TUMORS

TUMORS of
of the
the
CENTRAL
CENTRAL NERVOUS
NERVOUS SYSTEM
SYSTEM
CNS
CNS NEOPLASM
NEOPLASM

ADULTS CHILDREN
GLIOMAS MEDULLOBLASTOMAS
METASTATIC TUMORS CEREBELLAR ASTROCYTOMAS
MENINGIOMAS EPENDYMOMAS
CNS
CNS NEOPLASM
NEOPLASM
CNS
CNS NEOPLASM
NEOPLASM

 NINE

NINE TYPES
TYPES OF
OF CNS
CNS TUMORS
TUMORS
 1.

1.TUMORS
TUMORSOF
OFNEUROEPITHELIAL
NEUROEPITHELIALTISSUE
TISSUE
 2.

2.TUMORS
TUMORSOF
OFMENINGES
MENINGES
 3.

3.TUMORS
TUMORSOF
OFCRANIAL
CRANIALAND
ANDSPINAL
SPINALNERVES
NERVES
 4.

4.HEMATOPOIETIC
HEMATOPOIETICNEOPLASMS
NEOPLASMS
 5.

5.GERM
GERMCELL
CELLTUMORS
TUMORS
 6.

6.CYSTS
CYSTSAND
ANDTUMOR-LIKE
TUMOR-LIKELESIONS
LESIONS
 7.

7.TUMORS
TUMORSOF
OFTHE
THESELLAR
SELLARREGION
REGION
 8.

8.LOCAL
LOCALEXTENSIONS
EXTENSIONSFROM
FROMREGIONAL
REGIONALTUMORS
TUMORS
 9.

9.METASTATIC
METASTATICTUMORS
TUMORS
CNS
CNS NEOPLASM
NEOPLASM

 NINE

NINE TYPES
TYPES OF
OF CNS
CNS TUMORS
TUMORS
 1.

1.TUMORS
TUMORSOF
OFNEUROEPITHELIAL
NEUROEPITHELIALTISSUE
TISSUE
ASTROCYTOMAS

ASTROCYTOMAS
OLIGODENDROGLIOMAS

OLIGODENDROGLIOMAS
EPENDYMOMAS

EPENDYMOMAS
MIXED

MIXEDGLIOMAS
GLIOMAS
CHOROID

CHOROIDPLEXUS
PLEXUSTUMORS
TUMORS
NEURONAL

NEURONAL&&MIXED
MIXEDNEURONAL-GLIAL
NEURONAL-GLIALTUMORS
TUMORS
PINEAL

PINEALTUMORS
TUMORS
EMBRYONAL

EMBRYONALTUMORS
TUMORS
CNS
CNS NEOPLASM
NEOPLASM


 NINE
NINETYPES
TYPESOF
OFCNS
CNSTUMORS
TUMORS

 2.

2.TUMORS
TUMORSOF
OFMENINGES:
MENINGES:MENINGIOMAS
MENINGIOMAS
 3. TUMORS OF CRANIAL AND SPINAL NERVES:

3. TUMORS OF CRANIAL AND SPINAL NERVES:
SCHWANNOMAS
SCHWANNOMAS
NEUROFIBROMAS
NEUROFIBROMAS
MALIGNANT
MALIGNANTPERIPHERAL
PERIPHERALNERVE
NERVESHEATH
SHEATHTUMOR
TUMOR
 4.

4.HEMATOPOIETIC
HEMATOPOIETICNEOPLASMS:
NEOPLASMS:
LYMPHOMAS
LYMPHOMAS
SARCOMAS
SARCOMAS
 5.

5.GERM
GERMCELL
CELLTUMORS:
TUMORS:
GERMINOMAS,
GERMINOMAS,
TERATOMAS,
TERATOMAS,
EMBRYONAL
EMBRYONALCARCINOMAS
CARCINOMAS
CNS
CNS NEOPLASM
NEOPLASM


 NINE
NINETYPES
TYPESOF
OFCNS
CNSTUMORS
TUMORS

 6.

6.CYSTS
CYSTSAND
ANDTUMOR-LIKE
TUMOR-LIKELESIONS:
LESIONS:EPIDERMOID
EPIDERMOID
CYST,
CYST,DERMOID
DERMOIDCYST,
CYST,RATHKE’S
RATHKE’SCLEFT
CLEFTCYST
CYST
 7.

7.TUMORS
TUMORSOF
OFTHE
THESELLAR
SELLARREGION:
REGION:PITUITARY
PITUITARY
ADENOMAS,
ADENOMAS,CRANIOPHARYNGIOMAS
CRANIOPHARYNGIOMAS
 8.

8.LOCAL
LOCALEXTENSIONS
EXTENSIONSFROM
FROMREGIONAL
REGIONALTUMORS:
TUMORS:
CHONDROMAS,
CHONDROMAS,PARAGANGLIOMA
PARAGANGLIOMA
 9.

9.METASTATIC
METASTATICTUMORS
TUMORS
 0.

0.UNCLASSIFIED
UNCLASSIFIEDTUMORS
TUMORS
CNS TUMORS
CNS TUMORS

COMMON SIGNS & SYMPTOMS OF BRAIN

TUMORS:

PROGRESSIVE NEUROLOGIC DEFICIT 68%

MOTOR WEAKNESS 45%
HEADACHE 54%
SEIZURES 26%
SIGNS & SYMPTOMS
OF INCREASED ICP:
HEADACHE
NAUSEA &/OR
VOMITING
VI CN PALSY
CHANGE IN
SENSORIUM
PAPILLEDEMA
CNS TUMORS

 SIGNS & SYMPTOMS (Supratentorial)

 Increased ICP (mass effect, hydrocephalus)
 Progressive Neurologic Deficit
 Seizures (focal or generalized)
 Mental Changes (lethargy, confusion)
 “Tumor TIA” or “Stroke Like”
 CN I & II Deficits
 Endocrine Disturbances
CNS TUMORS

 SIGNS & SYMPTOMS (Infratentorial)

 Increased ICP (due to obst. hydrocephalus)
 Gait Disturbance / Ataxia
 Vertico
 Diplopia
 CN III to XII Deficits
CNS TUMORS
 DIAGNOSIS:  TREATMENT:
 CHEST X-RAY  SURGERY
 ESR  RADIOTHERAPY
 SKULL X-RAY  CHEMOTHERAPY
 CT SCAN  STEROID THERAPY
 MRI SCAN  RADIOSURGERY
 ANGIOGRAPHY / MRA
 CSF ANALYSIS
 TUMOR MARKERS: CRP,
NANA, CEA, NSE
CNS TUMORS
CNS TUMORS
Stereotactic Surgery
Neurotransplantation for Patients with Paralysis after Stroke
CNS TUMORS

 ASTROCYTOMA:

- MOST COMMON PRIMARY INTRA-AXIAL

BRAIN TUMOR
- INVOLVE ALL LOBES WITH PREFERENTIAL
TO FRONTAL & TEMPORAL LOBES
- GRADING BASED ON HISTOLOGY:
hypercellularity; pleomorphism;
vascular proliferation; necrosis
- TREATMENT: Surgery, Radiation,
Chemotheraphy or Combination
Pilocytic Astrocytoma (Grade I)
 Incidence: 3-6%
 Age Predilection: Under 20 yrs
 Gender Distribution: Equal
 Location: Posteror Cranial Fossa; Chiasma Region; Temporal Lobes
 Cardinal Symptoms: Headache, vomiting, ataxia, visual
disturbances, hypothalamic damage, convulsions
 Plain CT: Hypodense mass lesion, sometimes with calcium;
sometimes isodense/hyperdense
 Contrast CT: Strong enhancements; solid tumor nodules with cysts
and ring formations
 Histology: Fascicular arrangements of long bipolar cells
Astrocytoma Grade II

 Incidence: About 2%
 Age Predilection: 25-45 yrs
 Gender Distribution: Men slightly more frequently
 Location: Fronto-temporo-precentral; Temporo-parietal; Pons
(children)
 Cardinal Symptoms: Seizures; Later neurological malfunctions
 Plain CT: Circumscribed homogenous, sharply delimited
hypodense zone
 Contrast CT: No Change
 Histology: Isomorphous hypocellular tissue; No evidence of
mitosis; Few regularly structured vessels
CNS TUMORS
Anaplastic Astrocytoma (Grade III)
 Incidence: About 4%
 Gender Distribution: Slightly more in Men
 Location: Fronto-parieto-temporal; Parieto-temporal
 Cardinal Symptoms: Headache; Seizures; Focal neurological
 Plain CT: Non-uniform hypo and isodense zones
 Contrast CT: Slight to Medium perifocal edema; ring or solid
with cysts; may be similar to Grade II
 Histology: Cellular and nuclear polymorphy; occasional mitosis
and microfocal necroses; greater cell density
 Dupplementary Exam: EEG
CNS TUMORS
Glioblastoma
 Incidence: 12-20%
 Age Predilection: 40-65 yrs
 Gender Distribution: M;F=2:1
 Location: All regions (often multiple lobes); basal ganglia,
corpus callosum (butterfly); may be multicentric
 Cardinal Symptoms: Short history; distinct focal neurological;
Psychosyndromes; Seizures
 Plain CT: Mixed density tumor; distinct mass effect and
perifocal edema
 Contrast CT: Enhancement (ring-like to scalloped)
 Histology: Cellular polymorphism; rich in mitosis; vascular
proliferation, necrosis, hemorrhages; capillary thrombosis
CNS TUMORS
Meningioma
 Incidence: 14-15%
 Age Predilection: 35-70
 Gender Distribution: M;F=almost 2:1
 Location: Parasaggital; Falx; Convexity; Cranial Base;
Cerebellum; Tentorium; Lateral Ventricles (rarely)
 Clinical Symptoms: Headache; Focal Deficit; Seizures
 Plain CT Scan Usually hyperdense (sometimes isodense);
homogenous; calcifications; medium grade edema
 Conrast CT Scan: Distinct enhancement
 Supplementary Examinations: EEG; Skull X-Ray
(hyperostosis/erosion); Angiography (supply/embolization);
CNS TUMORS