Brain tumors are a diverse group of neoplasms that arise from different cells within the central nervous system. They are named based on their location and cell of origin. Common types include gliomas, meningiomas, and ependymomas. Tumors are classified based on location, morphology, and biological behavior. Symptoms depend on the location of the tumor and can include increased intracranial pressure, focal neurological deficits, and seizures. Diagnosis involves imaging and biopsy. Treatment options are surgery, radiation, chemotherapy, and targeted therapies depending on tumor type and grade.
WHO BRAIN TUMOR CLASSIFICATION 5th EDITIONKanhu Charan
The document summarizes some of the key changes in the 2021 5th edition of the WHO brain tumor classification compared to previous editions. Some notable changes include recognizing the distinction between adult and pediatric diffuse gliomas, adding 22 new tumor types, revising the terminology for 13 tumor types, introducing essential and desirable diagnostic criteria, and classifying tumors based on a combination of histopathological and molecular features. Sellar tumors, meningiomas, and ependymomas were also revised in the new classification system.
Low-grade gliomas are a diverse group of uncommon brain tumors that typically occur in young adults. While historically graded on features like cell abnormalities and proliferation, the current WHO system grades them from I-II based on these factors and prognosis. Grade I lesions rarely recur after surgery alone, while Grade II tumors are infiltrative and tend to progress despite low proliferation. Surgery aims for maximal safe resection, and radiation therapy after surgery can delay tumor recurrence by around 2 years based on clinical trials, though does not impact overall survival or rate of malignant transformation. Observation is reasonable for very low risk lesions with total resection in young patients.
Brain metastasis is an advance diseases with poor overall prognosis management of which is full of controversies. This slide aims to make metastasis simplified.
This document discusses the management of high grade brain tumors. It begins by stating that gliomas make up 60% of primary brain tumors, with two-thirds being clinically aggressive high-grade tumors. The treatment involves a multimodality approach of surgery, radiation therapy, and chemotherapy. For glioblastomas, all three modalities are typically used at initial diagnosis. The standard treatment for glioblastoma is maximal safe surgical resection followed by radiation therapy with concurrent temozolomide chemotherapy and subsequent adjuvant temozolomide chemotherapy. Radiation techniques, chemotherapy options, targeted therapies, and clinical prognostic factors are also discussed.
This document provides information on the management of diffuse gliomas, including:
1. It defines diffuse gliomas and discusses their WHO classification, typically involving infiltration of normal brain tissue without clear borders.
2. Symptoms can include raised intracranial pressure, seizures, focal neurological deficits, and others depending on the tumor location.
3. Managing diffuse gliomas requires a multidisciplinary team including radiologists, neurosurgeons, oncologists and others.
4. Trial evidence is discussed regarding the use of radiotherapy and chemotherapy at different doses and timings for diffuse low-grade gliomas.
The 2021 WHO classification of CNS tumors builds on the 2016 edition by placing greater emphasis on molecular markers for both classification and grading. Some tumors are now entirely classified based on their molecular profile, while others remain primarily histologically assessed. A layered report structure will integrate histological, grading, and molecular information. Notable changes include raising IDH status and 1p19q codeletion to prominence for diffuse gliomas. Grading now occurs within each tumor type rather than equivalently across types. Molecular features can supersede histology in determining grade.
This document discusses various tumors and lesions that can occur in the posterior fossa region of the brain. It provides CT and MRI images and descriptions of common tumors in this area, including medulloblastoma, ependymoma, choroid plexus papilloma, brain stem gliomas, gangliogliomas, pilocytic astrocytomas, hemangioblastomas, and metastases from other cancers. The document is intended as an imaging guide for physicians to identify and diagnose different infra-tentorial lesions and tumors based on scan findings.
WHO BRAIN TUMOR CLASSIFICATION 5th EDITIONKanhu Charan
The document summarizes some of the key changes in the 2021 5th edition of the WHO brain tumor classification compared to previous editions. Some notable changes include recognizing the distinction between adult and pediatric diffuse gliomas, adding 22 new tumor types, revising the terminology for 13 tumor types, introducing essential and desirable diagnostic criteria, and classifying tumors based on a combination of histopathological and molecular features. Sellar tumors, meningiomas, and ependymomas were also revised in the new classification system.
Low-grade gliomas are a diverse group of uncommon brain tumors that typically occur in young adults. While historically graded on features like cell abnormalities and proliferation, the current WHO system grades them from I-II based on these factors and prognosis. Grade I lesions rarely recur after surgery alone, while Grade II tumors are infiltrative and tend to progress despite low proliferation. Surgery aims for maximal safe resection, and radiation therapy after surgery can delay tumor recurrence by around 2 years based on clinical trials, though does not impact overall survival or rate of malignant transformation. Observation is reasonable for very low risk lesions with total resection in young patients.
Brain metastasis is an advance diseases with poor overall prognosis management of which is full of controversies. This slide aims to make metastasis simplified.
This document discusses the management of high grade brain tumors. It begins by stating that gliomas make up 60% of primary brain tumors, with two-thirds being clinically aggressive high-grade tumors. The treatment involves a multimodality approach of surgery, radiation therapy, and chemotherapy. For glioblastomas, all three modalities are typically used at initial diagnosis. The standard treatment for glioblastoma is maximal safe surgical resection followed by radiation therapy with concurrent temozolomide chemotherapy and subsequent adjuvant temozolomide chemotherapy. Radiation techniques, chemotherapy options, targeted therapies, and clinical prognostic factors are also discussed.
This document provides information on the management of diffuse gliomas, including:
1. It defines diffuse gliomas and discusses their WHO classification, typically involving infiltration of normal brain tissue without clear borders.
2. Symptoms can include raised intracranial pressure, seizures, focal neurological deficits, and others depending on the tumor location.
3. Managing diffuse gliomas requires a multidisciplinary team including radiologists, neurosurgeons, oncologists and others.
4. Trial evidence is discussed regarding the use of radiotherapy and chemotherapy at different doses and timings for diffuse low-grade gliomas.
The 2021 WHO classification of CNS tumors builds on the 2016 edition by placing greater emphasis on molecular markers for both classification and grading. Some tumors are now entirely classified based on their molecular profile, while others remain primarily histologically assessed. A layered report structure will integrate histological, grading, and molecular information. Notable changes include raising IDH status and 1p19q codeletion to prominence for diffuse gliomas. Grading now occurs within each tumor type rather than equivalently across types. Molecular features can supersede histology in determining grade.
This document discusses various tumors and lesions that can occur in the posterior fossa region of the brain. It provides CT and MRI images and descriptions of common tumors in this area, including medulloblastoma, ependymoma, choroid plexus papilloma, brain stem gliomas, gangliogliomas, pilocytic astrocytomas, hemangioblastomas, and metastases from other cancers. The document is intended as an imaging guide for physicians to identify and diagnose different infra-tentorial lesions and tumors based on scan findings.
This document summarizes recent advances in the management of high grade gliomas. It discusses current guidelines for radiotherapy treatment planning including target volume delineation. It describes the use of concurrent and adjuvant temozolomide with radiation. Response assessment is based on RANO criteria. Advances discussed include the prognostic value of methylation status and results of trials investigating dose-dense chemotherapy schedules and radiosurgery. MRS is shown to help delineate tumor volumes beyond what is seen on standard MRI alone.
In this presentation, i have explained different modalities available for radiological evaluation of cns tumors. How to approach to a radiographic image and how to approach to a patient of cns tumors radiologically.
Vascular brain lesions for radiology by Dr Soumitra HalderSoumitra Halder
- The document discusses various brain vascular lesions including aneurysms, vascular malformations, dural arteriovenous fistulas, and more.
- Aneurysms are abnormal bulges in arterial walls that can rupture and cause subarachnoid hemorrhage. Imaging like CTA can detect aneurysms with over 90% sensitivity. Treatment options include observation, surgical clipping, or endovascular coiling.
- Arteriovenous malformations are tangled masses of abnormal vessels that shunt blood from arteries to veins without an intervening capillary bed. They can cause headaches or neurological deficits. Treatment involves surgical excision, stereotactic radiosurgery, or endovascular embolization.
-
Brain imaging is important in trauma to identify injuries from primary impact and secondary complications. CT is best for acute trauma to detect fractures and hemorrhages while MRI is more sensitive for diffuse injuries. Common primary injuries seen include fractures, contusions, hematomas, shearing injuries and hemorrhages in various locations. Secondary complications can include swelling, infection and herniations putting pressure on vessels.
Dr Vandana, cranio spinal irradiation, radiotherapy, medulloblastoma, cancer, radiation, treatment, diagnosis, management, natural history of medulloblastoma, signs & symptoms of medulloblastoma,
current approach, future advancements
This document discusses the management of primary central nervous system lymphoma (PCNSL). It begins with defining PCNSL and discussing its epidemiology, which includes that it is a rare brain tumor with an increasing incidence in immunocompromised patients. The standard treatment involves high-dose methotrexate-based chemotherapy followed by whole brain radiotherapy, which provides the best outcomes compared to other regimens. Prognostic scoring systems can help determine a patient's prognosis based on factors like age, performance status, lactate dehydrogenase levels, and tumor location. Ongoing research is evaluating adding agents like cytarabine, thiotepa, and rituximab to standard chemotherapy regimens to improve survival further
This document provides an overview of low grade gliomas (LGGs), including their classification, diagnosis, prognosis, management controversies and treatment options. Some key points:
- LGGs include grade II astrocytomas, oligodendrogliomas and mixed gliomas. The 2016 WHO classification focuses on IDH mutation and 1p/19q codeletion status rather than histology alone.
- Common symptoms are seizures, headaches and focal neurological deficits. Imaging shows non-enhancing lesions that are T2 hyperintense. Prognostic factors like age, performance status and tumor size influence survival.
- Management is controversial due to lack of clinical trials. Options include observation, surgery,
This document discusses the classification and molecular markers of brain tumors according to the WHO. It focuses on gliomas, specifically glioblastoma multiforme and anaplastic astrocytoma. It describes the histopathological and molecular features used to classify these tumors, including markers like IDH1 mutation, 1p/19q codeletion, and ATRX mutation. Molecular testing is becoming increasingly important for diagnosis, prognosis, and predicting response to therapies of diffuse gliomas. The document also discusses treatment approaches including surgical resection and chemotherapy.
This document discusses brainstem gliomas, which comprise about 20% of pediatric brain tumors. It describes various classification systems for brainstem gliomas, including location-based classifications. Focal, discrete tumors have a more favorable prognosis compared to diffuse, infiltrative tumors. The document outlines clinical features, imaging characteristics, surgical approaches, intraoperative monitoring techniques, and management strategies for different types of brainstem gliomas. Diffuse tumors have the worst prognosis and are typically managed with biopsy and radiation therapy due to their infiltrative nature.
This document summarizes the management of high grade gliomas. It discusses the classification, molecular markers, diagnostic evaluation, treatment including surgery, radiation, chemotherapy, prognostic factors and response assessment for these aggressive brain tumors. Key points include the distinction between glioblastoma and anaplastic astrocytoma/oligodendroglioma, the role of maximal safe resection followed by concurrent chemoradiation using temozolomide as the standard of care, and important prognostic markers like MGMT promoter methylation status. Pseudoprogression and pseudoresponse on imaging are also reviewed.
Evolution of treatment strategies of brain tumorsAnil Gupta
The document discusses the evolution of treatment strategies for brain gliomas. It begins by providing background on gliomas and their classification. It then discusses advances in surgery, including neuronavigation, fluorescent guided resection, and intraoperative imaging. It also covers the evolution of radiotherapy techniques from early 2D approaches to modern 3D conformal radiotherapy and intensity modulated radiotherapy. Adjuvant therapies like chemotherapy and targeted drugs are also mentioned. Overall the document traces the development of surgical and radiation based approaches for glioma treatment over time.
This document summarizes guidelines for the radiotherapeutic and surgical management of patients newly diagnosed with brain metastases. It discusses various treatment modalities including whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and surgery. It reviews several studies comparing outcomes of different treatment approaches. The guidelines were developed by an international task group that systematically reviewed the literature to form consensus recommendations. Key findings included no clear survival benefit of adding SRS to WBRT for patients with multiple brain metastases, and that omitting WBRT after surgery or SRS for a limited number of metastases may be reasonable if patients are closely monitored.
1) Brain metastases are the most common intracranial tumors in adults and develop in nearly 30% of cancer patients. They indicate stage IV cancer with a median survival of under 1 year.
2) Treatment options include surgery, whole brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS). WBRT after surgery or SRS is considered the standard of care to prevent neurologic deaths from brain failure.
3) For a single brain metastasis, surgery or SRS with WBRT provides the best outcomes. For multiple metastases, WBRT is often used but SRS has emerged as an alternative for select patients with few metastases.
This is not a original work of mine based on Various text books, Journals and also Power Point presentations too
This is a WHO Classification 2021 Update and with brief about all tumor types.also added are the changes that are made in this classification
helpful for Neurology and Neurosurgery Residents
This Power Point Presentation is useful to revise the final exam
1) Medulloblastoma is the most common malignant brain tumor in children. It arises in the cerebellum and has a tendency to metastasize through the CSF pathways.
2) It is classified into molecular subgroups - WNT, SHH, Group 3, and Group 4 - which have different characteristics and predict survival outcomes.
3) Treatment involves maximal safe surgical resection followed by craniospinal radiation and chemotherapy based on risk stratification into standard-risk and high-risk groups. Modified radiation schedules are being studied to reduce long-term side effects.
This document provides information on astrocytoma neuroimaging and classification. It describes various types of astrocytomas including their cell of origin, common locations, histology, progression, and radiology characteristics. Key points covered include:
- Astrocytomas include low-grade diffuse astrocytoma, anaplastic astrocytoma, and glioblastoma.
- Radiology can show tumor infiltration and characteristics vary from non-enhancing to ring enhancement with necrosis.
- Pathology examines features like cell type, mitoses, and staining for markers like GFAP.
The document discusses medulloblastoma (MB), the most common malignant brain tumor in children. MB originates in the cerebellum and projects into the fourth ventricle. It is thought to arise from primitive neuroepithelial cells. On imaging, MB typically appears as a large lobulated mass in the posterior fossa that compresses the fourth ventricle and causes hydrocephalus. Molecular analysis has classified MB into four subgroups: SHH, WNT, Group III, and Group IV, which have different characteristics and prognoses. Prognostic factors include age at diagnosis, extent of disease, extent of resection, histology, and biological markers.
Brain tumors are responsible for approximately 2% of cancer deaths. They are the most common solid tumors in young patients, accounting for 20% of pediatric cancers. The overall incidence of brain tumors is 8-10 per 100,000 people per year, increasing with age to a maximum of 16 per 100,000 in the 7th decade of life. Brain tumors are classified based on the cell of origin, with gliomas arising from glial cells being the most common type. Astrocytomas range from low-grade to highly malignant and present with symptoms of increased intracranial pressure, focal neurological signs, or epilepsy.
The document discusses central nervous system (CNS) tumors. It notes that CNS tumors can be primary tumors originating in the brain or spinal cord, or metastatic tumors that have spread from other areas. Primary CNS tumors are more common in children, where 70% arise in the posterior fossa, while in adults most primary tumors arise supratentorially. CNS tumors are classified based on the type of tissue they originate from, with the main types being tumors of glial tissue (gliomas), neurons, and meninges. Gliomas include astrocytomas, oligodendrogliomas, and ependymomas, which are graded based on malignancy characteristics.
This document summarizes recent advances in the management of high grade gliomas. It discusses current guidelines for radiotherapy treatment planning including target volume delineation. It describes the use of concurrent and adjuvant temozolomide with radiation. Response assessment is based on RANO criteria. Advances discussed include the prognostic value of methylation status and results of trials investigating dose-dense chemotherapy schedules and radiosurgery. MRS is shown to help delineate tumor volumes beyond what is seen on standard MRI alone.
In this presentation, i have explained different modalities available for radiological evaluation of cns tumors. How to approach to a radiographic image and how to approach to a patient of cns tumors radiologically.
Vascular brain lesions for radiology by Dr Soumitra HalderSoumitra Halder
- The document discusses various brain vascular lesions including aneurysms, vascular malformations, dural arteriovenous fistulas, and more.
- Aneurysms are abnormal bulges in arterial walls that can rupture and cause subarachnoid hemorrhage. Imaging like CTA can detect aneurysms with over 90% sensitivity. Treatment options include observation, surgical clipping, or endovascular coiling.
- Arteriovenous malformations are tangled masses of abnormal vessels that shunt blood from arteries to veins without an intervening capillary bed. They can cause headaches or neurological deficits. Treatment involves surgical excision, stereotactic radiosurgery, or endovascular embolization.
-
Brain imaging is important in trauma to identify injuries from primary impact and secondary complications. CT is best for acute trauma to detect fractures and hemorrhages while MRI is more sensitive for diffuse injuries. Common primary injuries seen include fractures, contusions, hematomas, shearing injuries and hemorrhages in various locations. Secondary complications can include swelling, infection and herniations putting pressure on vessels.
Dr Vandana, cranio spinal irradiation, radiotherapy, medulloblastoma, cancer, radiation, treatment, diagnosis, management, natural history of medulloblastoma, signs & symptoms of medulloblastoma,
current approach, future advancements
This document discusses the management of primary central nervous system lymphoma (PCNSL). It begins with defining PCNSL and discussing its epidemiology, which includes that it is a rare brain tumor with an increasing incidence in immunocompromised patients. The standard treatment involves high-dose methotrexate-based chemotherapy followed by whole brain radiotherapy, which provides the best outcomes compared to other regimens. Prognostic scoring systems can help determine a patient's prognosis based on factors like age, performance status, lactate dehydrogenase levels, and tumor location. Ongoing research is evaluating adding agents like cytarabine, thiotepa, and rituximab to standard chemotherapy regimens to improve survival further
This document provides an overview of low grade gliomas (LGGs), including their classification, diagnosis, prognosis, management controversies and treatment options. Some key points:
- LGGs include grade II astrocytomas, oligodendrogliomas and mixed gliomas. The 2016 WHO classification focuses on IDH mutation and 1p/19q codeletion status rather than histology alone.
- Common symptoms are seizures, headaches and focal neurological deficits. Imaging shows non-enhancing lesions that are T2 hyperintense. Prognostic factors like age, performance status and tumor size influence survival.
- Management is controversial due to lack of clinical trials. Options include observation, surgery,
This document discusses the classification and molecular markers of brain tumors according to the WHO. It focuses on gliomas, specifically glioblastoma multiforme and anaplastic astrocytoma. It describes the histopathological and molecular features used to classify these tumors, including markers like IDH1 mutation, 1p/19q codeletion, and ATRX mutation. Molecular testing is becoming increasingly important for diagnosis, prognosis, and predicting response to therapies of diffuse gliomas. The document also discusses treatment approaches including surgical resection and chemotherapy.
This document discusses brainstem gliomas, which comprise about 20% of pediatric brain tumors. It describes various classification systems for brainstem gliomas, including location-based classifications. Focal, discrete tumors have a more favorable prognosis compared to diffuse, infiltrative tumors. The document outlines clinical features, imaging characteristics, surgical approaches, intraoperative monitoring techniques, and management strategies for different types of brainstem gliomas. Diffuse tumors have the worst prognosis and are typically managed with biopsy and radiation therapy due to their infiltrative nature.
This document summarizes the management of high grade gliomas. It discusses the classification, molecular markers, diagnostic evaluation, treatment including surgery, radiation, chemotherapy, prognostic factors and response assessment for these aggressive brain tumors. Key points include the distinction between glioblastoma and anaplastic astrocytoma/oligodendroglioma, the role of maximal safe resection followed by concurrent chemoradiation using temozolomide as the standard of care, and important prognostic markers like MGMT promoter methylation status. Pseudoprogression and pseudoresponse on imaging are also reviewed.
Evolution of treatment strategies of brain tumorsAnil Gupta
The document discusses the evolution of treatment strategies for brain gliomas. It begins by providing background on gliomas and their classification. It then discusses advances in surgery, including neuronavigation, fluorescent guided resection, and intraoperative imaging. It also covers the evolution of radiotherapy techniques from early 2D approaches to modern 3D conformal radiotherapy and intensity modulated radiotherapy. Adjuvant therapies like chemotherapy and targeted drugs are also mentioned. Overall the document traces the development of surgical and radiation based approaches for glioma treatment over time.
This document summarizes guidelines for the radiotherapeutic and surgical management of patients newly diagnosed with brain metastases. It discusses various treatment modalities including whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and surgery. It reviews several studies comparing outcomes of different treatment approaches. The guidelines were developed by an international task group that systematically reviewed the literature to form consensus recommendations. Key findings included no clear survival benefit of adding SRS to WBRT for patients with multiple brain metastases, and that omitting WBRT after surgery or SRS for a limited number of metastases may be reasonable if patients are closely monitored.
1) Brain metastases are the most common intracranial tumors in adults and develop in nearly 30% of cancer patients. They indicate stage IV cancer with a median survival of under 1 year.
2) Treatment options include surgery, whole brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS). WBRT after surgery or SRS is considered the standard of care to prevent neurologic deaths from brain failure.
3) For a single brain metastasis, surgery or SRS with WBRT provides the best outcomes. For multiple metastases, WBRT is often used but SRS has emerged as an alternative for select patients with few metastases.
This is not a original work of mine based on Various text books, Journals and also Power Point presentations too
This is a WHO Classification 2021 Update and with brief about all tumor types.also added are the changes that are made in this classification
helpful for Neurology and Neurosurgery Residents
This Power Point Presentation is useful to revise the final exam
1) Medulloblastoma is the most common malignant brain tumor in children. It arises in the cerebellum and has a tendency to metastasize through the CSF pathways.
2) It is classified into molecular subgroups - WNT, SHH, Group 3, and Group 4 - which have different characteristics and predict survival outcomes.
3) Treatment involves maximal safe surgical resection followed by craniospinal radiation and chemotherapy based on risk stratification into standard-risk and high-risk groups. Modified radiation schedules are being studied to reduce long-term side effects.
This document provides information on astrocytoma neuroimaging and classification. It describes various types of astrocytomas including their cell of origin, common locations, histology, progression, and radiology characteristics. Key points covered include:
- Astrocytomas include low-grade diffuse astrocytoma, anaplastic astrocytoma, and glioblastoma.
- Radiology can show tumor infiltration and characteristics vary from non-enhancing to ring enhancement with necrosis.
- Pathology examines features like cell type, mitoses, and staining for markers like GFAP.
The document discusses medulloblastoma (MB), the most common malignant brain tumor in children. MB originates in the cerebellum and projects into the fourth ventricle. It is thought to arise from primitive neuroepithelial cells. On imaging, MB typically appears as a large lobulated mass in the posterior fossa that compresses the fourth ventricle and causes hydrocephalus. Molecular analysis has classified MB into four subgroups: SHH, WNT, Group III, and Group IV, which have different characteristics and prognoses. Prognostic factors include age at diagnosis, extent of disease, extent of resection, histology, and biological markers.
Brain tumors are responsible for approximately 2% of cancer deaths. They are the most common solid tumors in young patients, accounting for 20% of pediatric cancers. The overall incidence of brain tumors is 8-10 per 100,000 people per year, increasing with age to a maximum of 16 per 100,000 in the 7th decade of life. Brain tumors are classified based on the cell of origin, with gliomas arising from glial cells being the most common type. Astrocytomas range from low-grade to highly malignant and present with symptoms of increased intracranial pressure, focal neurological signs, or epilepsy.
The document discusses central nervous system (CNS) tumors. It notes that CNS tumors can be primary tumors originating in the brain or spinal cord, or metastatic tumors that have spread from other areas. Primary CNS tumors are more common in children, where 70% arise in the posterior fossa, while in adults most primary tumors arise supratentorially. CNS tumors are classified based on the type of tissue they originate from, with the main types being tumors of glial tissue (gliomas), neurons, and meninges. Gliomas include astrocytomas, oligodendrogliomas, and ependymomas, which are graded based on malignancy characteristics.
O artigo fala sobre a reabilitação em pacientes com tumores cerebrais sob uma visão multidisciplinar, visando a funcionalidade e tratamento das sequelas.
Primary brain tumors are a diverse group of neoplasms that can arise from different cells in the central nervous system. The most common primary brain tumor in adults is brain metastasis. Meningiomas are the most common non-malignant primary brain tumor, followed by pituitary and nerve sheath tumors. Gliomas account for 75% of malignant brain tumors, over half of which are glioblastomas. Primary brain tumors are classified and graded according to the WHO system, with grade I being low proliferative potential and grade IV being most malignant. Clinical features vary depending on tumor location but often include headaches, nausea, seizures, and focal neurological deficits.
Primary brain tumours are a diverse group of neoplasm arising from different cells of the central nervous system.
It accounts for about 2% of all cancers with an overall annual incidence of 22 per 1,00,000 population.
Most common brain tumour in adults is Brain Metastasis.
Primary brain tumors occur in around 250,000 people globally each year, accounting for less than 2% of all cancers. The most common primary brain tumors are meningiomas (20.8% of cases) and gliomas (50.4% of cases), which originate from glial cells. Gliomas include astrocytomas, oligodendrogliomas, and ependymomas. Astrocytomas are the most common glioma and are graded from I to IV based on factors like cellularity and presence of necrosis, with glioblastoma multiforme being grade IV. Meningiomas originate from the meninges and are typically benign, though some can become malignant. Primary brain tumors are
1) Brain tumors are the 20th most common malignancy worldwide and their incidence varies based on factors like age, sex, and race.
2) Diagnostic workup involves imaging like MRI and CT scans, cerebrospinal fluid examination, and biopsy when needed. Molecular testing helps classify tumors.
3) Treatment depends on tumor type and grade but generally involves surgery, radiation, chemotherapy, and targeted therapies. Management of symptoms is also important.
4) Prognosis depends on tumor specific factors and can range from months to over 10 years depending on the tumor characteristics.
Meningiomas are the most common benign brain tumors. They originate from the meninges and are usually benign, though some can be atypical or malignant. Complete surgical resection is the primary treatment and aims for Simpson Grade I removal. Factors like tumor location, size, and shape impact recurrence risk. While radiation can be used for incomplete resection or recurrence, no medical therapies have significantly impacted meningioma progression. Careful preoperative planning including vascular imaging is important. Total resection is often achievable with meticulous dissection at the tumor-arachnoid interface while avoiding overzealous coagulation. Extended endoscopic approaches have higher complication risks than traditional microsurgery. Case examples demonstrated total resection of meningi
This document discusses primary central nervous system lymphoma (PCNSL) through several sections. It begins with an introduction that defines PCNSL and classifications. It then covers the pathology of PCNSL through sections on cell origin and pathogenesis, epidemiology, macroscopic and microscopic features, immunohistochemistry, genetics, radiology, growth patterns and spread, grading/behavior, and prognosis. Further sections discuss the presentation, differential diagnosis, investigations, and management protocol for patients with PCNSL.
Primary brain tumors originate from cells within the brain and can cause a variety of symptoms depending on their location. Common symptoms include increased intracranial pressure manifesting as headaches, nausea and vomiting, and vision changes. Diagnostic tests like CT, MRI, and EEG are used to identify tumors and develop a treatment plan which may involve surgery, radiation therapy, chemotherapy, or a combination. The goal of treatment is relief of symptoms and removal of as much of the tumor as possible without worsening neurological function.
I LOVE NEUROSURGERY INITIATIVE: INTRACRANIAL TUMORS.pptwalid maani
This document discusses intracranial tumors, including:
- Their incidence rates, with primary brain tumors occurring in 6 per 100,000 people and metastatic tumors in 30 per 100,000 people.
- Common tumor types like astrocytomas, oligodendrogliomas, ependymomas, medulloblastomas, meningiomas, and pituitary tumors.
- Risk factors, clinical presentation, investigations including CT, MRI, PET and angiography, pathology classification, and management approaches like surgery, radiation and chemotherapy.
This document discusses central nervous system tumors. It covers the cell types that make up the brain and spinal cord, including neurons, glia and other supporting cells. It notes that CNS tumors in children differ from those in adults in terms of location and histologic subtype. The document then classifies CNS tumors into nine categories based on the cell or tissue of origin, including tumors of glial tissue, neurons, mixed glial and neuronal tumors, poorly differentiated embryonal tumors, meninges tumors, and metastatic tumors from other sites. The overall goal is to discuss benign and malignant brain tumors and related familial tumor syndromes.
The document describes a 35-year-old male who presented with seizures. Imaging showed a lesion in the right frontal lobe suspected to be an ischemic infarct. Further MRI revealed features suggestive of an anaplastic astrocytoma. The patient underwent surgery and the tumor was diagnosed as a low-grade oligodendroglioma. The patient is currently undergoing radiotherapy.
The document provides an overview of central nervous system (CNS) tumor classification, grading, incidence, clinical presentation, diagnosis, types, pathobiology, and treatment. It discusses various types of glial and non-glial brain tumors such as glioblastoma, astrocytoma, oligodendroglioma, ependymoma, medulloblastoma, and meningioma. It also covers tumor grading systems, common genetic mutations in brain cancers, surgical resection, radiation therapies including stereotactic radiosurgery, chemotherapy, anti-angiogenic and immunotherapies.
This presentation reviews the current neurosurgical management of patients with medulloblastoma, including the data on molecular subtyping; uses “medulloblastoma” as a springboard to discuss other topics / tumor cell biology in general; and formulates research questions to further advance neurosurgical basic science.
Brain tumors can be primary (originating in the brain) or secondary (metastatic tumors from other areas). The most common primary brain tumors are gliomas, which originate from glial cells and infiltrate the brain tissue, making complete removal difficult. Meningiomas originate from the meninges and are usually benign. Pituitary adenomas account for 10-15% of brain tumors and can cause hormonal issues or pressure effects. Diagnostic tests include CT, MRI, biopsy and lumbar puncture. Treatment involves surgery, radiation, chemotherapy or a combination depending on tumor type and location. Nursing care focuses on neuro assessments, managing increased intracranial pressure, preventing injury and assisting with functional deficits.
This document discusses several types of childhood solid tumors, including central nervous system (CNS) tumors and neuroblastoma. It provides information on:
1) CNS tumors are the second most common malignancy in childhood, with astrocytomas making up 40% of cases. The most common astrocytoma is juvenile pilocytic astrocytoma.
2) Neuroblastoma is the most common extracranial solid tumor in childhood, arising from the sympathetic nervous system. It typically presents before 5 years of age and stages range from localized to widespread metastasis.
3) Treatment approaches for neuroblastoma and CNS tumors involve multimodal therapy including surgery, chemotherapy, and sometimes radiation
This document presents a seminar on glioblastoma multiforme (GBM) by Nuhu Sani Usman. It discusses key topics such as epidemiology, pathogenesis, risk factors, symptoms, diagnosis and treatment of GBM. GBM is the most common malignant brain tumor in adults, occurring more often in males than females with an average age of diagnosis of 64 years. Symptoms vary depending on the location of the tumor but may include headaches, vomiting and seizures. Diagnosis involves neurological exams, imaging tests and biopsy. Treatment options include surgery, chemotherapy, radiation therapy and tumor treating fields therapy. However, survival rates for GBM remain poor with approximately 40% surviving one year and 17% surviving two years.
Similar to Brain tumors 2020 by Assist.Prof. Ines Strenja MD, PhD Clinical hospital Rijeka, Neurology Dpt (20)
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
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2. • Brain tumors are a diverse group of
neoplasms arising from different cells
within the central nervous system (CNS) or
from systemic cancers that have
metastasized to the CNS.
4. Brain Tumor Characteristics
Start in the brain and grow steadily there.
Very rarely spread to other organs through the bloodstream.
Are named for the anatomic location of tumor and/or the cells from
which they arise, each having a certain function essential to normal
physiological functioning of the brain.
For example:
• Brain Stem Gliomas arise in the lowest part of the brain.
• Meningiomas arise in the meninges.
• Gliomas arise from glial cells that support the CNS.
• Astrocytomas arise from astrocytes
• Ependymomas arise from ependymal cells which line the ventricles
• Oligodendrogliomas arise from oligodentdrocyte cells which make up the
fatty substance called myelin that covers nerves like electrical insulation.
5. CNS tumor classification
• Based on the location (topography)
• Based on morphology ( histology)
• Based on the biological behavior ( malignant
or benign)
6. • Skull bones
• Meninges
• Neurons
• Neuroglia - macroglia
(astrocytes and
oligodendrocytes), ependymal
cells and microglia
• Blood vessels
• Pituitary
• Pineal gland
• The rest of the embryonic
epithelium
Tumors inside the skull
(origin)
7.
8. Spinal tumors
(origin)
• Spinal cord parenchyma
• Spinal sheaths (meninges)
• Spinal nerve root
• Spinal blood vessels
• Parts of the vertebrae
9.
10. Biological behavior of tumors
Criteria for establishing the stages of tumor malignancy
• Cell pleomorphism
• Nuclear atypia
• Mitotic index
• Vascular proliferation
• Necrosis
Tumor Behavior
Benign Tumors - Slow growing, Distinct borders, Rarely, spread
Malignant Tumors - Usually rapid growing, Invasive Life threatening
Borderline Malignant Tumors – Rare, Likely to Recur following Surgical Resection,
May become Life threatening
11. 1. Tumors of Neuroepithelial Tissue
2. Tumors of Cranial and Spinal Nerves
3. Tumors of the Meninges
4. Lymphomas and Hematopoietic Neoplasm
5. Germ Cell Tumor
6. Tumors of the Sellar Regions( pituitary /craniopharyngioma)
7. Metastatic Tumors
For the past century, the classification of brain tumors has been based largely on
concepts of histogenesis: Light microscopic features in hematoxylin and eosin
sections, immunohistochemical expression of proteins an ultrastructural
characterization.
WHO IV. classification of brain tumors 2007. and updates of
CNS tumors 2016. godine
19. Figure 2. Diagnostic schema for WHO World Health Organization grades II and III infiltrating gliomas in adults.
Johnson DR. Published Online: October 13, 2017
https://doi.org/10.1148/rg.2017170037
In primary brain malignant tumors, the presence of a genetic mutation is particularly important -
isocitrate dehydrogenase mutation (IDH1 / 2 mutation) and 1p / 19q chromosomal codellation.
Thus, a completely new diagnosis of glioblastoma multiforme in relation to the presence of IDH1
mutations would be: Glioblastoma, IDH mutant or wild type.
22. BRAIN TUMOR INCIDENCE
• The proportion of brain tumors is 2% of all tumors
• The frequency of various tumor types and grades varies by
age group..f.e.
• Meningiomas and glial tumors (eg, glioblastoma,
astrocytoma, oligodendroglioma) account for
approximately two-thirds of all primary brain tumors in
adults
• 50% of children's brain tumors are infratentorial
• 4/5 intracranial tumors
• 1/3 of brain tumors are malignant
• The frequency increases with age, most tumors occur in
the 6th decade of life!
23. EPIDEMIOLOGY OF BRAIN TUMOR
Rates of incidence for primary brain tumors in the Republic of
Croatia based on methodologically similar research projects
are between 4,57 – 15,8/100.000. (28,3/100.000 in Valle
d’Aosta, Italy)
Generally higher rates of incidence are associated to countries
with highly efficient and organisied epidemiological and
medical services (diagnostics, higher amount of autopsies
USA 29,9/100 000 - adults, 5.9/100 000 - children
Malignant tumor 60% children vs 30% adults
24.
25. • Glioms – most common tumors (30%)
• Glioblastoma as a majority
• Meningeoma (40%)
• Frequency of metastatic forms of brain tumors
increases with age (50% above the age of 40)
• Gender ratio (M- F) - 0,9-2,6 – difference between
specific histologic types based on the gender (Glioma
more common in M, meningeoma in F)
• Incidence rates differ based on age
• Mortality data on individuals with brain tumors
indicate that younger patients have a significantly
better prognosis compared with older individuals
27. CNS tumors aged 0 to 19
• Malignant brain and other CNS
tumors are the most common
cancer site in children up to
age 14 years, followed by
leukemia and soft tissues, and
the most common cause of
cancer death
• The CNS is the third most
common cancer site among
adolescents and young adults
32. Risk factors for brain tumors
Ionizing radiation is the only firmly established
environmental risk factor for brain tumors. Cohort
studies of atomic bomb survivors and childhood
cancer survivors have demonstrated that cranial
radiation is associated with increased risk for a
variety of brain tumors, including meningiomas,
gliomas, and nerve sheath tumors
The association between forms of nonionizing
radiation, such as low-frequency electromagnetic
fields and radiofrequency fields, and cancer is less
clear, and the data do not support an important role
for these types of radiation as risk factors for brain
tumors.
33. Risk factors for brain tumors…
There is no solid evidence of the influence of environmental
factors or the workplace on the occurrence of brain tumors,
although the connection in some workers, such as miners, oil
workers, rubber workers--
Infections / Toxoplasma g. Astrocyte and meningioma in 2
studies /
Ionizing radiation of the skull possible cause of meningioma,
glioma or neurinoma - glioma or neurinoma - for 5 years
continuously
Head irradiation and rdg imaging of teeth may be associated
with a risk of developing gliomas and meningiomas
Chemical substances (herbicides, pesticides); some viruses
(experiment)
Exposure to electromagnetic fields is cited in the literature
as a potential risk factor but there is no conclusive evidence
34. Corle C, Makale M, Kesari S. Cell phones and glioma risk: a review of the
evidence. J Neurooncol 2012; 106:1.
Musicco M, Sant M, Molinari S, et al. A case-control study of brain
gliomas and occupational exposure to chemical carcinogens: the risk to
farmers. Am J Epidemiol 1988; 128:778.
Piel C, Pouchieu C, Tual S, et al. Central nervous system tumors and
agricultural exposures in the prospective cohort AGRICAN. Int J Cancer
2017; 141:1771.
35. Genetic role CNS tumor development
A small proportion of brain tumors are due to
genetic syndromes that confer an increased risk of
developing tumors of the nervous system. These
include neurofibromatosis type 1 (NF1),
neurofibromatosis type 2 (NF2), von Hippel-Lindau
syndrome, Li-Fraumeni syndrome, familial
adenomatous polyposis, and the basal cell nevus
syndrome. Genetic susceptibility has also been
noted to play a role in determining risk of brain
tumors, although collectively these variants do not
account for a large proportion of risk.
36. 5% of patients have a predisposing genetic
syndrome for cancer
Neurofibromatosis is an autosomal dominant
disease, there are 2 types:
Type 1 (von Recklinghausen's disease) is the
most common, and causes neurological,
cutaneous and sometimes orthopedic
manifestations. TNF gene on chromosome 22
Type 2 Neurofibromatosis is manifested
primarily
37. von Recklinghausen's disease
Neurofibromatosis
•5% of patients have a predisposing genetic
syndrome for cancer
•Neurofibromatosis is an autosomal
dominant disease, there are 2 types:
Type 1 (von Recklinghausen's disease)
is the most common, and causes
neurological, cutaneous and sometimes
orthopedic manifestations. NF1 on
chromosome 17
Type 2 Neurofibromatosis is manifested
primarily congenital bilateral neuromas of
the auditory nerve, NF2 on chromosome 22
38. Possible causative factors that require further
investigation include allergies, nonionizing
radiation, physical and acoustic trauma, and
certain infection….
Holdhoff M, Guner G, Rodriguez FJ, et al. Absence of Cytomegalovirus in
Glioblastoma and Other High-grade Gliomas by Real-time PCR,
Immunohistochemistry, and In Situ Hybridization. Clin Cancer Res 2017; 23:3150.
Taha MS, Abdalhamid BA, El-Badawy SA, et al. Expression of cytomegalovirus in
glioblastoma multiforme: Myth or reality? Br J Neurosurg 2016; 30:307.
39. • Clinical course
Slow clinical course is shown by astrocytomas,
oligodendrogliomas, meningiomas, acoustic neuromas,
pituitary adenomas
Rapid clinical course has glioblastoma multiforme and
metastatic tumors!
• Symptoms and signs two groups:
Symptoms of increased intracranial pressure
Focal symptoms and signs
40. CLINICAL MANIFESTATIONS
Patients with brain tumors may present with
generalized and/or focal signs and symptoms
or they may be asymptomatic
General symptoms (signs of increased ICP)
Focal symptoms
41. The way the symptoms occur can be different:
Combination of progressive focal symptoms and
symptoms of elevated intracranial pressure (IP)
Only signs of increased intracranial pressure
Generalized epileptic seizures
Apoplectiform onset with loss of consciousness and
focal signs
42. Pathophysiology of CNS tumors
Expansion – tumor enlargement
around the central core with
compromised and susceptible to
destruction
Infiltration – spreading of the
tumor and ingrowth in the
proximal tissue, capable of
spreading to a significant distance
43. General symptoms
Headache
Vomiting
Edema of the optic nerve papilla (fundus)
Changes in heart rhythm (bradycardia,
tachycardia, arrhythmia)
Respiratory rhythm changes
Mental changes symptoms- irritability,
behavioral changes
Epileptic seizures
45. Brain edema around the tumor …
• Vasogenic edema – increase of
capillary permeability due to a
blood brain barrier disfunction
• Edema leeds to increase of
intracranial pressure (ICP)
• Obstruction CSF
• Focused neurological disorders
• Epileptic seizures
• Hypophyisis function disorder
46. Headache
Headache is a common manifestation of brain tumors and a
presenting symptom in up to half of patients, usually dull and
constant, but occasionally throbbing.
Symptom severity tends to progress over time. Severe headaches
are infrequent unless increased intracranial pressure (ICP) or
meningeal irritation is present.
Patients may report worsening of headache after a change in body
position, such as bending over, or with maneuvers that raise
intrathoracic pressure, such as coughing, sneezing, or the Valsalva
maneuver.
Tumor-related headaches may be worse at night and may awaken
the patient
Other features suggestive of a brain tumor or other causes of
secondary headache in a patient complaining of headaches include
new and progressive symptoms, morning nausea and vomiting,
a significant change in prior headache pattern, and an
abnormal neurologic examination.
47. Seizures
Focal seizures are among the most common
symptoms of primary and metastatic brain tumors
Seizures affect 50 to 80 % of patients with primary
brain tumors and 10 to 20 % of patients with
metastatic tumors
Among primary brain tumors, low-grade tumors are more
likely to cause seizures than high-grade tumors.
The clinical manifestations of focal seizures depend
upon tumor location…frontal lobe tumors may cause
focal tonic-clonic movements involving one extremity,
while seizures originating within the occipital lobe may
cause visual disturbances. Temporal lobe seizures,
with abrupt sudden behavioral changes may occur with
or without typical preseizure auras, such as abnormal
smell, taste, or gastrointestinal symptoms…
Focal-onset seizures Generalized tonic-
50. Increased intracranial pressure (ICP) - FACTS
Increased ICP can arise either from a large
mass or from restriction of cerebrospinal fluid
(CSF) outflow causing hydrocephalus.
Symptoms may be subtle or consist of the
classic triad of headache, nausea, and
papilledema.
Intratumoral bleeding
Peritumoral edema
The mechanism of brain autoregulation is lost,
cerebral perfusion is reduced, the end result is brain
herniation!
51. The types of brain herniation
• (1) cingulate gyrus herniation, (subfalcine herniation), occurs below the
falx cerebri.
• (2) lateral tentorial herniation (temporal uncus herniation), is the
herniation of medial edge of the temporal lobe (uncus) through the
tentorial notch.
• (3) central tentorial herniation, is a vertical displacement of the brainstem
and diencephalon through the tentorial notch.
• (4) cerebellar tonsil herniation, is the protrusion cerebellar tonsil through
the foramen magnum.
• (5) herniation of brain-tissue through the craniotomy defect.
56. Glioma
Glioma is the most common form of central nervous system
(CNS) neoplasm that originates from glial cells
45% of all intracranial tumors
They are formed by the proliferation
of glial cells
Degrees of malignancy from I-IV
55% of gliomas are astrocytomas
Pilocytic astrocytoma has a survival
of 10 years!
Glioblastoma multiforme (grade IV)
very malignant, cystic degeneration
and bleeding into the tumor are
common, survival 1 year
59. Oligodendroglioma
Most often in the 6th decade of
life
Contains higher amounts of
calcium (craniogram)
Slow-growing glial tumor, more
common in men
More often in the frontal lobe
Often butterfly spreading to
another hemisphere of the brain
Low-grade oligodenrogliomas
with the most epileptogenic
tumors
60. Ependymoma
Ependymoma is a type of tumor that
can form in the brain or spinal cord.
Most often occurs in young children,
can occur at any age
They arise most frequently in
the fourth ventricle and
cause hydrocephalus by blocking CSF
flow
Very often they can give droplet
metastases via cerebrospinal fluid to
other parts of the CNS
Only 45% of children survive 5 years,
poor prognosis!
Spinal ependymoma
61. Medulloblastoma
Childhood tumor, , ¾ up to 9
years, more common in boys
with a worse prognosis in them
Posterior cranial fossa
Very malignant. Hypocephalus
develops early with morning
sickness and vomiting, double
vision, and symptoms of
cerebellar dysfunction with
truncal ataxia, Nystagmus
Survival time 1 year.
Tendency to metastasize via
cerebrospinal fluid
TH. Surgery, radiotherapy,
chemotherapy, immunotherapy
62. Primary CNS lymphoma
PCNSL is now known to be a formof
extranodal, high-grade non-Hodgkin
B-cell neoplasm, usually large cell or
immunoblastic type. Rare <2% BT
It originates in the brain,
leptomeninges, spinal cord, or eyes;
typically remains confined to the
CNS; and rarely spreads outside the
nervous system.
Corticosteroids are avoided during
the initial workup, because their
administration may have a direct
antitumor effect on B-cell lymphoma
and cause dramatic reduction in MRI
abnormalities, making biopsy and
histologic confirmation more diff.
63. Meningeoma
Benign tumor that arises from the
meninges
Middle age
Slow growth
Malignant alteration
Most common form of BT, about
80% Grade I, which is usuallybe
cured by surgery. <1% aggresive!
MOST COMMON SITES: parasagittal
(falks) (25%), convexity (19%),
sphenoid bone (17%), suprasellar
(tuberculum) (9%), posterior
cranial fossa (9%), olfactory groove
(8%).
67. (A) Axial T1-weighted MRI showing edematous left temporal lobe with loss of sulci
and gray-white demarcation.
(B) After gadolinium infusion, a circular 2.5 cm x 2.5 cm area of irregular contrast
enhancement is seen in the left temporal lobe (arrow).
GLIOBLASTOMA
68. Left temporal glioblastoma
Brain MRI in a 53-year-old male presenting with several weeks of headaches and word-finding
difficulties. FLAIR (A) and postcontrast T1-weighted images (B) show a large, T2-hyperintense
mass in the left temporal lobe with heterogeneous enhancement and central necrosis. Pathology
confirmed a WHO grade IV glioblastoma.
MRI: magnetic resonance imaging; FLAIR: fluid-attenuated inversion recovery; WHO: World
Health Organization.
69. MRI appearance of low-grade oligodendroglioma
Brain MRI in a 40-year-old male presenting with first-time generalized tonic-clonic seizure.
Pathology confirmed a WHO grade II oligodendroglioma, IDH1 mutant, 1p19q-codeleted.
(Panel A) Axial FLAIR image showing a T2-hyperintense, expansile mass in the right frontal
lobe.
(Panel B) Post-contrast axial T1-weighted image showing no appreciable contrast
enhancement.
70. CT and MRI appearance of diffuse intrinsic pontine
glioma
(A) Axial unenhanced CT of the brain shows diffuse, symmetric low attenuation expansion of the pons
(arrows). There is mass effect on the ventral aspect of the fourth ventricle (arrowhead).
(B) An axial T2-weighted image reveals a large pontine mass associated with diffuse high signal
intensity (arrows). An area of signal heterogeneity within the tumor likely reflects necrosis (dashed
arrow).
(C) A sagittal Gd-enhanced T1-weighted image shows non-enhancement of the central necrotic region
(asterisk), enhancement of the region surrounding the necrosis (arrow), and non-enhancement of the
rest of the tumor (dashed arrow).
CT: computed tomography; MRI: magnetic resonance imaging; Gd: gadolinium.
71. The MRI examination in the transverse plane is from a 63-year-old
female with primary CNS lymphoma.
• The T1 weighted sequence (A)
reveals a single mass that
infiltrates the splenium of corpus
callosum [a relatively common
location for primary CNS
lymphoma] (arrow), abutting the
third ventricle anteriorly. The
mass enhances homogeneously
following gadolinium
administration (B), is relatively
dark on T2 weighted images (C),
and reveals restricted diffusion
on the diffusion weighted
sequence (bright, D). The reader
should note the relative lack of
edema on flair studies. These
features are consistent with the
diagnosis of primary lymphoma
of the brain.
72. CNS metastasis from melanoma
Axial images of a brain magnetic resonance imaging (MRI) study demonstrating an
intracerebral metastasis in a patient with melanoma. Following the injection of contrast
(B) the lesion enhances with a ring-like pattern.
(A) Pre-contrast.
(B) Post-contrast.
• Systemic cancers
most likely to
metastasize to the
CNS include lung
cancer, melanoma,
and breast cancer.
73. Intracranial meningioma
• A 70-year-old woman presented
with a several-week history of
confusion. Panels (A, B): Non-
contrast and contrast-enhanced
head CT shows a large bifrontal
lesion with calcifications and
surrounding edema.
• Panels (C, D): Non-contrast and
contrast-enhanced T1-weighted
axial MR images of the head also
demonstrate large flow voids
representing blood vessels in the
center of the tumor.
• Panel (E): Non-contrast T1-
weighted sagittal MR image.
Panel (F): Contrast-enhanced T1-
weighted coronal MR image.
74.
75. Brain MRI tumefactive demyelination
Axial FLAIR image (A) demonstrates a large demyelinating lesion in the left frontal lobe
with mass effect that shows peripheral enhancement on post-contrast T1-weighted
image (B).
MRI: magnetic resonance imaging; FLAIR: fluid-attenuated inversion recovery.
76. Therapy
The choice of treatment depends on the type of
tumor, localization, stage of the disease, age and
general condition of the patient
Radical surgery Maximum reduction + radiation
Radiosurgery
Primary radiation + symptomatic (antiedematous,
antiepileptic) + Cytostatics
Chemotherapy
Immunotherapy
77. The pathological diagnosis of CNS tumors is a multi-step process starting with tumor tissue and
in some cases also blood samples being analyzed with multiple tests to provide an integrated
diagnosis. Evaluation and discussion of the pathological diagnosis by a multidisciplinary board of
specialists from radiology, surgery, oncology, and (neuro)pathology is crucial for translating the
findings into optimal therapeutic management for individual patients.
79. RADIOTHERAPY
Cobalt, a linear accelerator, a
radiotherapy device, or the
implantation of radioactive
material into the tumor itself.
2 -4 weeks after surgery.
Irradiation is carried out by
external beams of radiation up to a
total dose of 50 to 60 Gy in 25 to
30 fractions.
Side effects of radiotherapy: acute
(edema and elevated ICP) and in
case of radiation overdose later
chronic side effects that are
irreversible, cerebral radionecrosis,
brain atrophy and dementia!!
80. RADIOSURGERY - GAMMA KNIFE
a device by which, with 201 radioactive air from a CO - 60
source, it is precisely directed to the area of the brain for the
treatment of tumors
82. Spinal Tumors
Intramedular
Ekstramedular
- intradural
- ekstradural
- ekstravertebral
10% of CNS tumors
Rare among children and elderly
83. Pathophysiological features of spinal
tumors
• Compression, iritation and straining of
spinal nerve roots
• Compression and dislocation of spinal
marrow
• Invasion and destruction of spinal marrow
• Spinal bloodstream disfunction
• Obstruction of CSF
84. Clinical picture of spinal ekstramedullar tumors
Pain and paresthesia (roots)
Motoric disorders with muscle
hypothrophy with lesions
Pyramidal lesion (spastic paralysis)
Sphincter dysfunction
Spinal cord necrosis – symptoms
of complete transversal lesion with
paraplegia and kompletne
transverzalne lezije s paraplagijom
i complete loss of sensations
85. Clinical picture of spinal intramedullar tumors
Sphincter disorders (more often
retention)
With their infiltrative growth,
they affect several segments of
the spinal cord
Various sensory disturbances
(similar to syringomyelia)
86. SPINAL METASTASES
Metastatic lesions are most
common tumors of the spine
(95-98%)
5-10% of the patients with
cancer develop spine metastases
All age groups with highest age
incidence in between 40 and 65
years
Male:Female – 3:2
Vertebral body affected first
Approximately 70% of patients
who die of cancer have evidence
of vertebral metastases on
autopsy
INTRASPINALNE METASTAZE
21%
15%
10%
10%
9%
7%
5%
4%
4%
15%
dojka
pluća
prostata
limforetikular
sarkom
bubreg
gastrointestinalni
melanom
nepoznat primarni
mješano
88. Immunotherapy as a new therapeutic option!
• Immunotherapy is the latest branch of modern oncology that
uses the body's immune system, either directly or indirectly, to
fight cancer.
• Monoclonal antibodies against immune system molecules
(Immune anti-checkpoint blockade therapy)
89. Checkpoint receptors such as cytotoxic T-lymphocyte antigen 4 (CTLA-4)
and programmed cell death receptor-1 (PD-1) (PD-1L) suppress T cell
activation, proliferation and function, thereby promoting proliferation.
90.
91. Figure 1. Summary of the different malignant brain tumors , their name-derived cell
of origin,