LindsayAWilson,pgy2

AMReport

1/27/2010

BrainTumors
Outline.

1.Reviewcancersthataremetastatictothe
brain.
2.Reviewclassificationofbraintumorsconfined
tothemeningesandbrainparenchyma(Glial
versusNon-glial).
3.Reviewcommonbraintumors.
4.Mentionbraintumorsfoundmainlyinkids

Mets

Metastaticbraintumors(cancerthatspreadsfromotherparts
ofthebodytothebrain)occuratsomepointin10to15%of
personswithcancerandarethemostcommontypeofbrain
tumor.
Breast
Melanoma
Kidney
GI
Thyroid
Lung
Ovarian
Testicular
PrimaryBrainTumorBasics

Adults=supratentorialvsKids=Infratentorial
Braintumorsrarelymetastasize
Benigncanbebadduetomasseffects
Easywaytodividetypesofbraintumorsisglialversusnon-
glial(50/50).Glialcells=astrocytes,oligodendrocytes,and
ependymalcells.OfprimaryCNStumors=80%
"Alarmsymptoms"thatpointtobraintumor:Headache
recursfrequently,issevere,startsinsomeonewhohasn't
hadheadachesbefore,occursatnight,ispresentupon
awakening,isaccompaniedbynausea,vomiting,poor
balance/coordination,doublevision,and/ordizziness.
Thethirdleadingcauseofcancerdeathinyoungadults
ages20-39.
WHOClassification
Tumours of neuroepithelial tissue(glial)
Astrocytic tumours***Oligodendroglial tumours***Mixedgliomas*** Ependymal
umours***Choroidplexustumours***
Neuronalandmixedneuronal-glialtumours
Neuroblastictumours**Pinealparenchymaltumours**Embryonaltumours
Tumours of peripheral nerves
Schwannoma (Neurinoma)**Neurofibroma**Perineurioma
Malignantperipheralnervesheathtumour(MPNST)
Tumours of the meninges
Tumoursofmeningothelialcells: Meningioma(WHOgradeI)Atypicalmeningioma
WHOgradeII)Anaplasticmeningioma(WHOgradeIII)
Mesenchymal,non-meningothelialtumours: Primarymelanocyticlesions
Lymphomas and haemopoietic neoplasms
Malignantlymphomas**Plasmacytoma**Granulocyticsarcoma**Germcelltumours
Germinoma**Embryonalcarcinoma**YolksactumourChoriocarcinoma**Teratoma**
Mixedgermcell
Tumors of the sellar region
Craniopharyngioma**Granularcelltumour**Metastatic tumours
DatafromLouis,DN,Ohgaki,H,Wiestler,OD,Cavenee,WK.WHOClassificationofTumoursof
heNervousSystem.IARCPress,Lyon2007.

GLIALTUMORS

Astrocytoma:
20%primaryintracranialneoplasms
Lifeexpectancyapproximates5years,worseprognosisif
transformationtoglioblastomamultiformeoccurs(10%of
cases)
Fourgrades...withgradeIVbeingGBM
Iflowgrade:
Difficulttoresectbutcompleteresectionisbetterthan
debulkingalone
Oftenfollowsurgeryw/RT
Ifreallysmall,willdelaysurgeryuntilsymptomsorsignsof
growth
GLIALTUMORS

High grade= Glioblastoma multiforme

Mostcommonbraintumor
Poorprognosis,oftendeath<1year
Tumorcrossesthecorpuscallosum=butterfly
Keypath:Pseudopalisadesandpseudorosettes

GLIALTUMORS

Oligodendrogliomas
5%ofglialtumors
frontallobe
path=friedegg
surgery+/-adj.therapyRT
chemosensitive

Ependymomas
5%ofglialtumors,kids>adults
4thventricle--obstructflowofCSF
rsxn,thenradiation,chemo
inadults,seeinspinalcord(75%)


NON-GLIAL

Meningioma
Secondmostcommonprimaryintracranialneoplasm
(accountfor20%)
Tumorisexternaltothebrain(displacesbraintissue)
Morecommoninwomenthanmen
Mostoftenoccursaftertheageof40
Originatesinthearachnoidalcells
Consideredabenign,slowlygrowingtumor
Canerodecontiguousbone
CanbeseeninassociationwithNF-2
Canbeinducedbyradiationtherapy(1960stineacapitus)


Treatment:
-Canbeconservative(ienotreatment)
-Surgery(eitherfullorpartialresectiondependingontumor
location),sometimesprecededbyembolization
-Radiationcanbeprimarytreatmentoradjuncttosurgery

 NON-GLIAL
Schwanomma (acoustic neuroma)
TumorderivedfromSchwanncells
Acousticneuromasmaycausetinnitus,deafness,compression
ofotherCNs
Surgeryusuallyresultsincure(RTalsoused,canobservetoo)
NF2(neurofibromatosis)ischaracterizedbybilateralacoustic
neuromas(autosomaldominantsyndrome)
NON-GLIAL

Lymphoma
PrimaryB-cell
AIDS
immunosupp.
linktoEBV
MTXbasedchemo
RT
Ocularinvolv.
slitlampexam
NON-GLIAL

Hemangioblastoma
Oftensyndromicandhereditary(Lindau,vonHippel-
Lindau=mutationsintumorsuppressorgeneVHL)
Cansecreteerythropoitinandinducepolycythemia
Highlyvascularized
Originatesinthecerebellum
Embolizationthensurgery
Braintumorsthataremorecommonin
kids(andthereforenotdiscussedany
further)
Choroidplexuspapilloma
Neuroblastoma
Retinoblastoma
Medulloblastoma
Ganglioglioma
Germcelltumors(canbeinyoungmen)
Workscited

Rubins
Uptodate
Wikipedia
MerckManual
PathologyBoardReviewSeries
NMSMedicine