CNS Tumors
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Transcript of CNS Tumors
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CNS tumors
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LEARNING OBJECTIVESClassify CNS tumors Describe general characteristics of CNS tumorsIdentify tumor type in relation to age and site of tumorDescribe primary peripheral nerve sheath neoplasms with clinical relevance
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FACTSTumors in adults are more commonly based in anterior fossa/ supratentorial location whereas childhood tumors are more commonly posterior fossa/ infratentorial in locationCNS tumors do not metastasize outside the brain and spinal cord.Even benign tumors can be sinister according to location.
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Tumor origin
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Tumor originNeuronalGlialNerve sheathMeningealOthersMetastatic
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CNS TUMOR CLASSIFICATIONPrimary tumors- 1/2 --3/4th Metastatic tumors-1/4 In primary tumors,WHO grading is done according to biologic behaviour into grade I to IV (depending on risk of recurrence)Under current classification scheme, lesions of different grades are given distinct names
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CNS TUMOR CLASSIFICATIONPRIMARY TUMORSGliomasNeuronal and glioneuronal tumorsPoorly differentiated tumorsOther parenchymal tumorsPrimary lymphomas 1% of intracranial tumorsGerm cell tumors 0.2-1%Pineal tumors
Tumors of meningesMeningiomas
Nerve sheath tumors SchwannomasNeurofibromas
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PRIMARY TUMORS
1-GliomasAstrocytomas (80% adult primary tumors)OligodendrogliomasEpendymomas and other paraventricular lesions
GradingAstrocytomasPilocytic astrocytoma(Non infiltrating)Grade IDiffuse astrocytoma- Grade IIAnaplastic astrocytoma- Grade IIIGlioblastoma multiforme-Grade IVOligodendrogliomasMostGrade IIAnaplasticGrade IIIEpendymomasMostGrade IIAnaplasticGrade III
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GliomasSITES and AGE groupAstrocytomaPilocytic (Children , posterior fossa)Infiltrating (Adults, Cerebral hemispheres)OligodendrogliomaAdults 4th-5th decade, cerebral hemispheresEpendymoma (2 groups)4th ventricle, childrenIntraspinal, adults
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Low grade vs High grade glioma
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Glioblastoma
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Cystic/ Pilocytic astrocytomaGliomas in children,are most common in the posterior fossa. Most childhood brain tumors arise below the tentorium, which is the reverse of the adult.
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OLIGODENDROGLIOMA
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EpendymomaEpendymoma arising from the ependymal lining of the fourth ventricle above the brainstem and bulging toward the cerebellum. Ependymomas are benign histologically.
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EpendymomaThis horizontal section of the brain reveals a large ependymoma of the fourth ventricle.
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Ependymoma
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Undifferentiated tumorsMedulloblastomaPredominantly in children (20% of brain tumors in children)Posterior fossa/ cerebellumHighly malignant but radiosensitiveAtypical teratoid/ rhabdoid tumorChildren less than 5 yrsDismal prognosis
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Medulloblastomairregular posterior fossa mass near the midline of the cerebellum and extending into the fourth ventricle in a child.
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CNS TUMOR CLASSIFICATIONMETASTATIC TUMORS to of brain tumorsMainly mtastatic carcinomas5 common primaries accounting for 80% metsBreastLungSkin (melanoma)KidneyGIT
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Metastasis from a lung carcinoma. Metastases most often appear at the border of the grey and white matter in the distribution of the middle cerebral artery,
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MENINGEAL TUMORSMeningiomas-Grade IAtypical meningiomas- Grade IIAnaplastic meningiomas-Grade III
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Meningioma
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Peripheral nerve sheath tumorsSchwaanomasNeurofibromasMalignant peripheral nerve sheath tumors/ MPNST
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Schwaanomas/ Acoustic neuromaThe mass lesion here is arising in the acoustic (eighth cranial) nerve at the cerebellopontine angle. This is a schwannoma. Patients may present with hearing loss. These benign neoplasms can be removed.
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SUMMARY (Common tumors)Childhood tumorsMedulloblastomas, high gradePilocytic astrocytomas, Grade IEpendymomas, posterior fossa(4th ventricle)Choroid plexus papillomas, lateral ventricles
Adult tumorsGliomasSpinal ependymomas, oligodendrogliomas
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TUMORS of PNSNeurofibromaCutaneousPlexiformSchwaanomaMalignant peripheral nerve sheath tumors
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NEUROFIBROMA
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PLEXIFORM NEUROFIBROMA
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PLEXIFORM NEUROFIBROMA