BRAIN NEOPLASM

General Considerations
1. Comprise: 10% of all tumors
2. Most common childhood neoplasms
3. Peak incidence at 5th decade
4. Supratentorial tumors in adults
5. Infratentorial tumors in childhood
6. Different tumors in different ages
7. Primary tumors infiltrative Metastatic - welldemarcated
8. Intraneural seeding occur, but no extraneural
metastasis
9. Produce neurologic symptoms by
size,location,invasiveness, and secondary effects

Varieties of brain tumors

Meninges: meningioma, hemangiopericytoma
Astrocytes: astrocytoma (various types)
Oligodendrocytes: oligodendroglioma
Ventricles: ependymoma, choroid plexus papilloma,
colloid cyst
Vascular: hemangioblastoma
Primitive cells: germinoma, medulloblastoma,
neuroblastoma, pineoblastoma, retinoblastoma
Neuronal: ganglioglioma, gangliocytoma
Pituitary: adenoma, craniopharyngioma
Nerves: schwannoma, neuroblastoma

Astrocytes: astrocytoma (various types)

Oligodendrocytes: oligodendroglioma
Ventricles: ependymoma, choroid plexus
papilloma, colloid cyst

GLIOMA

Incidence of Intracranial
Gliomas (All ages)
Glioblastomas

55.0%

Astrocytomas

20.5%

Ependymomas

6.0%

Medulloblastomas

6.0%

Oligodendrogliomas

5.0%

Choroid plexus papillomas

2.0%

Colloid cysts

2.0%

Incidence of Primary Intraspinal

Intramedullary Gliomas
Ependymomas

63.0%

Astrocytomas (grades 1 and 2)

24.5%

Glioblastomas
(Astrocytomas grades 3 and 4)

7.5%

Oligodendrogliomas

3.0%

Other tumors

2.0%

Frequent Brain Tumors

Meningioma
Astrocytoma/glioblastoma
Oligodendroglioma
Ependymoma
Medulloblastoma
Schwannoma/neurofibroma
Phakomatosis

Meningioma
Arachnoid cells origin
Attached to dura, subdural
Common sites: parasagittal (falx),
sphenoidridge, olfactory groove
Female:Male 3:2 or 2:1
Changes in cranium
Hyperostosis
Invasion
Microscopic: whorls and psammoma bodies

Menoingioma

Meningothelail whorls

Psammoma bodies

Gliomas
Astrocytes- astrocytomas
Fibrillary
Pilocytic
Oligodendrocytesoligodendrogliomas
Ependyma- ependymomas

Astrocytomas
Adult
Supratentorial
Solid
Malignant
Fibrillary

Childhood
Infratentorial
Cystic
Benign
Pilocytic

Fibrillary Astrocytomas
Grossly solid
Common in cerebral hemispheres
Low grade in young,
higher grade in older
Grading
Astrocytoma (low grade)
Anaplastic astocytoma
Glioblastoma multiforme

Fibrillary Astrocytoma:
microscopic
Low grade- hypercellularity,
pleomorphism
Anaplastic- as above plus mitosis,
vascular endothelial proliferation
Glioblastoma multiforme- as above plus
necrosis and pseudopalisades. Grossly
variegated appearance (multiforme)

Astrocytoma

Glioblastoma

Glioblastoma - pseudopalisade

Pilocytic Astrocytoma
Common in childhood
Most slow growing of the gliomas
Sites: cerebellum, around III V.,
optic nerve
Grossly cystic with mural nodule
Microscopic
Elongated hair-like (pilo)
elongated cells
Rosenthal fibers

Rosenthal fiber definition

Dense, eosinophilic fibers within
cytoplasmic processes of astrocytes.
Correspond to aggregate accumulation
of intermediate filaments in these
processes.

Pilocytic astrocytoma
Mural nodule

Pilocytic astrocytoma

Oligodendroglioma
Cells of origin: Oligodendrocytes
Common in cerebral hemispheres
Calcifications common among all
gliomas
Grades
Low grade
Anaplastic

Oligodendroglioma

Oligodendroglioma, calcifications

Tumors in Ventricles
1. Ependyma: Ependymoma
2. Choroid Plexus: Papilloma

Ependymomas
Arise from ependymal lining- ventricles
and central canal of spinal cord
Common in childhood
4th V. common in cerebrum
Most common tumor of spinal cord
parenchyma in adult
Microscopic
perivascular pseudorosettes
ependymal rosettes

Ependymoma

Ependymoma: perivascular pseudorosettes

Embryonal tumors
(Primitive neuroectodermal tumors)
Neuroblastoma - cerebral hemispheres
Neuroblastic (neuronal) differentiation
Medulloblastoma - cerebellum
Neuronal and glial differentiation
Ependymoblastoma ventricles
Ependymal differentiation
Pineoblastoma- pineal region
Retinoblastic differentiation
All commonly known as Primitive
neuroectodermal tumor (PNET)

Medulloblastoma
Origin: primitive neuroectodermal
cells
Age: 1st decade of life. Most
common brain tumor at this age.
Site: vermis of cerebellum
May cause hydrocephalus
Subarachnoid dissemination

Medulloblastoma

Homer-Wright rosettes

Histologic Patterns: definitions

Whorls: onion-skinning pattern of tumor cells
Psammoma bodies: laminated calcium
Pseudopalisading: lining up of the tumor
cells around a central necrotic area
Palisade: lining up of tumor cells around their
own cytoplasmic processes. No necrosis.
Pseudorosette: tumor cells around blood
vessels, cells equidistant from vessel walls.
Rosettes: tumor cells around central lumen or
fibrillary area of cellular processes

Brain Tumors: Microscopic

Tumor

Microscopic

Meningioma

Whorls and psammoma bodies

Glioblastoma

Pseudopalisades

Oligodendroglioma Mosaic/poached-egg
Ependymoma

Perivascular pseudorosettes

Medulloblastoma

Rosettes (Homer-Wright)

Tumors of Nerve Roots

and Peripheral Nerves
1.

Schwannoma
viii Cranial nerve (Acoustic sch.)
Spinal roots, posterior
Peripheral nerves

2. Neurofibroma
Spinal Roots, rare
Peripheral nerves
3. Malignant variants
Malignant peripheral nerve sheath tumor
(MPNT)
Rare

Peripheral nerve tumors

Schwannoma
Schwann cells
Compress the nerve trunk
Encapsulated
Easily resectable without
nerve damage
Microscopic:
Antony A and B fibers
Verocay bodies

Neurofibroma
Schwann cells, neurites,
fibroblasts
Fusiform and involves
nerve trunk
Not encapsulated
Not resectable without
sacrificing nerve
Micro- Intermingled cells
with wavy nuclei

Acoustic
Schwannoma

Antony B
Antony A

Palisades

Metastatic Brain Tumors

Most common brain tumor in adults.
Common primary sites: melanoma, lung,
breast, GI tract, kidney.
Most are in cerebrum (MCA territory).
In gray-white junctions due to rich capillarity
Discrete, globoid, sharply demarcated
tumors. Amenable to surgical resection.
Single or multiple.
Brain edema frequent.

Metastatic tumors

Phakomatosis : definition
Phakos (Greek): lentil mole or freckle.
Neurologic abnormalities combined with
defects of skin or retina, explained by
their common ectodermal origin.
Involvement of visceral organs

Phakomatosis
(Neurocutaneous dysplasia)
1. Neurofibromatosis
(von Recklinghausen's dis.)
2. Tuberous Sclerosis
3. Sturge-Weber disease
(Encephalofacial Angiomatosis)
4. von Hippel-Lindau Disease
5. Neurocutaneous Melanosis

Neurofibromatosis
1. Dominant inheritance
2. Multiple neurofibromas
Central - CNS
Peripheral nerves
3. Increased incidence of:
Meningioma
Glioma
Schwannoma - bilateral VIII N.
4. Cafe-au-lait (melanosis) in skin
5. Elephantiasis: increased connective
tissue

Caf-au-lait spots

Multiple neurofibromas

Tuberous Sclerosis
1. Dominant inheritance
2. Clinical triad:
Seizures
mental retardation
adenoma sebaceum
3. Retinal hamartoma (phakoma)
4. Tubers in cerebral cortex
5. Subependymal giant cell astrocytoma
6. Hamartomas in other organs: heart,
kidney

Tubers

Adenoma sebaceum

SELAMAT BELAJAR !!

Venice

Lessons in life

Take a deep look at yourself.

When trouble comesHang On!!

Never Give Up.

And dont forget to pray.