brain neoplasms
TRANSCRIPT
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Brain Neoplasms:Brain Neoplasms:General ConsiderationsGeneral 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:Brain Neoplasms: General ConsiderationsGeneral 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
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Varieties of brain tumorsVarieties 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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Incidence of Intracranial Incidence of Intracranial GliomasGliomas
(All ages)(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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Incidence of Primary Incidence of Primary IntraspinalIntraspinal
Intramedullary GliomasIntramedullary 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 tumorsFrequent brain tumors
Meningioma Astrocytoma/glioblastoma Oligodendroglioma Ependymoma Medulloblastoma Schwannoma/neurofibroma Phakomatosis
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MeningiomaMeningioma
Arachnoid cells originAttached to dura, subduralCommon sitesChanges in cranium Hyperostosis Invasion
Microscopic: whorls and psammoma bodies
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GliomasGliomas
Astrocytes- astrocytomas– Fibrillary– Pilocytic
Oligodendrocytes- oligodendrogliomas Ependyma- ependymomas
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AstrocytomaAstrocytomass
Adults:
Childhood:
SupratentorialSolidMalignant
InfratentorialCysticBenign
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Adult vs childhood astrocytomasAdult 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).
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Fibrillary astrocytomasFibrillary 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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Fibrillary astrocytoma: microscopicFibrillary 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)
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Pilocytic astrocytomaPilocytic 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 fiber definitionRosenthal fiber definition
Dense, eosinophilic fibers within cytoplasmic processes of astrocytes.
Correspond to aggregate accumulation of intermediate filaments in these processes.
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OligoOligodendrdendroglioogliomamaSlow growing tumor
Potentially malignant
Calcifications
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Tumors in Tumors in VentriclesVentricles
1. Ependyma: Ependymoma
2. Choroid Plexus: Papilloma
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EpendymomasEpendymomas
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
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Primitive neuroectodermal tumorsPrimitive neuroectodermal tumors
Neuroblastoma- cerebral hemispheres Medulloblastoma- cerebellum Ependymoblastoma- ventricles Pineoblastoma- pineal region
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MedulloblastomaMedulloblastoma
Origin: primitive neuroectodermal cells Age: 1st decade of life Site: vermis of cerebellum May cause hydrocephalus Subarachnoid dissemination
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Histologic patterns: definitionsHistologic 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
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Brain Tumors: Brain Tumors: MicroscopicMicroscopic
Meningioma Whorls and psammoma bodiesGlioblastoma PseudopalisadesOligodendroglioma Mosaic/poached-eggEpendymoma Perivascular pseudorosettesMedulloblastoma Rosettes
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1. Schwannoma viii Cranial nerve (Acoustic sch.) Spinal roots, posterior Peripheral nerves
2. Neurofibroma Spinal Roots, rare Peripheral nerves
3. Malignant variants Rare
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Peripheral nerve tumorsPeripheral nerve tumors
Schwannoma Schwann cells Compress the nerve trunk Encapsulated Easily resectable without
nerve 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 cells
with wavy nuclei
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Metastatic brain tumorsMetastatic 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: definitionPhakomatosis: 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
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((NNeeuurrooccuuttaanneeoouuss ddyyssppllaassiiaa))
1. Neurofibromatosis (von Recklinghausen's dis.)
2. Tuberous Sclerosis
3. Sturge-Weber disease (Encephalofacial Angiomatosis)
4. von Hippel-Lindau Disease
5. Neurocutaneous Melanosis
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NeurofibromatosisNeurofibromatosis
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
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Tuberous SclerosisTuberous 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
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