CNS TUMORS. D r. Ali Eltayb ( U. of Omdurman. I ). M. Path (U. of Alexandria)

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2 CNS TUMORS D r. Ali Eltayb ( U. of Omdurman. I ). M. Path (U. of Alexandria)

3 CNS TUMORS The annual incidence of intracranial tumors of the CNS ISmore than intraspinal tumors May be Primary or Secondary (metastases) Primary tumors are more common. are a larger proportion of cancers of childhood, (20% of all tumors. ) CNS tumors in childhood differ from those in adults both in histologic subtype and location. In childhood, tumors are likely to arise in the posterior fossa, while in adults they are mostly supratentorial

4 CNS TUMORS Primary Tumors of the nervous system may arise: from the cells of the coverings (meningiomas). From cells intrinsic to the brain (gliomas, neuronal tumors, choroid plexus tumors). From Other cell populations within the skull (primary CNS lymphoma, germ-cell tumors),

5 CNS TUMORS Tumors of the nervous system have unique characteristics: Histologic distinction between benign and malignant lesions may be more subtle. The pattern of growth of low-grade lesions may include infiltration of large regions of the brain (poor prognosis.) The anatomic site of the neoplasm have lethal consequences irrespective of histologic classification. The ability to resects a lesion may be limited because of its location The pattern of spread of primary CNS neoplasms differs from that of other tumors. Metastatic spread of brain tumors to other regions of the body is rare.*

6 CNS TUMORS The major classes of primary brain tumors include : I. Gliomas. II. Neuronal tumors. III. Poorly differentiated tumors. IV. Other parenchymal tumors: - Primary CNS Lymphoma - Germ-Cell Tumors. - Pineal Parenchymal Tumors. V. MENINGIOMAS

7 I. Gliomas:* 1.Gliomas. The most common group of primary brain tumors. include : A. Astrocytomas.** B. Oligodendrogliomas. C. Ependymomas A. Astrocytomas. most frequent type of brain tumours The most common types 1 - Fibrillary Astrocytoma 2 - Pilocytic astrocytomas

8 1.Gliomas. 1.Fibrillary Astrocytoma : Account for 80% of adult primary brain tumors. Age: fourth through sixth decades. Site, cerebral hemispheres. C/F: seizures, headaches, and focal neurologic deficits related to the anatomic site of involvement.

9 1.Gliomas. 1.Fibrillary Astrocytoma : Based on the degree of differentiation, they are classified into three groups: a. Astrocytoma. WD astrocytomas, static or progress only slowly a mean survival of more than 5 years b. Anaplastic astrocytoma. c. Glioblastoma multiforme:(poor-differentiated ) has very poor survival of only 8 to 10 months Morphology, The macroscopic: a poorly defined, gray, infiltrative tumor. In glioblastoma, variation in the gross, firm and white, others are soft and yellow, others show regions of cystic degeneration and hemorrhage.

10 I.Gliomas 1.Fibrillary Astrocytoma : :Morphology,Micrscopic: W-D fibrillary astrocytomas,a mild to moderate increase in the number of glial cell nuclei, variable nuclear pleomorphism, a fibrillary background (GFAP-positive). Anaplastic astrocytomas more densely cellular and have greater nuclear pleomorphism; increased mitoses. Glioblastoma, similar to anaplastic astrocytoma + necrosis and vascular or endothelial cell proliferation and pseudopalisading nuclei,. High-grade astrocytomas have abnormal vessels that are "leaky *

11 2-Pilocytic Astrocytoma: Are relatively benign tumors. I. Gliomas Age: occur in children and young adults. Site :usually located in the cerebellum Morphology is often cystic, with a mural nodule in the wall of the cyst if solid, it is usually well circumscribed microscopic The tumor is composed of areas with bipolar cells with long, thin "hairlike" processes that are GFAP positive. Necrosis and mitoses are absent

12 I. Gliomas B. Oligodendrogliomas. 5% to 15% of gliomas. common in the fourth and fifth decades. C/ F: Patients had several years of neurologic complaints, often including seizures. Site: the cerebral hemispheres, with a predilection for white matter. a better prognosis than do patients with astrocytomas Current treatment with surgery, chemotherapy, and radiotherapy yields an average survival of 5 to 10 years.

13 1.Gliomas. B. Oligodendrogliomas. Macroscopic: infiltrative,gelatinous, gray masses. May show cysts, focal hemorrhage, and calcification. Microscopic :.* Fried egg appearance Calcification, present in as many as 90% of these tumors

14 I.Gliomas C. Ependymomas Site: most often arise next to the ependyma-lined ventricular system. In first two decades of life, they typically occur near the fourth ventricle. In adults, the spinal cord is their most common location.. CSF dissemination is a common occurrence Morphology Macroscopic : In the fourth ventricle, solid or papillary masses extending from the floor of the ventricle. Microscopic* Tumor cells may form (rosettes, canals) or perivascular pseudo-rosettes.

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16 Ganglioglioma. : II. Neuronal Tumors The most common CNS tumor containing mature-appearing neurons (ganglion cells). Lesions contain mixtures of neuronal and glial elements. Most of these tumors are slow growing. often present as a seizure disorder. surgical resection of the tumor is usually effective in controlling the seizures. - tow subtypes -Central neurocytoma - Dysembryoplastic neuroepithelial tumor (childhood) both are a low-grade neuronal neoplasm.

17 III. Poorly Differentiated Neoplasms Medulloblastoma, : predominantly in children 20% of pediatric T. exclusively in the cerebellum. often largely undifferentiated. The tumor is highly malignant. prognosis IF untreated is dismal. exquisitely radiosensitive. With total excision and radiation, the 5-year survival rate may be as high as 75%

18 Morphology: Site: In children, midline of the cerebellum, lateral tumors in adults. Macroscopic: well circumscribed, gray, and friable,. Microscopically: extremely cellular, with sheets of anaplastic ("small blue") cells.mitoses are abundant

19 IV.OTHER PARENCHYMAL TUMORS Primary CNS Lymphoma Primary CNS lymphoma accounts for 2% of extra-nodal lymphomas and 1% of intra-cranial tumors. It is the most common CNS neoplasm in immunosuppressed individuals. In non-immunosuppressed populations the frequency increases after 60 years of age Primary brain lymphoma is often multifocal within the brain parenchyma, Most primary brain lymphomas are of B-cell origin. always high grade primary brain lymphoma is an aggressive disease as compared with peripheral lymphomas.

20 Germ-Cell Tumors Primary occur along the midline, most commonly in the pineal and the suprasellar regions. They are a tumor of the young, with 90% occurring during the first two decades. Germ-cell tumors in the brain share many of the features of their counterparts in the gonads. the counterpart to the testicular seminoma is called a germinoma.

21 V. Meningiomas Are benign tumors of adults. Arising from the meningothelial cell of the arachnoid. And usually attached to the dura, found in external surfaces of the brain or within the ventricular system. Presentation: -vague non localzing symptoms, -focal findings referable to compression of underlying brain..morphology: Macroscopic grow as well-defined dural-based masses. compress underlying brain but are easily separated from it. Extension into the overlying bone may be present Histologic patterns found in meningiomas,including: Syncytial,Fibroblastic, Transitional,. Psammomatous, Secretory, Microcystic,

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23 Atypical meningiomas Meningiomas lesions with a higher rate of recurrence. More aggressive local growth, A possible need for therapy in addition to surgery. Are recognized by several histologic features including a higher mitotic rate. Anaplastic (malignant) meningiomas are highly aggressive tumors that resemble a high-grade sarcoma, lthough most meningiomas are easily separable from underlying brain, some tumors infiltrate the brain. The presence of brain invasion is associated with increased risk of recurrence The overall prognosis of meningiomas is influenced by the size and location of the lesion, surgical accessibility, and histologic grade.

24 Metastatic Tumors Mostly carcinomas. The five most common primary sites are lung, breast, skin (melanoma), kidney, and gastrointestinal tract, 80% of all metastases. The meninges are also a frequent site of involvement by metastatic disease. GROSS: In the brain. Metastases form sharply demarcated masses. often at the gray matter-white matter junction. usually surrounded by a zone of edema.

25 Metastatic Tumors

26 Metastatic Tumors Presentaion: Direct and localized effects produced by metastases. (mass effect) paraneoplastic syndromes may involve the peripheral and central nervous systems. There are several manifestations - Subacute cerebellar degeneration,ataxia. - Limbic encephalitis causing a subacute dementia. - Subacute sensory neuropathy leading to altered pain sensation

27 In general following pathological and clinical changes are seen with intracranial tumors: Compression. Destruction. Cerebral edema. Convulsion. Hydrocephalus. Raised intracranial pressure *

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29 Thank you

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