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Brain Neoplasms: General Considerations

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1 Brain Neoplasms: General Considerations
1. Comprise: 10% of all tumors 2. Most common childhood neoplasms 3. Peak incidence at 5th decade 4. Supratentorial tumors in adults 5. Infratentorial tumors in childhood

2 Brain Neoplasms: General Considerations
6. Different tumors in different ages 7. Primary tumors infiltrative, metastatic well-demarcated 8. Intraneural seeding occur, but no extraneural metastasis 9. Produce neurologic symptoms by size, location, invasiveness, and secondary effects

3 Varieties of brain tumors
Meninges: meningioma, hemangiopericytoma Astrocytes: astrocytoma (various types) Oligodendrocytes: oligodendroglioma Ventricles: ependymoma, choroid plexus papilloma, colloid cyst Vascular: hemangioblastoma Primitive cells: germinoma, medulloblastoma, neuroblastoma, pineoblastoma, retinoblastoma Neuronal: ganglioglioma, gangliocytoma Pituitary: adenoma, craniopharyngioma Nerves: schwannoma, neuroblastoma

4 Incidence of Intracranial Gliomas (All ages)
Glioblastomas Astrocytomas Ependymomas Medulloblastomas Oligodendrogliomas Choroid plexus papillomas Colloid cysts 55.0% 20.5% 6.0% 5.0% 2.0%

5 Incidence of Primary Intraspinal Intramedullary Gliomas
63.0% 24.5% 7.5% 3.0% 2.0% Ependymomas Astrocytomas (grades 1 and 2) Glioblastomas (Astrocytomas grades 3 and 4) Oligodendrogliomas Other tumors

6 Frequent brain tumors Meningioma Astrocytoma/glioblastoma
Oligodendroglioma Ependymoma Medulloblastoma Schwannoma/neurofibroma Phakomatosis

7 Meningioma Arachnoid cells origin Attached to dura, subdural
Common sites Changes in cranium Hyperostosis Invasion Microscopic: whorls and psammoma bodies





12 Gliomas Astrocytes- astrocytomas Fibrillary Pilocytic
Oligodendrocytes- oligodendrogliomas Ependyma- ependymomas

13 Astrocytomas Adults: Childhood: Supratentorial Solid Malignant
Infratentorial Cystic Benign

14 Adult vs childhood astrocytomas
Adult: fibrillary. Grading varies from low grade malignancy to one of most malignant brain tumor. Childhood: pilocytic. Very low grade tumor (benign).

15 Fibrillary astrocytomas
Grossly solid Common in cerebral hemispheres Low grade in young, higher grade in older Grading astrocytoma (low grade) Anaplastic astocytoma glioblastoma multiforme


17 Fibrillary astrocytoma: microscopic
Low grade- hypercellularity, pleomorphism Anaplastic- as above plus mitosis, vascular endothelial proliferation Glioblastoma multiforme- as above plus necrosis and pseudopalisades. Grossly variegated appearance (multiforme)




21 Pilocytic astrocytoma
Common in childhood Most slow growing of the gliomas Sites: cerebellum, around III V., optic nerve Grossly cystic with mural nodule Microscopic elongated hair-like (pilo) elongated cells Rosenthal fibers

22 Rosenthal fiber definition
Dense, eosinophilic fibers within cytoplasmic processes of astrocytes. Correspond to aggregate accumulation of intermediate filaments in these processes.



25 Oligodendroglioma Slow growing tumor Potentially malignant



28 Tumors in Ventricles 1. Ependyma: Ependymoma
2. Choroid Plexus: Papilloma

29 Ependymomas Arise from ependymal lining- ventricles and central canal of spinal cord Common in childhood 4th V. common in cerebrum Most common tumor of spinal cord parenchyma in adult Microscopic perivascular pseudorosettes ependymal rosettes



32 Primitive neuroectodermal tumors
Neuroblastoma- cerebral hemispheres Medulloblastoma- cerebellum Ependymoblastoma- ventricles Pineoblastoma- pineal region

33 Medulloblastoma Origin: primitive neuroectodermal cells
Age: 1st decade of life Site: vermis of cerebellum May cause hydrocephalus Subarachnoid dissemination



36 Histologic patterns: definitions
Whorls: onion-skinning pattern of tumor cells Psammoma bodies: laminated calcium Pseudopalisading: lining up of the tumor cells around a central necrotic area Palisade: lining up of tumor cells around their own cytoplasmic processes. No necrosis. Pseudorosette: tumor cells around blood vessels, cells equidistant from vessel walls. Rosettes: tumor cells around central lumen or fibrillary area of cellular processes

37 Brain Tumors: Microscopic
Meningioma Whorls and psammoma bodies Glioblastoma Pseudopalisades Oligodendroglioma Mosaic/poached-egg Ependymoma Perivascular pseudorosettes Medulloblastoma Rosettes

38 Tumors of Nerve Roots and Peripheral Nerves
1. Schwannoma viii Cranial nerve (Acoustic sch.) Spinal roots, posterior Peripheral nerves 2. Neurofibroma Spinal Roots, rare 3. Malignant variants Rare

39 Peripheral nerve tumors
Schwannoma Schwann cells Compress the nerve trunk Encapsulated Easily resectable without nerve damage Microscopic: Antony A and B fibers Verocay bodies Neurofibroma Schwann cells, neurites, fibroblasts Fusiform and involves nerve trunk Not encapsulated Not resectable without sacrificing nerve Micro- Intermingled cells with wavy nuclei



42 Metastatic brain tumors
Most common brain tumor in adults. Common primary sites: melanoma, lung, breast, GI tract, kidney. Most are in cerebrum (MCA territory). In gray-white junctions due to rich capillarity Discrete, globoid, sharply demarcated tumors. Amenable to surgical resection. Single or multiple. Brain edema frequent.


44 Phakomatosis: definition
Phakos (Greek): lentil mole or freckle. Neurologic abnormalities combined with defects of skin or retina, explained by their common ectodermal origin. Involvement of visceral organs

45 Phakomatosis (Neurocutaneous dysplasia)
1. Neurofibromatosis (von Recklinghausen's dis.) 2. Tuberous Sclerosis 3. Sturge-Weber disease (Encephalofacial Angiomatosis) 4. von Hippel-Lindau Disease 5. Neurocutaneous Melanosis

46 Neurofibromatosis 1. Dominant inheritance 2. Multiple neurofibromas
Central - CNS peripheral nerves 3. Increased incidence of: meningioma glioma schwannoma - bilateral VIII N. 4. Cafe-au-lait (melanosis) in skin 5. Elephantiasis: increased connective tissue


48 Tuberous Sclerosis 1. Dominant inheritance 2. Clinical triad: seizures
mental retardation adenoma sebaceum 3. Retinal hamartoma (phakoma) 4. Tubers in cerebral cortex 5. Subependymal giant cell astrocytoma 6. Hamartomas in other organs: heart, kidney



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