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NEOPLASM OF THE CENTRAL
NERVOUS SYSTEM.
DR. AMITABHA BASU MD
General - Statistics vary
widely


Primary tumors of the CNS account for
about 9% of all neoplasms.
Of all intracranial tumors, approximately
30% are metastatic.
ANATOMICAL LOCATION OF TUMORS


70% of primary
intracranial tumors in
adults are
supratentorial.
70% of primary
intracranial tumors in
children are
infratentorial
INCIDENCE


The most common primary malignant
intracerebral tumor in adults is the
Glioblastoma Multiforme.
The most frequent malignant brain
tumor in children is the
Medulloblastoma.
Brain tumors
1.
Primary Neuroglial Tumor: (gliomas)
1.
2.
2.
Primitive Neuroepithelial Tumor
1.
3.
4.
5.
Astrocytoma
Oligodendroglioma
Medulloblastoma
Neuronal Tumor, Lymphoma
Meningioma
Metastatic Tumor
1. In the brain parenchyma
2. In the meninges
ASTROCYTOMA
Types
1. Fibrillary Astrocytoma
2. Pilocystic astrocytoma.
3. Glioblastoma Astrocytoma (high grade)
Genes and Markers:
Mutation of TP53 is important for the development of
this tumor.
Marker: GFAP = Glial Fibrillary acidic Protein
Fibrillary
Astrocytoma
Common in Adult
Fibrillary astrocytic astrocytoma: fibrillary
appearance.
Pilocystic Astrocytoma
Common in Children
Gross: cystic mass
Micro: Rosenthal fibers.
Pilocystic Astrocytoma
Cystic mass in cerebellum
Rosenthal fibers
Pilocytic Astrocytoma

Common in the children

Common sites:


Cerebellum, Third ventricle, Optic nerve
PROGNOSIS DEPENDS ON THE SITE.

If occur in Cerebellum = It is surgically resectable –
so good prognosis.
Glioblastoma Multiforme
GBM
Gross
Micro
Clinical Features
Prognosis & treatment
A Glioblastoma Multiforme ; very bad
prognosis; most aggressive neoplasm
Note: this one has crossed the midline to the
opposite hemisphere.
Glioblastoma Multiforme (GBM):
Histology
1. Demonstrates marked cellularity
2. Pleomorphism and high mitosis.
3. Area of necrosis with neoplastic cells
palisading around it.
4. Vascular proliferation
Palisading of Neoplastic
cells
Necrosis
Magnetic resonance imaging (MRI) scan of
the head in sagittal view

A large
glioblastoma
multiforme
involving the left
occipital lobe.
Symptoms and Signs Produced by
Brain Tumors
A. Tumor Mass Effect : compression of blood
vessels and herniation.
B. Effect due to Surrounding Edema ( by
metastatic Tumor: herniation
4 features
Clinical Features and Prognosis
3.
Raised intracranial Pressure
[Headache]
3.
Focal abnormality: Seizers
Uncontrollable shaking of his
arm and leg.
Prognosis & treatment

Prognosis depends upon
1. Location
2. Histological Grade
3. Age [ adult : bad prognosis]


Treatment
Surgical removal ( if possible) and
radio/chemo therapy.
Oligodendroglioma
This type of glioma tends to be well
circumscribed, with cystic areas and focal
calcification.
[Calcification = Important radiological Clue]


These tumors comprise about 5% of all
gliomas.
EPENDYMOMA
EPENDYMOMA



Age: Any age
Common in first 2
decades
Location :


Ventricles
Central canal of Spinal
Cord.
Microscopic appearance- 2 types
1.
In the ventricle ( within cranium): this
ependymoma reveals a true rosette pattern
with the cells arranged about a central
vascular space.
2.
Myxopapillary ependymoma, which is typically
found arising in the filum terminale of the
spinal cord .
Ependymoma reveals a rosette:
Perivascular
Myxopapillary ependymoma : The cells around
papilla that have a myxoid connective tissue core.
Found arising in the filum terminale of
the spinal cord
Ependymoma- Clinical features

Depends upon the location.
Intracranial Tumor = Hydrocephalous,
headache.

These tumor-cell can be seen in the CSF.

PRIMITIVE NEUROEPITHELIAL
NEOPLASM (PNET)
Medulloblastoma
Other tumors of PRIMITIVE
NEUROEPITHELIAL cell origin….
1. Pineoblastoma
2. Ependymoblastoma
Medulloblastoma

Lesion of the Cerebellum
Midline vermis in young children

Spread: through CSF

Micro: Homer-Wright rosettes

Occasionally there may be a suggestion of
neuronal differentiation (Homer-Wright
rosettes) .
Medulloblastoma


Without therapy, they are rapidly
fatal.
Surgical excision, chemotherapy, and
radiotherapy (to the entire spinal
cord), have produced 70% - 5-year
survivals.
Acoustic Neuromas

Origin: The VIII cranial nerve.
Location: In the cerebellopontine angle.

Clinical: Present with hearing loss.

Micro: Neurilemoma (Schwannoma).

Microscopic patterns


Antoni A pattern
Show Verocay
bodies.
The Antoni B
patterns: low
cellularity
Schwannoma is markedly positive
with S-100 staining
Metastatic tumor





Location: Border of the grey and white matter in
the distribution of the middle cerebral artery.
Multiple and well circumscribed.
Other site is meninges
The lung is the most common primary site.
Others: ALL, melanoma.
Meningeal Metastasis: Leptomeningeal
Carcinomatosis.


Metastases of malignant cells in the
leptomeninges.
Breast cancer is the most likely primary.
 Cranial
Nerve palsy is common in
Meningeal Metastasis.
Carcinoma Cells in the Meninges.
Meningioma




Derived from meningothelial cells.
Female > male
Attached to dura- parasagital
Micro:



Spindle cells in syncytial mass
Arranges in whorls
Psammoma body
Meningioma
whorls

Psammoma bodies may be seen on microcopy.
Meningioma- Associated with
Neurofibromatosis
Type 1
Neurofibroma, peripheral
schwanoma, Meningioma,
pigment is skin and iris.
Neurofibromatosis
Type II
Schwanoma of VIII cranial
nerve, Meningioma, post lens
opacification
MRI scan in axial view


A discrete mass along
the lateral convexity.
Clinical: slow growing,
weakness of the limbs.
Primary Brain Lymphoma



Etiology: EBV, AIDS and
immunosuppression.
Location of tumor cells: pervascular and
peri ventricular.
Type: NHL
Thanks, All of you, Wish you
Good luck!!
BE A GOOD DOCTOR

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