Brain tumors Epidemiology l Incidence l 2 8
Brain tumors
Epidemiology l Incidence: l 2. 8 -25/ 100. 000 reason of the death l Metastasis – ¼ of all tumors
Etiology l Genetical predisposition l Hereditary factors – m. Recklinghausen (also brain tumors), tuberous sclerosis. . . ) l Viral infections: Epstein-Barr virus - primary brain lymphoma l Environmental factors: pesticides, chemicals, RAT
Secondary brain tumors I - MTS l l l l Lung Breast Kidneys Malignant melanoma GIT Thyroid gland Gynecologic tumors Prostate
Secondary tumors I Originate from malignant tumors located primarily in other organs l Lung l Skin - Malignant melanoma l Kidney - hypernephroma l Breast – breast carcinoma l Colon – colon carcinoma These tumors cells reach the brain via the bloodstream
Secondary tumors I Originate from malignant tumors located primarily in other organs l Lung l Skin - Malignant melanoma l Kidney - hypernephroma l Breast – breast carcinoma l Colon – colon carcinoma These tumors cells reach the brain via the bloodstream
Secondary brain tumors II - MTS l l 25% of all brain tumors MTS – not only tu brain tissue, also to meninges meningeal carcinomatosis , malignant cell in CSF
Tumors of childhood l 20% of all tumors – tumors of childhood l More frequently malignant than in adults l The most frequent localisation - infratentorial (brainstem, cerebellum)
Benign vs malignant? l According histological structure l biopsy - (cell atypia, mitotic actibity, abnormal mitosis) l Localisation !!! l Benign tumors in brainstem or deep structures – bad prognosis
Brain tumors classification Neuroepitelial tumors 1. Astrocytoma I, II benign l l III (anaplastic astrocytoma) - malignant IV (gliobastoma multiforme) 2. Oligodendroglial tumors Oligodendroglioma 3. Ependymal tumors Ependymoma
Brain tumors classification 4. Mixed gliomas 5. Neuroepitelial tumors – unknown etiology 6. Chorioidal plexus tumors Papiloma, papilocarcinoma 7. Neuronal and mixed neuronalglial tumors 8. Pineal parenchymal tumors 9. Tumors with neuroblastic or glioblastic elements (embryonal tumors) Meduloblastoma
Brain tumors classification Other CNS tumors 1. Tumors of sellar region 1. Pituitar adenoma 2. Pituitar karcinoma 3. Kraniofaryngeoma 2. Hemopoetic tumors 1. Primary malignant lymfoma 2. Plazmocytoma
Brain tumors classification 3. Tumors from germinativ cells 4. Meningioma 5. Non-meningotelial meningeal tumors malignant melanoma malignant lymphoma
Brain tumors classification 6. Tumors of cranial and spinal cord nerves Neurinoma (Schwannoma) Neurofibroma 7. Local tumors Chondrosarkoma Chondrocarcinoma 8. Metastatic tumors 9. Nonclassified tumors 10. Cysts
Clinical feature I. 1. l l General symptoms Intracranial hypertension syndrome l Headache, vomiting, dizziness, blurred vision l Papilledema (prominent optic disc at the fundoscopis examination) l Dilatation of the pupile on the side of the lesion (anisocoria) New onset of epilepsy l Focal, GM Altered state of consciousness l Somnolence, coma Psychological changes (behavioral problems)
Clinical feature II. Focal signs l Depends on the localisation of tumor 2.
I. Neuroepitelial tumors l Astrocytoma 4 grades of malignity l l l I, II benign III (anaplastic astrocytoma) – malignant IV (gliobastoma multiforme) Adults l Frontal and temporal lobe l Rarely in childhood – pons l
Astrocytoma MRI T 1 weighted T 2 weighted flair
Astrocytoma – low grade – in pons Anaplastic astrocytoma
Gliobastoma multiforme l l l l The most malignant tumor of CNS Rapid progression 5. a 6. decade , men 2 x more often Deep part of hemispheres (bazal ganglia, talamus, white matter) Spreading by CSF, infiltration of corpus callosum, spreadin on the other side, infiltration of meninges) MTS also outside of CNS CT scan – cystic, necrosis, heamorrhages
Glioblastoma multiforme MRI T 1 weighted T 2 weighted
Glioblastoma multiforme Frequent mitosis Atypic cells Neovascularisation Bleeding
Glioblastoma multiforme MRI T 2 weighted SPECT
Glioblastoma multiforme
I. Neuroepitelial tumors l l l Oligodendroglial tumors Adults Frequently with calcifications Frontal lobe 5% of CNS tumors Low % is histological malignant
I. Neuroepitelial tumors 3. l l l Ependymal cells tumors 4% of CNS tumors Adults, children IV. Ventricle – obstructive hydrocefalus Spreading by CSF MTS in CNS
Ependymoma
I. Neuroepitelial tumors 4. l l l plexus choroideus tumors Papiloma or papilocarcinoma Rare Childhood Ventricles Hydrocefalus
Plexus choroideus tumors MRI histology
I. Neuroepitelial tumors 5. Neuroectodermal tumors l Childhood High grade of malignity l l MEDULOBLASTOMA 23% of CNS tumors in childhood Vermis, cerebellar hemispheres Rapid progression, compression of CSF athways, intracranial hypertension MTS in brain and outside of CNS – bones, lymphatic nodes
Meduloblastoma
4. Tumors of the meninges Meningioma l 15% of brain tumors l Localisation - hemisphers convexity, parasagital, n. olfactorius, sella turcica, pontocerebellar angle, tentorium l Benign l Bone usuration or hyperostosis
Meningioma CT MRI T 1 weighted
Meningioma l Parasagital l Monoparesis of contralateral lower extremity or paraparesis l Near l Unilateral anosmia l Near l bulbus olfactorius optic nerve Exoftlamus, monocular blindnsess, ipsilateral mydriasis with absent FR
Meningioma near optic nerve on the right side
Meningioma l Near l sphenoidal bone wings Epileptic seazures, lesion of cranial nerves – process near fissura orbitalis superior l Pontocerebellar l angle Loss of hearing, dizziness, Bells palsy
Brain CT – PCA meningioma
Brain CT - PCA meningioma
PCA meningioma
Meningioma Angiography
Meningioma Histology
Tumors of sellar region l Adenoma, adenocarcinoma l Chiasma opticum compression – bitemporal hemianopsy l Endocrinne lesions l Skull X-ray – enlargment of sella turcica
Tumors of sellar region
Secondary tumors CT MRI
Diagnosis l l l Slowly progressive focal neurological signs and signs of intracranial hypertension, epilepsy in a patient with negative history of epilepsy Optic fundus (oedema) Imaging l CT l MRI l Skull X-ray Angiography EEG, Histological examination of brain tumor tissue samples obtained either by means of brain biopsy or open surgery – definitive diagnosis
Therapy l Surgery Classical l Gamma knife l l Conservative Radiotherapy l Chemotherapy l Therapy of ICH and symptomatic therapy l
Gamma knife
Leksell gamma knife Súčasti: radiačná jednotka s operačným lôžkom a kolimátorovými helmicami, stereotaktický koordinačný rám a Gamma Plan - computerizovaný systém pre plánovanie a optimalizáciu radiochirurgickej liečby.
Pseudotumor cerebri l Idiopatic l l l intracranial hypertension Intracranial hypertension syndrome without tumor Papilledema (prominent optic disc at the fundoscopic examination) Women of middle age – more often After head injury Therapy – kortikosteroids, antidiuretics?
Paraneoplastic syndromes l Disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells These phenomena are mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by an immune response against the tumor l Middle aged to older patients l l The most commonly - cancers of the lung, breast, ovaries or lymphatic system (a lymphoma), also stomach, ovaria, prostata
Paraneoplastic syndromes l Sometimes the symptoms of paraneoplastic syndromes are present even before the diagnosis of a malignancy l 6, 6% - 10% patients with tumors l Antibodies against neuronal structures (anti Yo, anti Hu, anti Ri)
Paraneoplastic syndromes l All parts of nervous system Central NS l Periferal NS l Neuromuscular junction l Muscles l
Paraneoplastic syndromes l Small cell lung carcinoma l Breast carcinoma l Ovarial carcinoma l Hodgkin lymphoma l Tymoma l Neuroblastoma l Prostatic carcinoma
Paraneoplastic syndromes l Central nervous system l Multifocal encephalomyelitis l Cerebellar degeneration l Limbic encephalitis l Opsoclonus-myoclonus l Extrapyramidal syndrome l Brain-stem encephalitis l Necrotizing myelopathy l Motor neuron disease l Stiff person syndrome l Optic neuritis l Retinal degeneration l Peripheral nervous system l Sensory neuronopathy l Nerve vasculitis l Sensorimotor polyneuropathy l Motor neuropathy l Neuromyotonia l Autonomic insufficiency l Lambert–Eaton syndrome l Inflammatory myopathy l Necrotizing myopathy
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