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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
Most common tumors: 55-74
Most common tumors: 75+
5 year survival rate for all pts dx with malignant brain tumors 1992-1998
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)
-laboratory test (for byproducts that tumors produce)
Lab tests
-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
alpha fetaprotein
human chorionic gonadotropin
placental alkaline phosphatase
carcinoembryonic antigen
adrenocorticotropic hormone
growth hormone
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)
-swelling, neoplasm
-new growth
-usually focal
-autonomous and having no useful function
-slow growing
-distant spread (metastases)
-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
-anatomic extent of a tumor
-degree of malignancy based on histologic pattern
-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
-area of necrosis
Common symptoms of increased intracranial prssure
Pathological changes with intracranial expanding mass lesions
-brain edema
-brain herniations
-vascular changes
-obstructive hydrocephalus
-pituitary necrosis
Brain Edema
-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
-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
-predominantly benign tumors of adults
-usually attach to the dura
-arise from the meningothelial cells of the arachnoid
-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
-27% of all primary brain tumors
-frequently in middle-aged women
-most often a single tumor, but multiple meningiomas can occur
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
-kidney CA
-colon CA

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