Neuro Pathology I 10 526 201 CROSSSECTIONAL PATHOLOGY

Neuro Pathology I 10 -526 -201 - CROSS-SECTIONAL PATHOLOGY BENIGN AND MALIGNANT MASSES

Benign and Malignant Masses

Gliomas Primary tumor of the brain (malignant) Most aggressive brain tumors Most common in males age 50 -70 Accounts for 23% of all primary brain tumors. Axial CT scan of a diffuse brainstem glioma: Note very hypodense central portion of tumor with surrounding hypodensity spreading into the cerebellum. This spreading hypodensity commonly contains tumor cells. Contrast-enhanced T 1 -weighted image of diffuse intrinsic pontine glioma: This gadolinium- enhanced T 1 -weighted sagittal image shows an unusual amount of enhancement, as these tumors typically have heterogeneous or no enhancement. Both Images from: http: //ispn. guide/book accessed on 8 -12 -15

Cholesteatoma - Soft tissue mass/cyst in the middle ear - Bony erosion may be present - Benign mass usually - Treatment: surgery A large cholesteatoma in the right middle ear with destruction of the lateral wall of the tympanic cavity. The body of the incus, which is lateral to the mallear head is also eroded (arrow). Image from : Radiology assistant. nl accessed on 8 -12 -15

Acoustic neuroma Benign usually Develops on the main nerve leading from inner ear to brain ( 8 th cranial nerve ) Can cause balance issues, hearing loss and dizziness Treatment: monitoring, radiation, surgical removal Most common in adults age 50 -60 sexes affected equally 3, 000 new cases diagnosed yearly Imaged taken from : http: //usercontent 2. hubimg. com accessed 8 -12 -15

Pineal gland tumors Named after the location of the tumor which is generally in the pineal gland region Involved in secretion of hormone melatonin Gland is linked to the sleep-wake cycle. Most common in children and young adults A 12 -year-old boy came from Jamshedpur with severe headache vomiting and dimness of vision. MRI scan brain showed a tumor in pineal region with hydrocephalus. These are very difficult tumor to operate as the area is very difficult to access and it has a number of critical nerves and blood vessels. We did occipital transtentorial approach and did a total resection of the tumor. The biopsy came as papillary tumor of pineal region. This is a very rare tumor and only 60 odd cases have been reported in world literature. Images obtained: http: //www. neurosurgeoninkolkata. com accessed: 8 -14 -15

Pituitary adenoma Tumor arising from the pituitary gland, usually in the anterior lobe Generally affects the floor of sella turcica Usually slow growing, probably have it for years as symptoms progress. Accounts for 6% of brain tumors Most common surgical procedure is through the nose called a transsphenoidal operation Tomograms through midplane of sella turcica demonstrating destruction of floor (arrows) caused by a pituitary adenoma. A, Lateral tomogram. B, AP tomogram. Images obtained from Merrills Atlas 11 th edition via pageburst on Evolve

Astrocytoma Can appear in various areas within the brain. Four major descriptions and grades based on the tumor location and size Tumor that arises from astrocyte cells which is part of the supportive tissue in the brain Most common adult males age 30 -50. Accounts for 4% of all brain tumors This MRI study of Brain shows: An ill defined right insular focal parenchymal swelling, hyper intense on T 2 and FLAIR with low signal on T 1, a patchy enhancement on post contrast T 1. No dense dystrophic calcification or hemosiderin staining on T 2*GRE. Mild compression over right lateral ventricle. No significant mass effect or mid line shift. On MR Spectroscopy, markedly reduced NAA and Creatinine, raised choline. Imaging findings are typical of Anplastic astrocytoma. Images obtained: http: // www. neuroradiologycases. com Accessed: 8 -14 -15

Medulloblastoma In children these are found in the cerebellum (brains coordination center) In adults they are often associated with spinal cord lesions and spread to CSF. Not typically aggressive tumors HA, early morning vomiting, lethargy, personality changes, eye pressure Image from https: //www. urmc. rochester. edu Accessed: 8 -14 -15

Craniopharyngioma Tumor developing near the pituitary gland Benign tumor but tend to grow and cause issues. Often accompanied with a cyst A result of residual cells from fetal development Children as well as adults age 50 -60. HA, visual changes, weight gain, developmental delay Image obtained: http: //www. virtualmedstudent. com Accessed: 8 -14 -15

CNS lymphoma Generally found in patient with compromised immune systems Can be a primary tumor Two times more common in men. Image obtained: https: //www. urmc. rochester. edu Accessed: 8 -14 -15

Tumors of central nerve sheath cells Nerve sheath tumors develop from Schwann cells along any nerve of the head or neck Grow slowly and almost always benign Symptoms oral or facial mass with pain, loss of hearing and muscle weakness Men & women are affected equally between age 30 -50.

Metastases Most common type of brain tumor Totals outnumber all other brain tumors combined Most common source in Males = lung cancer Females = breast cancer Cerebellum involvement in 80 -85% of all mets Interventions: Whole brain radiation, surgical removal, or gamma knife radiosurgery. Image obtained http: //www. braintumors Accessed: 8 -14 -15

Overview Specific location of the tumor is important due to fixed area of the brain. Many tumors cause increased intracranial pressure causing HA, vomiting, blurred vision or seizure.

Image obtained: http: //neurooncology. oxfordjournals. org/content/15/suppl_2/ii 1/F 6. expansion. html Accessed: 8 -14 -15

Image obtained http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 3480240/ Accessed: 8 -14 -15