1. incidence and location of the major types of primary and secondary brain tumors

2. Tumors of the CNS can be: Primary Secondary
- benign or malignant tumors arise from various elements of the CNS
tumors metastasize to CNS from many primary sources (lung, breast, kidney, GI tract, melanomma)

3. ADULT: Glioma
Metastatic tumor
Meningioma
Pituitary Tumor
Acoustic Neuroma
CHILDREN: Medulloblastoma(PNET)
Astrocytoma
Ependymoma
Brainstem Glioma
Craniopharyngioma
Pineal Gland Tumor

4. Secondary tumors most common type of brain tumor
may lodge to the following:
Brain parenchyma metastasis
5-40% of brain tumor, found in advanced age
cerebrum, cerebellum, brainstem
Usually found with disseminating systemic disease
Lung and breast – 2 most common metastasis to brain
Leptomeningeal metastasis
Pia and arachnoid mater
Lymphoma – most common metastasis
8% of patients with cancer
Dural metastasis
Prostate CA for males and breat CA for females

5. Primary tumors Gliomas Hemangioblastoma Meningioma Embryonal tumors
Tumors of pituitary gland
Craniopharyngoma
Vestibular Schwannoma
Germ cell tumors
Lymphoma

6. Glioma Involve all lobes with preference to frontal & temporal lobes
Most common primary brain tumor
50% of all symptomatic brain tumors
Incidence with advancing age
Can be located anywhere –cerebrum, cerebellum, brainstem (pons)
Involve all lobes with preference to frontal & temporal lobes
Types:
Astrocytoma
Oligoendroglioma
Ependymoma

7. Glioma - Astrocytoma Classification: Pilocytic Astrocytoma Grade I
Low Grade Astrocytoma
Grade II
Anaplastic Astrocytoma
Grade III
Glioblastoma Multiforme
Grade IV
Median Age
13 years
35-45 years
46 years
50-60 years
Incidence
2% of gliomas
5%-25% of gliomas
10%-30% of gliomas
45%-50% of gliomas
Location
Cerebellum, Brain stem, Optic nerve, Cerebral hemisphere
Cerebral hemispheres (frontal 40%), pons thalamus, midbrain
Cerebral hemispheres, thalamus, midbrain, pons
Any region particularly cerebral hemispheres (frontal 40%)
Presentation
Depending on site, inc. ICP, seizures, motor deficit
Seizures(65%), Incr.ICP, Mental status change, motor deficit
Seizures(50%), Incr.ICP,
Mental status change, motor deficit
Increased ICP, mental changes, motor deficit, seizures

8. Glioma - Oligodendroglioma
2-10% of all intracranial gliomas
Most often in y/o
male:female = 2:1
Found primarily in cerebral hemisphere (frontal, temporal,parietal often towards the midline) within brain parenchyma

9. Glioma - Ependymoma More common in children (0-20)
Located in 4th, 3rd and lateral ventricle ventricle (most common in 4th ventricle)
Ataxia, vertigo, increased ICP
Spinal lesions more common in adults
Predominantly men

10. Meningioma Second most common primary tumor
20% of all intracranial tumors
Location: Parasagittal, falx, convexity, entire cranial base, cerebellum, tentorium, rarely lateral ventricles
Most diagnosed in 60 – 70y/o
female:male = 2:1
90% intracranial, 10% intraspinal

11. Tumors of Pituitary Gland
3rd most common primary brain tumor
Incidence 8-12%
Most common in adults (20-50y/o)
Located in sella region .

12. Vestibular Schwannoma
Aka acoustic neuroma or acoustic neurofibroma
4th most common tumor
5-10% of intracranial tumor
Arises from schwann cells of vestibular branch of CN VIII
Location: cerebellopontine angle (statoacoustic nerve), base of the middle cranial fossa (trigeminal nerve)
Peak age 40-60y/o
female:male = 2:1
Hearing loss, tinnitus, dysequilibrium

13. Lymphoma found in brain parenchyma
Usually develop in immunocompromised individuals
Peak incidence 50-70y/o
male:female = 3:2
98% B-cell tumors, 2% T-cell tumor

14. Hemangioblastoma 1-2% of intracranial neoplasms Predominantly males
All ages are affected more frequently in young and middle-aged adults
Predominantly in the cerebellum
Associated with polycythemia

15. Embryonal tumor – Primitive Neuroectodermal Tumor (PNET)
Include a wide variety of tumors w/c seem to have common pathologic features suggesting origin from primitive neuroectodermal cells
Medulloblastoma (most common), Retinoblastoma, Pineoblastoma, Neuroblastoma, Ependymoblastoma, etc

16. MEDULLOBLASTOMA Accounts for 30%of all intra-
cranial tumors in children & is the
most malignant pediatric brain
tumor

17. PINEAL GLAND TUMOR pediatric brain tumors) than in adults (<1%)
Common in children (3%-8% of
pediatric brain tumors) than in adults (<1%)
- A variety of tumors may occur in this
location, the most common is Germ
cell tumors comprising 27%-30% of
cases
- Clinical manifestations: signs &
symptoms of increased ICP,
hydrocephalus, lethargy, memory
disturbance, & in children seizures &
increasing head circumference
- Parinaud’s syndrome, precocious
puberty

18. CRANIOPHARYNGIOMA - arise from anterior superior margin of
the pituitary; are lined with stratified
squamous epithelium
6-10% of intracranial tumor