORIAL LOCATION FOURTH VENTRICLE, REST IN CP ANGLE, SUPRATENTORIAL
LOCATION HEMISPHERIC PARENCHYMAL LESIONS.
INFRATENTORIAL C/F : OBSTRUCTIVE HYDROCEPHALUS, HEADACHE, VOMITING ,PAPPILEDEMA,
SUPRATENTORIAL C/F : SEIZURES, FOCAL NEUROLOGICAL DEFICITS.
AGE: BIMODAL: 1-5 YRS AND 20-30 YRS
MOST COMMON SITE: POSTERIOR FOSSA
THIRD MOST COMMON POSTERIOR FOSSA TUMOR OF CHILDHOOD.
D/D: MEDULLOBLASTOMA, SUPRATENTORIAL:ANAPLASTIC ASTROCYTOMA, GLIOBLASTOMA
MULTIFORME.
MX: SURGICAL RESECTION OF IS DIFFICULT DUE TO ADHERENCE AND INFILTRATING NATURE OF
TUMOR, MAXIMUM CYTOREDUCTION SURGERY RADIOTHERAPY

35. CT IMAGING OF EPENDYMOMA
NCCT NCCT

36. CT IMAGING OF EPENDYMOMA
T1WI T1WI T2WI T1WIC+

37.  TYPICAL (BENIGN) MENINGIOMA: WHO GRADE I
 ATYPICAL MENINGIOMA : WHO GRADE II
 MALIGNANT MENINGIOMA :WHO GRADE III
 2 BASIC MORPHOLOGIES
GLOBOSE :GLOBULAR, WELL-DEMARCATED NEOPLASM WITH WIDE DURAL ATTACHMENT (DURAL TAIL)
EN PLAQUE :SHEET-LIKE EXTENSION COVERING DURA WITHOUT PARENCHYMAL INVAGINATION
 SHARPLY CIRCUMSCRIBED SMOOTH MASS ABUTTING DURA
 HYPERDENSE, ISODENSE, HYPODENSE, FAT DENSITY (RARE LIPOBLASTIC SUBTYPE),
 CAN BE DIFFUSE, FOCAL, SAND-LIKE ("PSAMMOMATOUS")
 "SUNBURST,” GLOBULAR, RIMPATTERNS
 NECROSIS, CYSTS, HEMORRHAGE CAN BE SEEN IN 8-23% CASES
 TRAPPED CSF POOLS, CYSTS IN ADJACENT BRAIN COMMON
 PERITUMORAL HYPODENSE VASOGENIC EDEMA
 HYPEROSTOSIS, IRREGULAR CORTEX,↑VASCULAR MARKINGS
 INTENSE HOMOGENEOUS ENHANCEMENT OF CECT

38.  LOCATION:
 SUPRATENTORIAL :PARASAGITTAL CONVEXITY (MOST COMMON)
SPHENOID RIDGE
SKULL BASE,
OLFACTORY GROOVE,
CAVERNOUS SINUS.
LESS COMMON FOURTH VENTRICLE,
PINEAL REGION.
EXTRADURAL (ORBIT, PARANASAL SINUSES),
INTRADIPLOIC / INTRAOSSEOUS.
 INFRATENTORAL : CEREBELLAR, CP ANGLE
• C/F: DEPENDS ON SIZE & LOCATION, MOST COMMON IS HEADACHE, PARESIS, MENTAL CHANGES.
• AGE : MIDDLE & OLDER ADULTS. PEAK AGE 60-70 YRS.
• ASSOCIATED WITH NF-2 (VESTIBULAR SCHWANOMA, MENINGIOMA, EPENDYMOMA).
• EPI:MOST FREQUENTLY DIAGNOSED PRIMARY BRAIN TUMOR

39. CT IMAGING OF MENINGIOMA
NCCT CECT

40. MRI IMAGING OF MENINGIOMA
T1WI T2WI T1WIC+ T1WIC+

41.  WHO GRADE I
 AVIDLY ENHANCING CYLINDRICAL (IAC) OR "ICECREAM ON CONE” (CPA-
IAC) MASS
 SMALL LESIONS:2-10MM AND LARGER LESIONS:UPTO5 CM
 ENCAPSULATED TUMOR THAT ARISES FROM SCHWANN CELLS OF NERVE
SHEATHS OF CRANIAL AND SPINAL NERVES.
 C/F: MOSTLY ASYMPTOMATIC, SENSORINEURAL HEARING LOSS.
 DX: MENINGIOMA CP ANGLE, EPIDERMOID CYST, FACIAL NERVE
SCHWANNOMA.

42. CT IMAGING OF VESTIBULAR
SCHWANNOMA
NCCT CECT

43. CT IMAGING OF VESTIBULAR
SCHWANNOMA
T1WIC+
T1WI T2WI FLAIR

44. THE RADIOLOGIST IS THE FIRST PHYSICIAN TO DIAGNOSE A PROBABLE
BRAIN TUMOR, AND THE DESCRIPTION AND DIFFERENTIAL DIAGNOSIS
PROVIDED HAVE PROFOUND IMPLICATIONS FOR SUBSEQUENT CLINICAL
DECISION MAKING.
THE STANDARDIZATION OF GLIOMA CATEGORIZATION AND GRADING
UNDER THE WHO SYSTEM HAS BEEN EXTREMELY BENEFICIAL, AS IT
ALLOWS PATIENTS, PHYSICIANS, AND RESEARCHERS AROUND THE WORLD
TO SHARE A COMMON LANGUAGE FOR TREATMENT AND RESEARCH

45. THANK YOU