1 / 149

Pathology of CNS tumors

Pathology of CNS tumors for preclinical medical students.

vmshashi
Download Presentation

Pathology of CNS tumors

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pathology of CNS tumors CPC-4.3.7 – Jenna 27y teacher. <ul><li>Jenna is a 27 year old teacher in Ingham who collapsed in her classroom today . She was seen by her pupils to ‘ shake all over ’. </li></ul><ul><li>Brought to ED by paramedics, accompanied by teaching colleague. Collapsed approx 30 mins ago. </li></ul><ul><li>(Aim: The aim of this CPC is to get students to initially look at a broad range of differential diagnoses for a witnessed, generalized tonic- clonic seizure . Then get them to focus on idiopathic epilepsy , convulsion secondary to infection ( meningitis ), and convulsion secondary to brain tumour . get them to discuss ‘what if’ questions; outlined below are a variety of scenarios for you to draw from. </li></ul><ul><li>please remind students re. importance of accurate collateral history in seizure description </li></ul>

  2. CPC-4.3.7 – Differential Diag. <ul><li>Epileptic seizure </li></ul><ul><ul><li>Idiopathic - epilepsy </li></ul></ul><ul><ul><li>Secondary: </li></ul></ul><ul><ul><ul><li>Stroke - Cerebrovascular accident n.b. sub- arachnoid haemorrhage in this scenario. </li></ul></ul></ul><ul><ul><ul><li>Infection ( meningitis,encephalitis ) </li></ul></ul></ul><ul><ul><ul><li>Tumour : primary or secondary </li></ul></ul></ul><ul><ul><ul><li>Drugs : drug or alcohol withdrawal; drug overdose cocaine; amphetamines; tricyclics, buproprion (Zyban) </li></ul></ul></ul><ul><ul><ul><li>Genetic : neurofibromatosis;tuberous sclerosis.. </li></ul></ul></ul><ul><ul><ul><li>Autoimmune : SLE; Hashimoto’s, encephalitis </li></ul></ul></ul><ul><ul><ul><li>Head Injury : Trauma . </li></ul></ul></ul><ul><ul><ul><li>Metabolic disorders: uraemia; hypoglycaemia; hypo-+ hypercalcaemia; hypo-+hypernatraemia </li></ul></ul></ul><ul><ul><ul><li>Neurodegenerative diseases e.g. Alzheimer’s </li></ul></ul></ul><ul><li>Non epileptic events : consider syncope ; cardiac arrythmias ; pseudoseizures; TIA…etc </li></ul> CPC-4.3.7 – Differential Diag. <ul><li>Epileptic seizure </li></ul><ul><ul><li>Idiopathic - epilepsy </li></ul></ul><ul><ul><li>Secondary: </li></ul></ul><ul><ul><ul><li>Stroke - Cerebrovascular accident n.b. sub- arachnoid haemorrhage in this scenario. </li></ul></ul></ul><ul><ul><ul><li>Infection ( meningitis,encephalitis ) </li></ul></ul></ul><ul><ul><ul><li>Tumour : primary or secondary </li></ul></ul></ul><ul><ul><ul><li>Drugs : drug or alcohol withdrawal; drug overdose cocaine; amphetamines; tricyclics, buproprion (Zyban) </li></ul></ul></ul><ul><ul><ul><li>Genetic : neurofibromatosis;tuberous sclerosis.. </li></ul></ul></ul><ul><ul><ul><li>Autoimmune : SLE; Hashimoto’s, encephalitis </li></ul></ul></ul><ul><ul><ul><li>Head Injury : Trauma . </li></ul></ul></ul><ul><ul><ul><li>Metabolic disorders: uraemia; hypoglycaemia; hypo-+ hypercalcaemia; hypo-+hypernatraemia </li></ul></ul></ul><ul><ul><ul><li>Neurodegenerative diseases e.g. Alzheimer’s </li></ul></ul></ul><ul><li>Non epileptic events : consider syncope ; cardiac arrythmias ; pseudoseizures; TIA…etc </li></ul>

  3. Scenario: Epilepsy: <ul><li>ABC breathing spontaneously rr 14/min; 4l O2 via mask , sats (O2 Sat study) 96% ; pulse 100 bpm regular good volume T 36.1 C BP 148/94. </li></ul><ul><li>GCS E2V3M4 </li></ul><ul><li>Detailed check no neck stiffness , no skin lesions/rash </li></ul><ul><li>Tongue has been bitten; pupils equal and reactive to light; fundoscopy normal </li></ul><ul><li>Decreased tone R upper limb, ?normal tone other limbs </li></ul><ul><li>Reflexes increased on R upper + lower limb; decreased on L upper +lower; </li></ul><ul><li>Plantar reflexes upgoing </li></ul><ul><li>Evidence of urinary incontinence </li></ul><ul><li>All other systems : nil abnormal </li></ul><ul><li>Ix - BSL : 5.1; toxicology screen : negative </li></ul> Scenario: Epilepsy: <ul><li>ABC breathing spontaneously rr 14/min; 4l O2 via mask , sats (O2 Sat study) 96% ; pulse 100 bpm regular good volume T 36.1 C BP 148/94. </li></ul><ul><li>GCS E2V3M4 </li></ul><ul><li>Detailed check no neck stiffness , no skin lesions/rash </li></ul><ul><li>Tongue has been bitten; pupils equal and reactive to light; fundoscopy normal </li></ul><ul><li>Decreased tone R upper limb, ?normal tone other limbs </li></ul><ul><li>Reflexes increased on R upper + lower limb; decreased on L upper +lower; </li></ul><ul><li>Plantar reflexes upgoing </li></ul><ul><li>Evidence of urinary incontinence </li></ul><ul><li>All other systems : nil abnormal </li></ul><ul><li>Ix - BSL : 5.1; toxicology screen : negative </li></ul>

  4. Scenario: Meningitis <ul><li>ABC breathing spontaneously rr 18/min 4l O2 via mask, sats 90%; pulse 110 bpm reg small volume; BP 90/60 mmHg T39.6C </li></ul><ul><li>GCS - E2V3M4 </li></ul><ul><li>Detailed check - petechiae non blanching rash trunk, buttocks, Neck stiffness </li></ul><ul><li>Small contusion L temperoparietal area </li></ul><ul><li>Capillary refill time > 3 secs, peripheral cyanosis+ </li></ul><ul><li>Brudzinski sign positive </li></ul><ul><li>Ix skin scraping from lesion : gram negative diplococci ; CSF gram negative diplococci; FBC wcc 18 (polymorhic leucocytosis ) </li></ul>Brudzinski sign, Kernig sign, CSF findings Scenario: Meningitis <ul><li>ABC breathing spontaneously rr 18/min 4l O2 via mask, sats 90%; pulse 110 bpm reg small volume; BP 90/60 mmHg T39.6C </li></ul><ul><li>GCS - E2V3M4 </li></ul><ul><li>Detailed check - petechiae non blanching rash trunk, buttocks, Neck stiffness </li></ul><ul><li>Small contusion L temperoparietal area </li></ul><ul><li>Capillary refill time > 3 secs, peripheral cyanosis+ </li></ul><ul><li>Brudzinski sign positive </li></ul><ul><li>Ix skin scraping from lesion : gram negative diplococci ; CSF gram negative diplococci; FBC wcc 18 (polymorhic leucocytosis ) </li></ul>Brudzinski sign, Kernig sign, CSF findings

  5. Core Learning Issues: <ul><li>Pathology Major CLI: </li></ul><ul><ul><li>Raised ICP – Pathology & Clinical features. </li></ul></ul><ul><ul><li>Pathology of common Primary and secondary CNS tumors in different age groups. </li></ul></ul><ul><ul><li>Astrocytoma – grades, clinical types, presentation & complications. </li></ul></ul><ul><ul><li>Pathology & Microbiology of Meningitis – common types *Bacterial, viral, fungal & others. </li></ul></ul><ul><li>Pathology Minor CLI: </li></ul><ul><ul><li>Pathology of Epilepsy (note this is major clinical learning issue) </li></ul></ul><ul><ul><li>Meningioma, Acoustic neuroma, Craniopharyngioma / pituitary tumors. Medulloblastoma. </li></ul></ul><ul><ul><li>Overview of Pathogenesis of Epilepsy (include theories for idiopathic epilepsy). </li></ul></ul><ul><ul><li>CJD-Creutzfeldt jakob's disease. (Mad cow disease). </li></ul></ul> Core Learning Issues: <ul><li>Pathology Major CLI: </li></ul><ul><ul><li>Raised ICP – Pathology & Clinical features. </li></ul></ul><ul><ul><li>Pathology of common Primary and secondary CNS tumors in different age groups. </li></ul></ul><ul><ul><li>Astrocytoma – grades, clinical types, presentation & complications. </li></ul></ul><ul><ul><li>Pathology & Microbiology of Meningitis – common types *Bacterial, viral, fungal & others. </li></ul></ul><ul><li>Pathology Minor CLI: </li></ul><ul><ul><li>Pathology of Epilepsy (note this is major clinical learning issue) </li></ul></ul><ul><ul><li>Meningioma, Acoustic neuroma, Craniopharyngioma / pituitary tumors. Medulloblastoma. </li></ul></ul><ul><ul><li>Overview of Pathogenesis of Epilepsy (include theories for idiopathic epilepsy). </li></ul></ul><ul><ul><li>CJD-Creutzfeldt jakob's disease. (Mad cow disease). </li></ul></ul>

  6. In every person who comes near you look for what is good and strong; honor that; try to learn it, and your faults will drop off like dead leaves when their time comes. --John Ruskin Look for good in others “No one is without faults and everyone has some good qualities…!” In every person who comes near you look for what is good and strong; honor that; try to learn it, and your faults will drop off like dead leaves when their time comes. --John Ruskin Look for good in others “No one is without faults and everyone has some good qualities…!”

  7. Pathology of CNS Tumors Dr. Venkatesh M. Shashidhar, MD Associate Professor & Head of Pathology Pathology of CNS Tumors Dr. Venkatesh M. Shashidhar, MD Associate Professor & Head of Pathology

  8. CNS Tumors: General Features <ul><li>10% of all tumors. </li></ul><ul><li>Commonest solid cancers in children.(2 nd to Leuk for all malignancies) </li></ul><ul><li>Age: double peak 1 st & 6 th decade </li></ul><ul><li>Adults - 70% supratentorial </li></ul><ul><li>Children - 70% infratentorial </li></ul><ul><li>No/very rare extraneural spread. </li></ul><ul><li>Metastasis most common. </li></ul>Adults Children CNS Tumors: General Features <ul><li>10% of all tumors. </li></ul><ul><li>Commonest solid cancers in children.(2 nd to Leuk for all malignancies) </li></ul><ul><li>Age: double peak 1 st & 6 th decade </li></ul><ul><li>Adults - 70% supratentorial </li></ul><ul><li>Children - 70% infratentorial </li></ul><ul><li>No/very rare extraneural spread. </li></ul><ul><li>Metastasis most common. </li></ul>Adults Children

  9. Clinical features: <ul><li>Raised Intracranial Pressure * </li></ul><ul><ul><li>Headache (morning) , vomiting, slow pulse, papilloedema. </li></ul></ul><ul><li>Local damage: </li></ul><ul><ul><li>Nerve & tract deficits, Paralysis, seizures etc. </li></ul></ul> Clinical features: <ul><li>Raised Intracranial Pressure * </li></ul><ul><ul><li>Headache (morning) , vomiting, slow pulse, papilloedema. </li></ul></ul><ul><li>Local damage: </li></ul><ul><ul><li>Nerve & tract deficits, Paralysis, seizures etc. </li></ul></ul>

  10. . CNS Tum: Clinical Features-Pathogenesis <ul><li>Headaches (morning) </li></ul><ul><li>Papilloedema </li></ul><ul><li>Nausea or vomiting </li></ul><ul><li>Bradycardia </li></ul><ul><li>Seizures (convulsions). </li></ul><ul><li>Drowsiness, Obtundation </li></ul><ul><li>Personality or memory </li></ul><ul><li>Changes in speech </li></ul><ul><li>Limb weakness </li></ul><ul><li>Balance/Stumbling </li></ul><ul><li>eye movements or vision </li></ul><ul><li>Increased ICP </li></ul><ul><li>Increased ICP </li></ul><ul><li>ICP – Medulla ob. </li></ul><ul><li>ICP – Parasymp. </li></ul><ul><li>Irritation. </li></ul><ul><li>Brain Stem compress </li></ul><ul><li>Frontal lobe </li></ul><ul><li>Temporal lobe </li></ul><ul><li>Motor area </li></ul><ul><li>Cerebellum </li></ul><ul><li>Optic tract, occipital. </li></ul>

  11. . CNS Anatomy - Clinical Features

  12. . CNS Tumors Classification: <ul><li>Primary Tumors: </li></ul><ul><li>Meninges – Meningioma </li></ul><ul><li>Glial cells: Glioma </li></ul><ul><ul><li>Astrocytoma & Glioblastoma. Oligodendroma, ependymoma. </li></ul></ul><ul><ul><li>Nerve sheath – Schwanoma, Neurofibroma. </li></ul></ul><ul><li>Embryonal – Medulloblastoma , neuroblastoma, teratoma. </li></ul><ul><li>Blood vessels – angioma, angiosarcoma etc. </li></ul><ul><li>* Other Epithelial, Pituitary & Pineal gland tumors. </li></ul><ul><li>Secondary Tumors - Metastasis – common Melanoma, breast, lung, GIT. </li></ul>

  13. . <ul><li>Adults: </li></ul><ul><ul><li>Astrocytoma & Glioblastoma. </li></ul></ul><ul><ul><li>Meningioma </li></ul></ul><ul><ul><li>Metastasis. </li></ul></ul><ul><li>Children: </li></ul><ul><ul><li>Astrocytoma </li></ul></ul><ul><ul><li>Medulloblastoma </li></ul></ul>Common:

  14. . Meningioma: <ul><li>Arise from arachnoid granulations of venous sinuses. Attached to dura. </li></ul><ul><li>Common sites: parasagittal (falx), sphenoid ridge, olfactory groove, cerebellopontine angle.  specific clinical features. </li></ul><ul><li>Females common (2:1) </li></ul><ul><li>Slow growth, well differentiated & demarcated. Does not invade brain (Benign). </li></ul><ul><li>Reactive skull Hyperostosis over the tumor. </li></ul><ul><li>Microscopy: spindle cells in whorls and psammoma bodies(microcalcification). </li></ul>

  15. . Meningioma

  16. . Meningioma

  17. . Meningioma

  18. . Meningioma

  19. . Meningioma

  20. . Meningioma

  21. . Meningioma <ul><li>Well demarcated </li></ul><ul><li>Capsulated </li></ul>

  22. . Meningioma – whorls of clear cells. Normal Arachnoid Granulation

  23. . Meningioma Nodules Psammoma Body

  24. . Psammoma bodies (calcification)

  25. . Glioma: <ul><li>Gliomas are neoplasms of glial cells. </li></ul><ul><li>Commonest both in adults and children </li></ul><ul><li>Benign * to Aggressively malignant. </li></ul><ul><ul><li>Astrocytoma ( anaplastic & G.B.M ) </li></ul></ul><ul><ul><li>Ependymoma - Rare, 4th ventricle. </li></ul></ul><ul><ul><li>Oligodendroglioma - Benign, adults, rare </li></ul></ul>

  26. . Astrocytomas <ul><li>Adults : </li></ul><ul><ul><li>Commonest 80%, Supratentorial. </li></ul></ul><ul><ul><li>Solid – Fibrillary – low grade*. </li></ul></ul><ul><ul><li>Varigated, Hemorrhagic - Malignant, glioblastoma multiforme. </li></ul></ul><ul><li>Children: </li></ul><ul><ul><li>Infratentorial (Cerebellum), </li></ul></ul><ul><ul><li>Cystic, Low grade*, Pilocytic </li></ul></ul>

  27. . Astrocytoma-Lowgrade fibrillary

  28. . Astrocytoma

  29. . Astrocytoma: * Lat. Vent. *petechial hem.

  30. . Glioma Brain Stem – note diffuse tumor

  31. . Glioma Cerebrum cystic degeneration

  32. . Glioma:

  33. . Astrocytoma (Glioma)

  34. . Glioma Brain Normal

  35. . Astrocytoma

  36. . Astrocytomas <ul><li>Adults : </li></ul><ul><ul><li>Commonest 80%, Supratentorial. </li></ul></ul><ul><ul><li>Solid – Fibrillary – low grade*. </li></ul></ul><ul><ul><li>Varigated, Hemorrhagic - Malignant, glioblastoma multiforme. </li></ul></ul><ul><li>Children: </li></ul><ul><ul><li>Infratentorial (Cerebellum), </li></ul></ul><ul><ul><li>Cystic, Low grade*, Pilocytic </li></ul></ul>

  37. . Glioblastoma Multiforme (GBM): <ul><li>High grade Astrocytoma - Grade IV </li></ul><ul><li>Commonest & malignant brain tumor in adults – mean survival <1y – cerebral supratentorial . </li></ul><ul><li>Loss of heterozygosity on Chromosome 10 (80%) </li></ul><ul><li>Most GBMs have lost one entire copy of C – 10 </li></ul><ul><li>2 types: Primary (worst) or Secondary from low grade astrocytomas (better prog). </li></ul><ul><li>Variants: giant cell GBM, gliosarcoma </li></ul><ul><li>Microscopy: </li></ul><ul><li>Necrosis , palisading , hypercellularity, nuclear atypia & vascular proliferation & mitoses. </li></ul>

  38. . Genetic abnormalities in Glioma: Low grade  Anaplastic  GBM

  39. . Glioma: high grade

  40. . Glioma: Enhancement with peritumoral edema.

  41. . Glioblastoma:

  42. . GBM: + glioma Enhancement with peritumoral edema.

  43. . Glioblastoma – high grade Astrocytoma

  44. . Glioblastoma – high grade Astrocytoma

  45. . Glioblastoma Multiforme (high grade Astrocytoma)

  46. . Glioblastoma Cerebrum

  47. . Glioblastoma Cerebrum

  48. . Glioblastoma Multiforme Palisading Necrosis

  49. . Glioblastoma Multiforme Necrosis Palisading

  50. . Glioblastoma Multiforme Palisading B.V Necrosis

More Related