Brain Tumors Lindsay A Wilson, pgy2 AM Report 1/27/2010.

Brain Tumors

Lindsay A Wilson, pgy2AM Report1/27/2010

Outline.

1. Review cancers that are metastatic to the brain.2.  Review classification of brain tumors confined to the meninges and brain parenchyma (Glial versus Non-glial).  3.  Review common brain tumors.4.  Mention brain tumors found mainly in kids 

Mets

 Metastatic brain tumors (cancer that spreads from other parts of the body to the brain) occur at some point in 10 to 15% of persons with cancer and are the most common type of brain tumor. • Breast• Melanoma• Kidney• GI• Thyroid• Lung• Ovarian• Testicular

Primary Brain Tumor Basics

• Adults=supratentorial vs Kids=Infratentorial• Brain tumors rarely metastasize• Benign can be bad due to mass effects• Easy way to divide types of brain tumors is glial versus

non-glial (50/50).   Glial cells = astrocytes, oligodendrocytes, and ependymal cells.   Of primary CNS tumors=80%

• "Alarm symptoms" that point to brain tumor:  Headache recurs frequently, is severe, starts in someone who hasn't had headaches before, occurs at night, is present upon awakening, is accompanied by nausea, vomiting, poor balance/coordination, double vision, and/or dizziness.

•  The third leading cause of cancer death in young adults ages 20-39.

WHO ClassificationTumours of neuroepithelial tissue (glial)Astrocytic tumours*** Oligodendroglial tumours*** Mixed gliomas*** Ependymal tumours*** Choroid plexus tumours*** Neuronal and mixed neuronal-glial tumoursNeuroblastic tumours** Pineal parenchymal tumours **Embryonal tumoursTumours of peripheral nervesSchwannoma (Neurinoma)** Neurofibroma** PerineuriomaMalignant peripheral nerve sheath tumour (MPNST)Tumours of the meninges Tumours of meningothelial cells:  Meningioma (WHO grade I) Atypical meningioma (WHO grade II) Anaplastic meningioma (WHO grade III) Mesenchymal, non-meningothelial tumours:  Primary melanocytic lesions Lymphomas and haemopoietic neoplasms Malignant lymphomas** Plasmacytoma** Granulocytic sarcoma** Germ cell tumours Germinoma** Embryonal carcinoma** Yolk sac tumour Choriocarcinoma** Teratoma** Mixed germ cell Tumors of the sellar region

Craniopharyngioma** Granular cell tumour** Metastatic tumours Data from Louis, DN, Ohgaki, H, Wiestler, OD, Cavenee,WK. WHO Classification of Tumours of

the Nervous System. IARC Press, Lyon 2007.

GLIAL TUMORS

Astrocytoma:• 20% primary intracranial neoplasms• Life expectancy approximates 5 years, worse prognosis if

transformation to glioblastoma multiforme occurs (10% of cases) 

• Four grades...with grade IV being GBM• If low grade:• Difficult to resect but complete resection is better than

debulking alone• Often follow surgery w/ RT• If really small, will delay surgery until symptoms or signs of

growth

GLIAL TUMORS

High grade= Glioblastoma multiforme• Most common brain tumor• Poor prognosis, often death < 1 year• Tumor crosses the corpus callosum=butterfly• Key path:  Pseudopalisades and pseudorosettes

GLIAL TUMORS

Oligodendrogliomas5% of glial tumorsfrontal lobepath=fried eggsurgery +/- adj. therapy RTchemo sensitive Ependymomas 5% of glial tumors, kids>adults4th ventricle--obstruct flow of CSFrsxn, then radiation, chemoin adults, see in spinal cord (75%) 

NON-GLIAL

Meningioma• Second most common primary intracranial neoplasm

(account for 20%)        • Tumor is external to the brain (displaces brain tissue) • More common in women than men• Most often occurs after the age of 40• Originates in the arachnoidal cells• Considered a benign, slowly growing tumor          • Can erode contiguous bone• Can be seen in association with NF-2• Can be induced by radiation therapy (1960s tinea capitus)

Treatment:-Can be conservative (ie no treatment)-Surgery (either full or partial resection depending on tumor location), sometimes preceded by embolization-Radiation can be primary treatment or adjunct to surgery

NON-GLIALSchwanomma (acoustic neuroma)• Tumor derived from Schwann cells• Acoustic neuromas may cause tinnitus, deafness, compression

of other CNs• Surgery usually results in cure (RT also used, can observe too)•  NF2 (neurofibromatosis) is characterized by bilateral acoustic

neuromas (autosomal dominant syndrome)

NON-GLIAL

Lymphoma• Primary B-cell• AIDS• immunosupp.• link to EBV• MTXbased chemo• RT• Ocular involv.• slit lamp exam

NON-GLIAL

Hemangioblastoma• Often syndromic and hereditary (Lindau, von Hippel-

Lindau=mutations in tumor suppressor gene VHL)• Can secrete erythropoitin and induce polycythemia• Highly vascularized• Originates in the cerebellum• Embolization then surgery

Brain tumors that are more common in kids (and therefore not discussed any further)• Choroid plexus papilloma • Neuroblastoma• Retinoblastoma• Medulloblastoma• Ganglioglioma• Germ cell tumors (can be in young men)

Works cited

RubinsUptodateWikipediaMerck ManualPathology Board Review SeriesNMS Medicine