Brain Tumors PDF

​ Half of all brain and spinal cord tumors are metastasic ○​ Can come from anywhere; breast and lungs are the two most common that go metastasize to the brain, the 3rd is bone ​ Most frequent primary CNS tumors ○​ Meningiomas ​ Meninges in brain and spinal cord...

​ Half of all brain and spinal cord tumors are metastasic ○​ Can come from anywhere; breast and lungs are the two most common that go metastasize to the brain, the 3rd is bone ​ Most frequent primary CNS tumors ○​ Meningiomas ​ Meninges in brain and spinal cord ○​ Glioblastoma multiforme ​ One of the most common tumors in the CNS**** ​ Primary malignant tumors ○​ 2-3% of all cancer deaths ​ Mortality is low because they are not common; lung cancer is the most mortal in both genders; breast cancer second most common in females and prostate cancer in males ○​ Children - medulloblastoma ​ Increase mortality in children ​ Clinical Manifestations ○​ Headache ​ Worse at night and early morning ​ Constant! Raise sometimes and decrease a little; increased pressure in brain ​ NSAIDs do not help at all ○​ Seizures ​ With tremors if involves cerebral cortex ​ Depends if the size of tumor, can cause seizures ○​ Mental changes ​ Memory deficit ​ Concentration deficit ​ Usually when it’s in the pineal gland; loss of memory ○​ Increase Intracranial pressure ​ 1. Presence of a space-occupying mass ​ 2. Blockage of CSF flow ​ 3. Edema around the tumor ​ If it is obstructed, swelling surrounding the tumor can cause an increase in intracranial pressure ​ Common to have confusion & seizures in increased intracranial pressure ​ Differences between primary and metastatic tumors ○​ Primary ​ Poorly circumscribed ​ Circumscribed: it could affect surrounding tissue without demarcation meaning they do not have a limit ​ Usually single  ​ Location varies ○​ Metastatic ​ Well circumscribe ​ Often multiple ​ Usually located at the junction between gray matter (in the cortex in the brain) and white matter (in the center of the brain) ​ Malignant CNS tumors do not metastasize outside the cranial cavity ○​ Very rare for tumors that originate from the brain and metastasize outside of the cranial cavity; they stay in the brain cavity ​ ​ Brain tumors distribution (based off anatomical presentation) ○​ Falx cerebri; tentorial; etc. ○​ Posterior fossa tumors: common in children ○​ Anterior fossa tumors: common in adults ○​ ​ Astrocytoma ○​ Originate from astrocytes; common to appear in the cerebellum ​ Function of astrocytes: 1) they join the vessels and neurons together so they are able to provide nutrients, 2) they protect the vessels because they surround (2 things that protect the vessels: endothelial cells that have tight junctions and astrocytes), and 3) in the synaptic cleft, astrocytes appear to help the movement of  different NTs from the presynaptic to postsynaptic in the synaptic cleft ○​ Diffuse pattern of growth ○​ Slow growing****** ○​ Males***** > females ○​ Most common location: in white matter**** ○​ Types: ​ Fibrillary 80% (most common) ​ Pilocytic ○​ Grading: ​ Grade 1-2 - well-differentiated* ​ Grade 3 - anaplastic astrocytomas - proliferation and expansion ​ ​ Non-differentiated ​ Grade 4 - glioblastoma multiforme (GBM) - hypoxia and necrosis ​ Is the worst because hypoxia presents and becomes necrotic due to oxygen not coming through ​ ○​ GBM ​ The most common CNS primary malignancy ​ Will not go to other tissues in body ​ Always fatal ​ Males***** > females ​ Histology ​ Marked nuclear atypia mitosis ​ Necrotic areas surrounded by rows of neoplastic cells ​ Vascular endothelial hyperplasia ​  ○​ Well-differentiated (the first two gradings) ​ Affect younger patients ​ Infratentorial location ​ Grow slowly ○​ Anaplastic astrocytomas and GBM ​ Aggressive ​ Older patients ​ Supratentorial location ​ More aggressive ​ Oligodendroglioma ○​ Glioma of oligodendrogial origin ○​ 30 -50 y/o patients ○​ Location ​ White matter* of cerebral hemispheres ○​ Common manifestation: seizures ○​ Histopathology ​ “fried egg” appearance due to a pronounced perinuclear halo ​ ○​ Slow growing ○​ Long survival 5-10 years ○​ Recur after surgery resection ​ Ependymoma ○​ Glioma of ependymal origin ​ Come from ependymal cells* CSF ​ Found in cavities and are overgrown ​ Hydrocephalus secondary to ependymoma ○​ Location: ​ Children – fourth ventricle*** ​ Adults – lateral ventricle*** or spinal canal ○​ Histology ​ Ependymal rosettes – cells organized around the lumen ​ Perivascular pseudorossttes – cells around small vessels  ○​ ○​ Often patients present obstructive hydrocephalus ​ When is present in the fourth ventricle ​ ○​ Tend to recur after surgery and become more aggressive ​ Medulloblastoma ○​ Arises in the cerebellar vermis (midline location) ​ Vermis is the connection and it appears here ○​ Grows rapidly**** ○​ Spreads through CSF ○​ Resection and radiation therapy allow 5-year survival of 75% ○​ Common in children*** ○​ Males > Females ○​ ​ Meningioma ○​ Originates from meningothelial cells of the arachnoid ○​ Tumor of adulthood*** ○​ Very rare in children**** ○​ Women******* > men ○​ Attached to the dura without brain invasion ○​ Histology ​ Psammoma bodies  ​ Are concentric lamellated calcified structures (dystrophic calcification) ​ ○​ Generally good prognosis ○​ ​ Schwannoma ○​ Originates from Schwann cells of cranial or spinal nerves ○​ Female**** > Males ○​ Most frequent location ​ CN VIII–Cerebellopontine angle (CPA) ○​ Manifestations ​ Loss of hearing and tinnitus (acoustic neurinoma)**** ​ Acoustic schwannoma: CN VII and CVIII are affected ​ Deficits: facial paralysis and hearing and equilibrium thrown off ​ Problems of hearing & balance first starts (as it grows bigger, facial nerve affected and facial paralysis presents) ○​ Histology ​ Verrocay bodies: parallel rows of neoplastic Schwann cells ​ ○​ Good prognosis after surgical resection Schwannoma and Meningioma are the two tumors that are common in women; the rest in males****