LAPORAN KEGIATAN

DUTCH FOUNDATION COURSE: UPDATE DIAGNOSTIC & MANAGEMENT OF CNS TUMOR

Neuroepithelial tumor yang paling banyak Glioblastoma

Meningeal tumor yang paling banyak Meningioma

Sella tumor yang paling banyak Pituitary tumor

Tumor Primer:

36,6% Meningioma

24,7% Glioma

16% Pituitary

CNS tumor termasuk rare case, yang menduduki peringkat:

1. Prostat Ca
2. Breast Ca
3. Colorectal, Lung Ca

Meningioma is the commonest brain tumor, median age is 41-50 y.o

Di RSU dr. Soetomo >>> wanita usia sekitar 44,5% dengan 87% riwayat KB hormonal +

Childhood Brain Tumor:

-banyak solid mass

-banyak pada pria

-klinis: Supratentorial: seizure, headache, eye movement, gait abnormality

Infratentorial: headache, vomiting, hydrocephalus, gait abnormality, visual loss

-paling banyak: Meduloblastoma, Astrocytoma, dengan lokasi paling banyak infratentorial

Data USA 2013:

34% meningioma

27% glioma
15% pituitary tumors

23% lymphoma, nerve sheet tumor dll

Dari keseluruhan > 35% Maligna

Meningioma

-Risk factor: Radiasi (low dose: tinea capitis, high dose: neoplasma (meningioma))

Germ line mutations

-MRSpectroscopy can help differentiated from mimics, based on:

-Alanine (Ala) increase

-Choline (Cho) increase: indicate tumor cellularity

-N. Acetyl Aspartat (NAA) decrease/- : non neuronal origin

-Creatin (Cr) decrease/-

-Arise from the leptomeningens

-Most are hypervascular, vascular suplai from intra & extracranial

-Predictors of recurrent meningioma:

-tumor size -cortical penetration on T2WI

-mushroom shape -brain tumor interface at surgery

-osteolysis -proximity to major sinus

-edema grade -simpson grade

-malignancy (WHO grade III): 50-90% recurrence

PRIMARY CNS LYMPHOMA (PCNSL)

-Rare form of extranodal NHL (< 5% primary brain tumor)

-involves brain, leptomeningens, eyes or spinal cord, without evidence of systemic lymphoma.

Site of disease:

-brain hemisphere 38 %

-thalamus/GB 16%

-corpus callosum 14%

-periventricular 12%
 -cerebellum 9%

-meninges 16%

-eyes 5-20%

-spinal cord/nerves <1-1%

-PCNSL 90%: diffuse large B cell lymphoma (DLBCL)

10%: low grade lymphoma, burkitt lymphoma, T cell lymphoma

-Insidennya sama pada pria dan wanita

-Patofisiologi: sel Lymphoma memasuki CNS melalui:

1. Hematogenous spread
2. Direct expansion of adjacent bone metastases
3. By centripetal growth along the neurovascular bundle
4. Lymphoma cells may spread from the retroperitoneal or bone marrow lymph to leptomening via
the intervertebral venous plexus

-Clinical features: focal neurologic deficit, raised intracranial pressure, seizures

-Alarm Symptoms:

1. New, increasing and ultimately severe pain

2. New progressive peripheral neurological deficit

3. Rapid increase in the size of a plexiform neurofibroma (maligna)

4. Change in texture of the tumor from soft to hard

-Prognostic: 1. Usia > 60 thn

2. Peningkatan serum LDH

3. Protein CSF tinggi

4. Lokasi tumor di otak bagian dalam

Glioblastoma (GBM) is the most common primary malignant brain tumor comprising 16% of all primary
brain and central nervous system neoplasms

The average age adjusted incidence rate is 3,2 /100.000

TAKE HOME POINT!

 For brain tumor, MRI is better than CT scan.

 Advanced MRI is the best imaging modality to differentiate between benign vs malignant brain
tumor, lesion mimicking tumor & differentiate primary tumor from metastasis.
 Advanced MRI try to approach the histologic grading for brain tumor, but should be aware
about pitfalls of advanced MRI by combining MRS with other advanced imaging techniques such
as DWI, PWI, and permeability maps improves diagnostic accuracy for brain tumors.