wilson brain tumors

7/31/2019 Wilson Brain Tumors

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Brain Tumors

Lindsay A Wilson, pgy2AM Report1/27/2010


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Outline.

1. Review cancers that are metastatic to thebrain.2. Review classification of brain tumors confined

to the meninges and brain parenchyma (Glialversus Non-glial).3. Review common brain tumors.4. Mention brain tumors found mainly in kids


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Mets

Metastatic brain tumors (cancer that spreads from other partsof the body to the brain) occur at some point in 10 to 15% ofpersons with cancer and are the most common type of brain

tumor. Breast Melanoma Kidney GI Thyroid Lung Ovarian Testicular


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Primary Brain Tumor Basics

Adults=supratentorial vs Kids=Infratentorial Brain tumors rarely metastasize Benign can be bad due to mass effects Easy way to divide types of brain tumors is glial versus non-

glial (50/50). Glial cells = astrocytes, oligodendrocytes,and ependymal cells. Of primary CNS tumors=80%

"Alarm symptoms" that point to brain tumor: Headacherecurs frequently, is severe, starts in someone who hasn'thad headaches before, occurs at night, is present uponawakening, is accompanied by nausea, vomiting, poorbalance/coordination, double vision, and/or dizziness.

The third leading cause of cancer death in young adultsages 20-39.

t


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ass cat onumours of neuroepithelial tissue (glial)strocytic tumours*** Oligodendroglial tumours*** Mixed gliomas*** Ependymalmours*** Choroid plexus tumours***euronal and mixed neuronal-glial tumourseuroblastic tumours** Pineal parenchymal tumours **Embryonal tumoursumours of peripheral nerveschwannoma (Neurinoma)** Neurofibroma** Perineuriomaalignant peripheral nerve sheath tumour (MPNST)umours of the meningesumours of meningothelial cells: Meningioma(WHO grade I) Atypical meningioma

HO grade II) Anaplastic meningioma (WHO grade III)esenchymal, non-meningothelial tumours: Primary melanocytic lesionsymphomas and haemopoietic neoplasmsalignant lymphomas** Plasmacytoma** Granulocytic sarcoma** Germ cell tumourserminoma** Embryonal carcinoma** Yolk sac tumour Choriocarcinoma** Teratoma**

ixed germ cellumors of the sellar regionraniopharyngioma** Granular cell tumour** Metastatic tumoursata from Louis, DN, Ohgaki, H, Wiestler, OD, Cavenee,WK. WHO Classification of Tumours of

e Nervous System. IARC Press, Lyon 2007.


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GLIAL TUMORS

Astrocytoma: 20% primary intracranial neoplasms Life expectancy approximates 5 years, worse prognosis if

transformation to glioblastoma multiforme occurs (10% of

cases) Four grades...with grade IV being GBM If low grade: Difficult to resect but complete resection is better than

debulking alone Often follow surgery w/ RT If really small, will delay surgery until symptoms or signs of

growth


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GLIAL TUMORS

High grade= Glioblastoma multiforme Most common brain tumor Poor prognosis, often death < 1 year Tumor crosses the corpus callosum=butterfly Key path: Pseudopalisades and pseudorosettes


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GLIAL TUMORS

Oligodendrogliomas5% of glial tumorsfrontal lobepath=fried eggsurgery +/- adj. therapy RTchemo sensitiveEpendymomas

5% of glial tumors, kids>adults

4th ventricle--obstruct flow of CSFrsxn, then radiation, chemoin adults, see in spinal cord (75%)


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NON-GLIAL

Meningioma Second most common primary intracranial neoplasm

(account for 20%) Tumor is external to the brain (displaces brain tissue)

More common in women than men Most often occurs after the age of 40 Originates in the arachnoidal cells Considered a benign, slowly growing tumor Can erode contiguous bone Can be seen in association with NF-2 Can be induced by radiation therapy (1960s tinea capitus)


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Treatment:-Can be conservative (ie no treatment)-Surgery (either full or partial resection depending on tumorlocation), sometimes preceded by embolization-Radiation can be primary treatment or adjunct to surgery


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NON-GLIALchwanomma (acoustic neuroma)

Tumor derived from Schwann cells

Acoustic neuromas may cause tinnitus, deafness, compressionof other CNs

Surgery usually results in cure (RT also used, can observe too) NF2 (neurofibromatosis) is characterized by bilateral acoustic

neuromas (autosomal dominant syndrome)


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NON-GLIAL

Lymphoma Primary B-cell AIDS immunosupp.

link to EBV MTXbased chemo RT Ocular involv. slit lamp exam


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NON-GLIAL

Hemangioblastoma Often syndromic and hereditary (Lindau, von Hippel-

Lindau=mutations in tumor suppressor gene VHL) Can secrete erythropoitin and induce polycythemia

Highly vascularized Originates in the cerebellum Embolization then surgery


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Brain tumors that are more common inkids (and therefore not discussed any

further) Choroid plexus papilloma Neuroblastoma Retinoblastoma Medulloblastoma Ganglioglioma Germ cell tumors (can be in young men)


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Works cited

RubinsUptodateWikipediaMerck ManualPathology Board Review SeriesNMS Medicine

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