brain neoplasms3073 (1)
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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
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Brain Neoplasms:
General Considerations
6. Different tumors in different ages
7. Primary tumors infiltrative, metastatic
well-demarcated
8. Intraneural seeding occur, but noextraneural metastasis
9. Produce neurologic symptoms by size,location, invasiveness, and secondaryeffects
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Var ieties 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
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I ncidence of I ntracranial Gl iomas (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%
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I ncidence of Primary Intraspinal I ntramedul lary Gliomas
Ependymomas
Astrocytomas (grades 1 and 2)
Glioblastomas(Astrocytomas grades 3 and 4)
Oligodendrogliomas
Other tumors
63.0%
24.5%
7.5%
3.0%
2.0%
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Frequent brain tumors
Meningioma
Astrocytoma/glioblastoma
Oligodendroglioma
Ependymoma Medulloblastoma
Schwannoma/neurofibroma
Phakomatosis
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Meningioma
Arachnoid cells origin Attached to dura, subduralCommon sites
Changes in craniumHyperostosisInvasion
Microscopic: whorls and psammoma bodies
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Gliomas
Astrocytes- astrocytomas
– Fibrillary
– Pilocytic
Oligodendrocytes- oligodendrogliomas Ependyma- ependymomas
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Astrocytomas
Adul ts :
Chi ldhood:
SupratentorialSolidMalignant
InfratentorialCysticBenign
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Adult vs chi ldhood astrocytomas
Adult: fibrillary. Grading varies from low grade
malignancy to one of most malignant brain
tumor.
Childhood: pilocytic. Very low grade tumor
(benign).
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F ibr i l lary astrocytomas
Grossly solid
Common in cerebral hemispheres
Low grade in young, higher grade in older
Grading – astrocytoma (low grade)
– Anaplastic astocytoma
– glioblastoma multiforme
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F ibr i l lary astrocytoma: microscopic
Low grade- hypercellularity, pleomorphism
Anaplastic- as above plus mitosis, vascular
endothelial proliferation
Glioblastoma multiforme- as above plusnecrosis and pseudopalisades. Grossly
variegated appearance (multiforme)
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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
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Rosenthal f iber def ini tion
Dense, eosinophilic fibers within cytoplasmic
processes of astrocytes.
Correspond to aggregate accumulation of
intermediate filaments in these processes.
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Oligodendroglioma
Slow growing tumor
Potentially malignant
Calcifications
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Tumors in Ventr icles
1. Ependyma: Ependymoma
2. Choroid Plexus: Papilloma
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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 cordparenchyma in adult
Microscopic
– perivascular pseudorosettes
–ependymal rosettes
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Primitive neuroectodermal tumors
Neuroblastoma- cerebral hemispheres
Medulloblastoma- cerebellum
Ependymoblastoma- ventricles
Pineoblastoma- pineal region
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Medulloblastoma
Origin: primitive neuroectodermal cells Age: 1st decade of life
Site: vermis of cerebellum
May cause hydrocephalus
Subarachnoid dissemination
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H istologic patterns: def ini tions
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H istologic patterns: def ini tions
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
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T f N R t
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Tumors of Nerve Roots
and Per ipheral Nerves
1. Schwannomaviii Cranial nerve (Acoustic sch.)Spinal roots, posterior
Peripheral nerves
2. NeurofibromaSpinal Roots, rarePeripheral nerves
3. Malignant variantsRare
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Peripheral nerve tumors
Schwannoma
Schwann cells
Compress the nerve trunk
Encapsulated
Easily resectable withoutnerve 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 cellswith wavy nuclei
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Metastatic brain tumors
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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.
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Phakomatosis: def inition
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
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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
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1. Dominant inheritance
2. Multiple neurofibromasCentral - CNSperipheral nerves
3. Increased incidence of:meningiomagliomaschwannoma - bilateral VIII N.
4. Cafe-au-lait (melanosis) in skin5. Elephantiasis: increased connective tissue
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Tuberous Sclerosis
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Tuberous Sclerosis
1. Dominant inheritance
2. Clinical triad:seizuresmental retardationadenoma 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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Venice
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