TUMORS OF CNS

Classification

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Glioma Neuronal Embryonal Meningioma

Tumors Tumors

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Gliomas
C
L
A
S
Astrocytoma
Astrocyto
S ma
I
F
I
C Oligo-
Ependymoma
A dendroma
T
I
O
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N
ASTROCYTOMA
Diffuse (grade II)

Anaplastic (grade III)

Glioblastoma
(grade IV)

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 Diffuse Astrocytoma

? 80% of primary brain tumors

? Cerebral hemispheres
? 4th - 6th decade
? Signs- seizure, headache,
focal neurologic deficits

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MORPHOLOGY
Gross -
Poorly demarcated and
infiltrative tumor
Cut surface : Gray, firm or
soft and gelatinous. May
show cystic degeneration.
IHC -immunopositivity for GFAP (glial fibrillary acid protein).
Microscopy -
Mild to moderate cellularity
Variable degree of nuclear
pleomorphism.
Fibrillary background:
Extensive network of fine,
GFAP-positive astrocytic
processes
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Anaplastic Astrocytoma

? Densely cellular
? Nuclear
pleomorphism
? Anaplasia
? Presence of mitotic
figure

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 Glioblastoma

1. Serpentine (snake like)

pattern of necrosis
Palisading tumor cells :
'pseudopalisading
(garlanding)'

2. Vascular or endothelial
cell proliferation
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 OLIGODENDROGLIOMA
Infiltrating gliomas
4th - 5th decade

● White matter of the cerebral hemispheres

● Well-circumscribed, gelatinous, and gray
● May show cysts, areas of hemorrhage, and
calcification

Prognosis: Better than astrocytomas.

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 Microscopy

● Sheets of regular cells.

● Spherical nuclei with
fine granular chromatin,
surrounded by a clear
halo of cytoplasm.
● Stroma - Delicate
network of capillaries
● Calcification
(calcospherites) 12
 PATHOGENESIS
1. Mutation in IDH

“ (isocitrate
dehydrogenase) genes
( IDH 1 and IDH 2)
2. Mutation in promoter
for telomerase
3. Mutation in 1p and
19q
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 EPENDYMOMA

Ventricular system, including central

canal of the spinal cord.
● First 2 decades of life: Fourth
ventricle.
● Adults: Spinal cord-frequently
associated with neuro fibromatosis
type 2 (NF2).

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 MORPHOLOGY

GROSS :
Usually solid or papillary.
Moderately well demarcated from
adjacent brain parenchyma.

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MICROSCOPY
Tumor cells resemble normal ependymal cells
Nuclei round to oval having abundant granular chromatin.
1. Ependymal rosettes: gland like round or elongated
structures (rosettes or canals) --- show long, delicate
processes extending into a lumen.

2. Perivascular pseudorosettes: Tumor cells are arranged

around vessels
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Neuronal Tumors
 1 2 3
Central neurocytoma Dysembryoplastic Gangliogliomas-
- low-grade neoplasm neuroepithelial neuronal tumors with a
found within and tumor- low-grade mixture of glial
adjacent to the tumor of children and elements. Slow
ventricular system young adults that growing, and often
characterized by grows slowly, typically manifest with seizures.
evenly spaced, round, is located in the
uniform nuclei and superficial temporal
islands of neuropil. lobe and consists of
small, round neuronal
cells arranged in
columns.
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Embryonal Tumors

3
MEDULLOBLASTOMA

● Children
● Cerebellum
● Highly malignant
● Radiosensitive

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MICROSCOPY
1. Highly cellular,
anaplastic cells
2. Tumor cells - small,
scanty cytoplasm,
hyperchromatic
nuclei
3. Homer-Wright =
central neurophil +
primitive tumor cells
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Meningiomas

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? Benign intracranial tumors
? Meningothelial cells of
arachnoid mater
? Slow growing
? 4th - 5th decade
? Female predominance
? Symptoms due to
compression
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MICROSCOPY
1. Meningothelial - whorled
2. Fibroblastic - collagen
3. Transitional - both
4. Psammomatous - psammoma bodies
5. Secretory - gland like

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Metastatic Tumors
Breast
Lung Kidney

Choriocarc
inoma Skin GIT

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THANK YOU

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