1. CNS Neoplasm Dr. Raid Jastania, FRCPC Assistant Professor, Faculty of Medicine, Umm Alqura University Vice Dean, Faculty of Dentistry

2. Reference and Contact Robbins Basic Pathology http://www.pathoma.com/ Jastania@hotmail.com http://uqu.edu.sa/staff/ar/4180114

3. Before We Start: 50 year old female presented with personality change, aggressive behaviour, persistent headache and confusion. She was referred to neurology clinic. Clinical assessment: no neurological deficit. CT scan of brain showed contrast enhanced lesion of 4 cm in the left frontal lobe with surrounding edema.

4. Before We Start: What is the diagnosis? Explain How does cancer (neoplasm) develop? What are the criteria of Malignancy?

5. At the end of the lecture you will be able to: List the most common neoplasms of the CNS. Explain the “cell of origin” of common CNS neoplasms. Explain the criteria of “malignancy/Benignity ” in CNS neoplasms and the WHO grading system. Compare the pathological features of Astrocytoma, oligodendrogioma, ependymoma, meningioma and Medulloblstoma. List the most common metastatic tumors of the brain.

6. At the end of the lecture you will be able to: List the most common neoplasms of the CNS. Explain the “cell of origin” of common CNS neoplasms. Explain the criteria of “malignancy/Benignity ” in CNS neoplsms and the WHO grading system. Compare the pathological features of Astrocytoma, oligodendrogioma, ependymoma, meningioma and Medulloblstoma. List the most common metastatic tumors of the brain.

7. CNS Neoplasm 10-17 / 100,000 intracranial 1-2 / 100,000 intraspinal 50% Metastatic Common primary CNS tumors: Glioblastoma Multiforme (GBM) Astrocytoma Oligodentroglioma Ependymoma Meningioma Medulloblastoma ?? Glioma

8. At the end of the lecture you will be able to: List the most common neoplasms of the CNS. Explain the “cell of origin” of common CNS neoplasms. Explain the criteria of “malignancy/Benignity ” in CNS neoplsms and the WHO grading system. Compare the pathological features of Astrocytoma, oligodendrogioma, ependymoma, meningioma and Medulloblstoma. List the most common metastatic tumors of the brain.

9. Cells in the CNS Neuron / Ganglion Glial Cells – Astrocyte – Oligodendrocyte – Ependymal cell – Meningothelial cell – ?Primitive cell – Schwann cell

16. At the end of the lecture you will be able to: List the most common neoplasms of the CNS. Explain the “cell of origin” of common CNS neoplasms. Explain the criteria of “malignancy/Benignity ” in CNS neoplasms and the WHO grading system. Compare the pathological features of Astrocytoma, oligodendrogioma, ependymoma, meningioma and Medulloblstoma. List the most common metastatic tumors of the brain.

17. Malignancy Criteria What are the features of Malignancy?

18. Malignancy Criteria What are the features of Malignancy? – Rapid rate of growth – Invasion – Anaplasia – Metastasis What about: – The brain contains critical/vital structures! – Metastasis of primary brain tumors is Rare – Pattern of growth: diffuse, pushing, infiltrative

19. WHO Grading System Grades: – Grade 1 – Grade 2 – Grade 3 – Grade 4 Criteria for grading: – Atypia, cellularity, pleomorphism – Necrosis – Vascular proliferation – Mitotic activity

21. At the end of the lecture you will be able to: List the most common neoplasms of the CNS. Explain the “cell of origin” of common CNS neoplasms. Explain the criteria of “malignancy/Benignity ” in CNS neoplasms and the WHO grading system. Compare the pathological features of Astrocytoma, oligodendrogioma, ependymoma, meningioma and Medulloblstoma. List the most common metastatic tumors of the brain.

22. Astrocytoma 80% of adult primary brain tumors 4 th -6 th decade Cerebral hemisphere Seizure, headache, focal neurological deficit Grades: 2, 3, 4 Mean survival: 5 years

23. Oligodendroglioma 5-15% of Glioma 4 th -5 th decade Seizure Cerebral hemisphere, white matter Better prognosis than astrocytoma Mean survival: 5-10y Heterozytosity of Chromosome 1p 19q with good response to chemotherapy

24. Glioblastoma Multiforme Grade 4 Astrocytoma Grade 4 Oligodendroglioma

25. Ependymoma Arise next to ependymal surface Near fourth ventricle In children and adult Neurofibromatosis type2 CSF spread Prognosis variable

26. Medulloblastoma Children Cerebellum Undifferentiated, high grade Radiosensitive 75% 5 year survival

27. Meningioma Benign tumor Adults Arise from meningothelial cells Vague, non localizing symptoms Neurofibromatosis type2

29. At the end of the lecture you will be able to: List the most common neoplasms of the CNS. Explain the “cell of origin” of common CNS neoplasms. Explain the criteria of “malignancy/Benignity ” in CNS neoplasms and the WHO grading system. Compare the pathological features of Astrocytoma, oligodendrogioma, ependymoma, meningioma and Medulloblstoma. List the most common metastatic tumors of the brain.

30. Metastasis Carcinoma: lung, breast, melanoma, kidney, GI Sharply demarcated At gray-white matter junction

31. At the end of the lecture you will be able to: List the most common neoplasms of the CNS. Explain the “cell of origin” of common CNS neoplasms. Explain the criteria of “malignancy/Benignity ” in CNS neoplasms and the WHO grading system. Compare the pathological features of Astrocytoma, oligodendrogioma, ependymoma, meningioma and Medulloblstoma. List the most common metastatic tumors of the brain.

32. Further questions and readings What other neoplasms occur in the CNS What are the clinical presentations of CNS neoplasms? What is paraneoplastic syndromes? What is neurofibromatosis, Von Hippel-Lindau disease How do we teat CNS neoplasms?