neoplasm of the central nervous system. dr. amitabha basu md
TRANSCRIPT
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NEOPLASM OF THE NEOPLASM OF THE CENTRAL NERVOUS CENTRAL NERVOUS
SYSTEM.SYSTEM.
DR. AMITABHA BASU MDDR. AMITABHA BASU MD
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General - Statistics vary General - Statistics vary widelywidely
Primary tumors of the CNS account Primary tumors of the CNS account for about 9% of all neoplasms. for about 9% of all neoplasms.
Of all intracranial tumorsOf all intracranial tumors, , approximately 30% are metastatic. approximately 30% are metastatic.
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ANATOMICAL LOCATION OF TUMORSANATOMICAL LOCATION OF TUMORS
70% of primary 70% of primary intracranial tumors intracranial tumors in adults are in adults are supratentorial. supratentorial.
70% of primary 70% of primary intracranial tumors intracranial tumors in children are in children are infratentorialinfratentorial
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INCIDENCEINCIDENCE
The most common primary The most common primary malignant intracerebral tumor in malignant intracerebral tumor in adultsadults is the is the Glioblastoma Glioblastoma MultiformeMultiforme..
TThe most frequent malignant he most frequent malignant brain tumor in brain tumor in childrenchildren is the is the MedulloblastomaMedulloblastoma..
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Brain tumorsBrain tumors
1.1. Primary Neuroglial Tumor: (gliomas)Primary Neuroglial Tumor: (gliomas)1.1. AstrocytomaAstrocytoma2.2. OligodendrogliomaOligodendroglioma
2.2. Primitive Neuroepithelial TumorPrimitive Neuroepithelial Tumor1.1. MedulloblastomaMedulloblastoma
3.3. Neuronal Tumor, LymphomaNeuronal Tumor, Lymphoma4.4. MeningiomaMeningioma5.5. Metastatic TumorMetastatic Tumor
1.1. In the brain parenchymaIn the brain parenchyma2.2. In the meningesIn the meninges
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ASTROCYTOMAASTROCYTOMATypesTypes
1.1. Fibrillary AstrocytomaFibrillary Astrocytoma
2.2. Pilocystic astrocytoma.Pilocystic astrocytoma.
3.3. Glioblastoma Astrocytoma (high grade)Glioblastoma Astrocytoma (high grade)
Genes and Markers:Genes and Markers:
Mutation of TP53 is important for the development of Mutation of TP53 is important for the development of this tumor.this tumor.
Marker: GFAP = Glial Fibrillary acidic ProteinMarker: GFAP = Glial Fibrillary acidic Protein
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Fibrillary Fibrillary AstrocytomaAstrocytoma
Common in AdultCommon in Adult
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Fibrillary astrocytic astrocytoma: fibrillary Fibrillary astrocytic astrocytoma: fibrillary appearance.appearance.
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Pilocystic AstrocytomaPilocystic Astrocytoma
Common in ChildrenCommon in Children
Gross: cystic massGross: cystic mass
Micro: Rosenthal fibers.Micro: Rosenthal fibers.
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Pilocystic AstrocytomaPilocystic Astrocytoma
Rosenthal fibersRosenthal fibersCystic Cystic mass in cerebellum mass in cerebellum
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Pilocytic AstrocytomaPilocytic Astrocytoma Common in the childrenCommon in the children Common sites:Common sites:
Cerebellum, Cerebellum, Third ventricle, Third ventricle, Optic nerveOptic nerve
PROGNOSIS DEPENDS ON THE SITE.PROGNOSIS DEPENDS ON THE SITE. If occur in Cerebellum = It is surgically If occur in Cerebellum = It is surgically
resectable – so good prognosis.resectable – so good prognosis.
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Glioblastoma MultiformeGlioblastoma Multiforme
GBMGBMGross
Micro
Clinical Features
Prognosis & treatmentPrognosis & treatment
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A Glioblastoma Multiforme ; very bad A Glioblastoma Multiforme ; very bad prognosis; most aggressive neoplasmprognosis; most aggressive neoplasm
Note: this one has crossed the midline to the opposite hemisphere.
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Glioblastoma Multiforme (GBM): Glioblastoma Multiforme (GBM): HistologyHistology
1.1. Demonstrates marked cellularityDemonstrates marked cellularity
2.2. Pleomorphism and high mitosis. Pleomorphism and high mitosis.
3.3. Area of necrosis with neoplastic Area of necrosis with neoplastic cells palisading around it.cells palisading around it.
4.4. Vascular proliferation Vascular proliferation
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Necrosis
Palisading of Neoplastic cells
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Magnetic resonance imaging (MRI) scan of Magnetic resonance imaging (MRI) scan of
the head in sagittal viewthe head in sagittal view
A large A large glioblastoma glioblastoma multiforme multiforme involving the involving the left occipital left occipital lobe.lobe.
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Symptoms and Signs Produced by Symptoms and Signs Produced by Brain TumorsBrain Tumors
A.A. Tumor Mass EffectTumor Mass Effect : compression of blood : compression of blood vessels and herniation.vessels and herniation.
B.B. Effect due to Surrounding EdemaEffect due to Surrounding Edema ( ( by by metastatic Tumormetastatic Tumor: herniation : herniation
4 features
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Clinical Features and PrognosisClinical Features and Prognosis
3.3. Raised intracranial PressureRaised intracranial Pressure
[Headache][Headache]
3.3. Focal abnormality: SeizersFocal abnormality: Seizers
Uncontrollable shaking of his Uncontrollable shaking of his
arm and leg.arm and leg.
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Prognosis & treatmentPrognosis & treatment
Prognosis depends uponPrognosis depends upon
1.1. LocationLocation
2.2. Histological GradeHistological Grade
3.3. Age [ adult : bad prognosis]Age [ adult : bad prognosis]
TreatmentTreatment Surgical removal ( if possible) and Surgical removal ( if possible) and
radio/chemo therapy.radio/chemo therapy.
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OligodendrogliomaOligodendroglioma
This type of glioma tends to be well This type of glioma tends to be well circumscribed, with cystic areas and circumscribed, with cystic areas and focal calcification.focal calcification.
[Calcification = Important radiological [Calcification = Important radiological Clue]Clue]
These tumors comprise about 5% of These tumors comprise about 5% of all gliomas. all gliomas.
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EPENDYMOMAEPENDYMOMA
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EPENDYMOMAEPENDYMOMA AgeAge: Any age: Any age Common in first 2 Common in first 2
decadesdecades Location :Location :
VentriclesVentricles Central canal of SpinalCentral canal of Spinal
Cord.Cord.
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Microscopic appearance- 2 types Microscopic appearance- 2 types
1.1. In the ventricle ( within cranium): this In the ventricle ( within cranium): this ependymoma reveals a ependymoma reveals a true true rosette rosette patternpattern with the cells arranged about a with the cells arranged about a central vascular space. central vascular space.
2.2. Myxopapillary ependymomaMyxopapillary ependymoma, which is , which is typically found arising in the typically found arising in the filum filum terminale of the spinal cordterminale of the spinal cord . .
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Ependymoma reveals a rosette: Ependymoma reveals a rosette: PerivascularPerivascular
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Myxopapillary ependymomaMyxopapillary ependymoma : The cells around : The cells around
papilla that have a myxoid connective tissue core.papilla that have a myxoid connective tissue core.
Found arising in the Found arising in the filum terminale filum terminale of the spinal cordof the spinal cord
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Ependymoma- Clinical featuresEpendymoma- Clinical features
Depends upon the location.Depends upon the location. Intracranial Tumor = Intracranial Tumor =
HydrocephalousHydrocephalous, headache., headache.
These tumor-cell can be seen in the These tumor-cell can be seen in the CSF.CSF.
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PRIMITIVE NEUROEPITHELIAL PRIMITIVE NEUROEPITHELIAL NEOPLASM (PNET)NEOPLASM (PNET)
MedulloblastomaMedulloblastoma
Other tumorsOther tumors of of PRIMITIVE PRIMITIVE NEUROEPITHELIAL cell origin….NEUROEPITHELIAL cell origin….
1.1. PineoblastomaPineoblastoma
2.2. EpendymoblastomaEpendymoblastoma
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MedulloblastomaMedulloblastoma
Lesion of the CerebellumLesion of the Cerebellum Midline vermisMidline vermis in young children in young children
Spread: through CSFSpread: through CSF
Micro: Micro: Homer-Wright rosettesHomer-Wright rosettes
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Occasionally there may be a suggestion of Occasionally there may be a suggestion of neuronal differentiation neuronal differentiation (Homer-Wright (Homer-Wright
rosettesrosettes) .) .
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MedulloblastomaMedulloblastoma
Without therapy, they are Without therapy, they are rapidly fatal. rapidly fatal.
Surgical excision, chemotherapy, Surgical excision, chemotherapy, and radiotherapy (and radiotherapy (to the entire to the entire spinal cordspinal cord), have produced ), have produced 70% 70% - 5-year survivals. - 5-year survivals.
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Acoustic NeuromasAcoustic Neuromas
Origin: The VIII cranial nerve.Origin: The VIII cranial nerve. Location: In the cerebellopontine Location: In the cerebellopontine
angle.angle.
Clinical: PClinical: Present with hearing loss.
Micro: Neurilemoma (Schwannoma)Schwannoma).
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Microscopic patterns Microscopic patterns Antoni A Antoni A
patternpattern Show Show VerocayVerocay bodies. bodies.
The Antoni B The Antoni B patterns: low patterns: low cellularitycellularity
Schwannoma is markedly Schwannoma is markedly positive with S-100 stainingpositive with S-100 staining
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Metastatic tumorMetastatic tumor
Location: BLocation: Border of the grey and white order of the grey and white matter in the distribution of the middle matter in the distribution of the middle cerebral arterycerebral artery..
Multiple and well circumscribed.Multiple and well circumscribed. Other site is meningesOther site is meninges The The lunglung is the most common is the most common primary site.primary site. Others: ALL, melanoma.Others: ALL, melanoma.
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Meningeal Metastasis: Leptomeningeal Meningeal Metastasis: Leptomeningeal Carcinomatosis.Carcinomatosis.
Metastases of malignant cells in the Metastases of malignant cells in the leptomeninges. leptomeninges.
Breast cancer is the most likely Breast cancer is the most likely primary.primary.
Cranial Nerve palsy is Cranial Nerve palsy is common in Meningeal common in Meningeal Metastasis.Metastasis.
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Carcinoma Cells in the Meninges.Carcinoma Cells in the Meninges.
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MeningiomaMeningioma
Derived from meningothelial cells.Derived from meningothelial cells. Female Female > male> male Attached to dura- parasagitalAttached to dura- parasagital Micro: Micro:
Spindle cells in syncytial massSpindle cells in syncytial mass Arranges in whorlsArranges in whorls Psammoma bodyPsammoma body
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MeningiomaMeningioma
Psammoma bodies may be seen on microcopy.Psammoma bodies may be seen on microcopy.
whorlswhorls
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Meningioma- Meningioma- Associated with Associated with
NeurofibromatosiNeurofibromatosis Type 1s Type 1
Neurofibroma, Neurofibroma, peripheral peripheral schwanomaschwanoma, , MeningiomaMeningioma, , pigment is skin and iris.pigment is skin and iris.
NeurofibromatosiNeurofibromatosis Type IIs Type II
Schwanoma of VIII cranial Schwanoma of VIII cranial nervenerve, , MeningiomaMeningioma, post lens , post lens opacificationopacification
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MRI scan in axial view MRI scan in axial view
A discrete mass A discrete mass along the lateral along the lateral convexity.convexity.
Clinical: slow Clinical: slow growing, weakness growing, weakness of the limbs.of the limbs.
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Primary Brain LymphomaPrimary Brain Lymphoma
Etiology: EBV, AIDS and Etiology: EBV, AIDS and immunosuppression. immunosuppression.
Location of tumor cells: pervascular Location of tumor cells: pervascular and peri ventricular. and peri ventricular.
Type: NHLType: NHL
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