Neuro:Brain Tumors
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- incidence of primary brain tumors
- 14 per 100,000 persons (0.014%)
- Tumor Specific Statistics
-
27% meningiomas
23% glioblastomas
12% asctrocytomaa
8% nerve sheath tumors (acoustic neuromas)
7% pituitary tumors
3% lymphomas
3% oligodendogliomas
2% medulloblastoma - Age specific Statisitics
-
0-4 embryonal.primative neuroectodermal/medulloblastomas
5-19 pilocytic astrocytomas
20-34 pituitary tumors
35-54 meningiomas
55-74 glioblastomas
75+ meningioma - Most common tumors: 0-4 yo
- embryonal/primative neuroactodermal medulloblastomas
- Most common tumors: 5-19 yo
- pilocytic astrocytomas
- Most common tumors: 20-34
- pituitary tumors
- Most common tumors:35-54
- meningiomas
- Most common tumors: 55-74
- glioblastomas
- Most common tumors: 75+
- meningioma
- 5 year survival rate for all pts dx with malignant brain tumors 1992-1998
- 32%
- risk factors for brain tumors
-
-no risk factors have been identified for the majority of brain tumors
-only proven risk factor (environmental) is exposure to ionizing radiation - genetic factors and brain tumors
- -only 5-10% of all cancers are herditary/familial
- brain tumors that are linked to genetic mutations include:
-
-Li-fraumeni syndrome (TP53 gene)
-tuberous sclerosis (TSC 1 & 2)
-Turcots (APC gene)
-Gorlins (PTCH gene)
-NF1 and NF 2 - Diagnoses for brain tumors
-
-neurological exam
-scans (CT, MRI, angiography, MRS, PET)
-xrays
-laboratory test (for byproducts that tumors produce)
-BIOPSY - Lab tests
-
-LP
-endocrine evaluation - Lumbar Puncture tumor markers
-
-germ cell tumors (AFP, HCG, PLAP)
-tumors of the arachnoid/pia mater (CEA) - Endocrine Evaulation
-
-pituitary or hypothalamic tumors
-ACTH, GH, PRL, TSH - AFP
- alpha fetaprotein
- HCG
- human chorionic gonadotropin
- PLAP
- placental alkaline phosphatase
- CEA
- carcinoembryonic antigen
- ACTH
- adrenocorticotropic hormone
- GH
- growth hormone
- PRL
- prolactin
- TSH
- thyroid stimulating hormone
- Types of biopsy
-
-diagnostic bx (sterotaxic) (remove 1-2 cells)
-intraoperative frozen section (remove part of lesion, slice into pieces, freeze it)
-surgical pathology specimen (remove whole lesion) - Tumor
- -swelling, neoplasm
- neoplasm
-
-new growth
-usually focal
-autonomous and having no useful function - benign
-
-noninvasive
-localized
-slow growing - malignant
-
-invasive
-distant spread (metastases)
-lethal - Cancer
- -any malignant neoplasm
- Primary tumor
- -found where it began
- Secondary tumor
- -distant spread from primary site, (metastatic)
- Metastatic tumor
- -secondary tumor
- Infiltrative Tumor
- -direct extension or spread
- Staging
- -anatomic extent of a tumor
- Grading
- -degree of malignancy based on histologic pattern
- prognosis
-
-forecast of the probable outcome of a disease (staging and grading are both designed to arrive at prognosis)
-includes demographics, race, socioeconomic class to some extent - Grade I tumor
-
-slow growing
-least malignant
-ususally associated with long-term survival - Grade II tumor
-
-relatively slow growing
-can invade adjacent normal tissue
-can recur as high grade tumor - Grade III tumor
-
-actively producing abnormal cells
-infiltrate adjacent normal brain tissue
-tumor tends to recur, often at higher grade - Grade IV tumor
-
-abnormal cells which reproduce rapidly
-angiogenesis
-area of necrosis - Common symptoms of increased intracranial prssure
-
-headache
-nausea
-vomiting
-drowsiness - Pathological changes with intracranial expanding mass lesions
-
-brain edema
-brain herniations
-vascular changes
-obstructive hydrocephalus
-pituitary necrosis - Brain Edema
-
-vasogenic
-results from breakdown of the BBB
-increased permeability of capillaries and escape of fluids and plasma proteins into the extracellular space
-cheifly in the white matter - Transtentorial Herniations
-
-hemispheric lesions displace the hippocampus and uncus through the tentorial opening
-oculomotor nerveroot is pressed against the sharp edge of the tentorium causing ipsilateral oculomotor nerve palsy
-dilated fixed pupil and ptosis - Cerebellar-tonsillar Herniations
-
-mass lesion in posterior fossa displaces the cerebellar tonsils through the foramen magnum
-subsequently, the medulla is compressed
-leads to resp impairment/ acute resp failure
-usually fatal - Vascular Changes
-
-caused by stretching or compression of blood vessels
-consequences may include occipital infarct and Pontine hemorrhage (Duret) - 4 main types of brain tumors
-
1. gliomas
2. neuronal tumors
3. poorly differentiated neoplasms
4. meningiomas - Gliomas
-
-derived from glial cells
-include astrocytomas, glioblastomas,oligodendrogliomas, ependymomas - Neuronal Tumors
-
-ganglion cell tumors
-include ganglioglioma, dysembryonoplastic neuroepithelial tumor - Poorly Differentiated Neoplasms
-
-express few if any of the phenotypic markers of mature cells
-include medulloblastoma - Meningiomas
-
-predominantly benign tumors of adults
-usually attach to the dura
-arise from the meningothelial cells of the arachnoid - Astrocytoma
-
-tumors that arise from astrocytes (supportive tissue of the brain)
-can be malignant or benign
-look like normal brain tissue
-graded 1-IV - Types of astrocytoma
-
-cerebellar astrocytoma
-desmoplastic infantile astrocytoma
-pilocytic astrocytoma
-subependymal giant cell astrocytoma - Glioblastoma Multiforme (GBM)
-
-20% of all primary brain tumors
-50% of glioma
-rapid growing
-5 year survival <1% - GBM are generally found in the...
- cerebral hemispheres
- GBM sx are usually due to...
- -increased intrcranial pressure
- On CT, GMC has a characteristic..
- characteristic enhancing ring
- Meningioma arises from...
- arachnoid mater
- Meningioma
-
-27% of all primary brain tumors
-frequently in middle-aged women
-most often a single tumor, but multiple meningiomas can occur
-benign - Meningiomas risk factors
-
-radiation exposure
-neurofibromatosis type 2 - Choroid plexus papilloma look like...
-
-bunch of grapes
-can see tumor cells in CSF with lumbar puncture - Central neurocytoma is often associated with ...
- obstructive hydrocephalus
- Most common metastatic (secondary) brain tumors:
-
-lung CA
-breast CA
-melanoma
-kidney CA
-colon CA