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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. Brain Neoplasms: General Considerations.

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brain neoplasms general considerations
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

brain neoplasms general considerations2
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

varieties of brain tumors
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
incidence of intracranial gliomas all ages
Incidence of Intracranial Gliomas(All ages)

Glioblastomas

Astrocytomas

Ependymomas

Medulloblastomas

Oligodendrogliomas

Choroid plexus papillomas

Colloid cysts

55.0%

20.5%

6.0%

6.0%

5.0%

2.0%

2.0%

incidence of primary intraspinal intramedullary gliomas
Incidence of Primary IntraspinalIntramedullary 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

frequent brain tumors
Frequent brain tumors
  • Meningioma
  • Astrocytoma/glioblastoma
  • Oligodendroglioma
  • Ependymoma
  • Medulloblastoma
  • Schwannoma/neurofibroma
  • Phakomatosis
meningioma
Meningioma

Arachnoid cells origin

Attached to dura, subdural

Common sites

Changes in cranium

Hyperostosis

Invasion

Microscopic: whorls and psammoma bodies

gliomas
Gliomas
  • Astrocytes- astrocytomas
    • Fibrillary
    • Pilocytic
  • Oligodendrocytes- oligodendrogliomas
  • Ependyma- ependymomas
astrocytomas
Astrocytomas

Adults:

Childhood:

Supratentorial

Solid

Malignant

Infratentorial

Cystic

Benign

adult vs childhood astrocytomas
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).
fibrillary astrocytomas
Fibrillary astrocytomas
  • Grossly solid
  • Common in cerebral hemispheres
  • Low grade in young, higher grade in older
  • Grading
    • astrocytoma (low grade)
    • Anaplastic astocytoma
    • glioblastoma multiforme
fibrillary astrocytoma microscopic
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)
pilocytic astrocytoma
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
rosenthal fiber definition
Rosenthal fiber definition
  • Dense, eosinophilic fibers within cytoplasmic processes of astrocytes.
  • Correspond to aggregate accumulation of intermediate filaments in these processes.
oligodendroglioma
Oligodendroglioma

Slow growing tumor

Potentially malignant

Calcifications

tumors in ventricles
Tumors in Ventricles

1. Ependyma: Ependymoma

2. Choroid Plexus: Papilloma

ependymomas
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
primitive neuroectodermal tumors
Primitive neuroectodermal tumors
  • Neuroblastoma- cerebral hemispheres
  • Medulloblastoma- cerebellum
  • Ependymoblastoma- ventricles
  • Pineoblastoma- pineal region
medulloblastoma
Medulloblastoma
  • Origin: primitive neuroectodermal cells
  • Age: 1st decade of life
  • Site: vermis of cerebellum
  • May cause hydrocephalus
  • Subarachnoid dissemination
histologic patterns definitions
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
brain tumors microscopic
Brain Tumors: Microscopic

Meningioma Whorls and psammoma bodies

Glioblastoma Pseudopalisades

Oligodendroglioma Mosaic/poached-egg

Ependymoma Perivascular pseudorosettes

Medulloblastoma Rosettes

tumors of nerve roots and peripheral nerves
Tumors of Nerve Rootsand Peripheral Nerves

1. Schwannoma

viii Cranial nerve (Acoustic sch.)

Spinal roots, posterior

Peripheral nerves

2. Neurofibroma

Spinal Roots, rare

Peripheral nerves

3. Malignant variants

Rare

peripheral nerve tumors
Peripheral nerve tumors

Neurofibroma

  • Schwann cells, neurites, fibroblasts
  • Fusiform and involves nerve trunk
  • Not encapsulated
  • Not resectable without sacrificing nerve
  • Micro- Intermingled cells with wavy nuclei

Schwannoma

  • Schwann cells
  • Compress the nerve trunk
  • Encapsulated
  • Easily resectable without nerve damage
  • Microscopic:
    • Antony A and B fibers
    • Verocay bodies
metastatic brain tumors
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.
phakomatosis definition
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
phakomatosis neurocutaneous dysplasia
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

neurofibromatosis
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

tuberous sclerosis
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