P BRAIN

TUMORS

Brain

Glioma

WHO

Classification

Askooytoma

1(

Grade

"

Circumscribed

Mc

subtype

relatively

Grade

'

Tumors

Diuse

aha

indolent

fbrillay

borders

cyshc change

likely to

Glioblastoma

4 most

freq

necrosis

only

grows

lu%

in

protoplasmic

astro oytomas

occur

edema

enhancement

multi

most

+
.

may

extensive

show

more

gemistogtic

asbooyhmas )

Grade

a)

calcification

plastic

ashogloma

aihooytom

ill defined

he

cystic change

Grade 3

pilocytic

benign

cell types

astnoytomas

tme)

malignant

rapidly

children

mainly

adults

owGradlghom=
partial

young
or

hypbmknce

generated

IT

enhancement

transformation

is

hyper intense

usually

E to %)

sutures

rare

TZ

ipnseuce

of enhancement

may

suggest

Malignant

*Pdogfc@radeDaswgtom=

common

MRI

located

well circumscribed

malignant

tx

it

ganglia

enhancing

some

"

cysts

enhancing

or

mural

is

rare

resection

alone Is indicated

Radiation

for unreadable

chemo

or

EpngnssivedlfiiTM

surveillance
2

( rarest )

contrast

transformation

possible

tumors

hypothalamus , basal

"

pattern

ophc tracts

in

NFI

ssx

nodule

children

in

MRI

patterns
!1!

repeated

once

twice

or

yearly

most

are

slowly

growing

of progression

diuse

of either

extension

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Astnglvma
-

almost

GBM

Both :

ring

like

incurable

Steroids
neg

in

so

-75%

Glioblaswma

spread systemically

never

st

interfere

aim
I

irregular

enhancement
;

help

of

loco regional

hypo dense

treatment to

so

lesion

surrounding

vasogenk edema
chemo

chemo

radiotherapy

malignant ashocyloma

improves

chemotherapy

Oligodendrgluma

* Ana plastic

eect ;

Iv mass

adiothoapy

must

improves
we

17

irregularly

improve

extension ; lesser

lowest

freq

hypo intense

shaped foci

leptomeningeal
+1

enhance

presumed necrosis

neurological deficits

deficit

wlm few days

ecient

dose

but

can

KHshcasmdGBM-td.AE
systemically
methylphenidate

specific tx :

not be

should

Ds

6- not

resechm

of all
also

Can

most
-

signs

tx

GFAP

testing

in

33%

Or

children

uj

brain tumors

of

iuthoie

<3

go

505

ventricle

( Mc

children

in

pressure

( esp

those

4h

in

ventricle

ataxia

gnomonic

D% positive

Datho

be attempted

could

resection

+1

radiation

variant
poor

lacks

prognostic

location

an

aplastic

survival

Pineal

mc

can

presentation

Oclulomotw
-

Jys

in

parnchymal

am presses

resection

rate

most children

4th ventricle

in

4 incomplete

prevention

ttlwpamal

"

assets

ependymal

markers

sx

as

"

Pathology
-

type

NF

ASSX

in

intracranial

of

sx

posterior fossa

lhdude

to

adults

SX

only

cognitive

new

tumor

common

flow of

radiotherapy

tumors

in

common

improve

most

occur

help

chemo

pediatric

locations

Common

tt

can

.Ependymaltum=

prescribed

secrete

lo

t5%

tumors

zoyr

headache

superior
nerve

to

Tang
,

NN

calculus
paresis

melatonin

presentation
corned

age of
by

Vertical gate

13

yrs

aqueducthl
palsy

compression

that +1

assx

hydroceph

nupillary

or

Non

Brain Tumors
Malignant

Medulloblastoma

always

located

&

Pathology

fossa

CNS

tend

adult

A by

pressure

to

into

lox

the

fibril lay

plays

role

Predisposing faetrs
-

EBV
Hiv

post

lg

in

in

lmmmnoam

deficiency
Aldrich

cell nuclei

from the

Vanis

laterally

the past

transplant

plastic

AIDS

Wiskott

neo

Ghost tumors / Micagkomas

prior infxn

processed

arise

majority

rosettes

Wright

4th ventricle

located

usually

lymphomas

factor

cerebellum

the

in

protrude
onset

arise

hydrocephalus

obstructive

decades

immunowmpelent

nennectodermal

primitive

cellular

extremely

94%

EBU
-

tumor

neunblastio
or Homer
form
disposed in radial arrangement around

PNETD

brain tumor

l% of adult

ID

)
"

mfratentonab

intracranial

classic

10 CNS
-

posterior

WHO oracle

rapid growth
Sx of raised

MRI

"

predilection

tumor

pediatric

common

cerebellum

tumors
.

in

"

small round blue cell tumor

"

ped brain

1520 %

most

Choma

syndrome

promised

forms

in

both

immunoam

promised

Pathology

typically

what matter

majority

vast

Csf

positive

MRI :

TI

enhancement

low

disseminated

in

prior to

poor

is

Primitive

neunecto

are

tt
worse

dermal

lumorj usually

rate

majority

derived from
cells

vivid

infreq

lymphoma

enhancement

homogeneous

seen

involvement

appear

shrink

timor

can

become

should

impossible

be

avoided

after

injection

irradiation

brain

who

are

lmmuhocom promised

( PNETD

tumors

( young

-50%

neuroectdem
primitive

mild

Interrelation

those

only

or

dramatically

whole

for

Mc

irregular

Uncommon

is

children

in

survival

to

NOT

is

histological

overall

so

cell

7585%

skrnds

as

Prognosis

wypoinlense

absent

is

chemo ( high doses )

+
-

biopsy

artx

dier

meniyeab

predominantly

iso

/ spinal

enhancement

In

homogeneous

deep locations

Burkitt like

arise

origin

in

/T2

PCNSL

grade

grade

can

uncommon

calloswm
is

is

intense

corpus

that

Glucose

supraknlonab

crossing

/ high

lymphoma

be

cytology

hypo

typically

T proteins

lesions

mass

settlers

lmmunodefiaent pts

B- cell

grade

disorders

neurological

origin

in

diuse
large
tend to
low

focal

infiltrating

as

in

esp

B cell

pressure

gray matter

necrosis

may have

present

deep

intracranial

of raised

signs
-

cunt 'd

lymphoma

CNS

"

adults

but

<

25

have

yrs

not

developed

dierentiated

10

Non

Brain
Tumors
Beni

Glioma

Adenoma
Pituitary

pituitary

our

classified

broadly

pituitary

<

adenoma

710

associated

either present due

eect
4

'

multiple

rarely catastrophic

blood

Supply

Homme

750%

an

secretory

paladin

48%

larger
4

tend

tumors

classically

micro

optic

( bleeding

or

mass

chiasm

into

or

impaired

GSH)
be

to

NON

l%

occasional

or

paladin

eect likely

(
to

compression

is

of

adenoma

macro

imbalance

4-

paladin

inhibited

by

paladin inhibiting

ophc chiasm
cn#

are

Ironically

dopamine

compress

most

hormonal

moderately

release
aka

secretory

lead to

can

humane
:

%)

hormone

Growth

hynopituitwism

w|

mixed

-35%

mass

xnyriolwpin

pancreas

( 6 %)

Aoht

MACRO

pimitny apoplexy

gland)

pituitary

adenomas

imbalance

to

due

both

type

neoplasia

/ pituitary

parathyroid

macro

mt

endocrine

adenoma

MICRO

as

imbalance

structures

she

in

common

hormonal

to

adjacent

on

neoplasms

site

in

mm

as

0
-

intracranial

common

10mm

adenoma

minority of tumors

most

of

sites

adenoma

macro

MACRO

into

micro

pituitary

pituitary

gland

in

or

less

invasion

freq

into the

CNI

cavernous

sinus

Pituitary

depends

on

presence

of

sx

surgical deampcrsin

for

large

medical

for

thou

Radio

management

bmmocriphne
surgery

Meningoma
in of
-

site

Cont 'd

Adenoma

types
0
!2!

!3!

60 's

occasionally

-70 's

benign

atypical
Anaplastc

Grade

( Grades

( Grade

DA

/ cell type
tumor

that

agonist
and

are

ma

eect

hwmme
can

( transphenoidally )

secreting
she

but

risk

if

hemorrhage

Tumorsofsekarregim
-

Craniophaynyomas
arise

slow

M
Oadamantinomal
mixed

Bimodal

Sx

polyuna
!1!

Sellar

Cd

of

deposits

'
-

evident

+1

excision

HLT

adjuvant radiotherapy

if

unable

distribution

afe
,

( peds)

45%

headaches

( adult

papillary

!3!

pituitary

amptetely

remove

!2!

Rata

trans sphenoid al

subfmkl /

to
-

jantains

growing

of he anterior

precursor

tumors

aka

( WHO grade 1)
fun sellar / supra

benign

embryonic

Tlcpsx
,

diabetes insipidus
,

10

and

Mylo

hormonal

balance

middle

imbalance

disorder

short stature

weight gain ,

/ delayed puberty

wypersomnia

Adamant nomawus
lobwlated

Cat

colour

multiple

cystic

lesions

'

common

tend to se large

!2!

very

Papillary
-

tend

to

Can

uncommon

tend

to

be

mwe

displace

superiorly into

extending

spherical

adjacent

lack

structures

Cyshc

Id

ventricle

component

encasing

vessels

* Rathke

aefto
's

pohm

anterior

of

develop

txr

types

fluid filled cyst

postern

in

Rathke 's pouch does

when

occurs

iyst

dysfunction

NOT

taking

visual

trigger

can

biopsy

radical

excision

more

is

bleeding

nine

tumour (
meningiomas

cysts

headache

and

drainage

symptomatic

amman

are

pituitary

dangerous

cysts

symptomatic

gland

gland

properly

disturbances
-

pituitary

pituitary

asymptomatic

glrmmwnar

commas

less

hamartomas

Gcrmmma

midline

our

pineal

in

Sx

hypopihntnnsm
.

geimmman
normal tissue

red

in

M
-

are

tissue

lsoihtenk

TITC

vivid

chiasm

SOFT

tissue

ovoid

urhyrr
w

me

supra sell

in

density

of

Ca

or

Dl

sym

region

"

in

lobulated

floor

'd

ventricle

infundibulum

pituitary

lap

masses

pineal regin

engulfing

of

fun

compression

enhancing

along

or

pineal region

of

compression

presence

lumw

me

parinand synd

ophc

( )

pineal regius

>>

hydro ,

mass

isomlenu

central
-

TL

ny1D

population

soft
17

lo

region

obstructive

either C

young pts

found

growth

benign

tend to

mefnl

"

maker

calcified pineal

"

engulf
of

tumor

gland

intense

hypomlenfe

can

thunoglncovs

/ may

have

get

formation

+1

hemorrhage

ant 'd

txcerminoma
Is

buy tem

-90%

to

radiotherapy

rate

awe

chemo

good

prognosis
*

Hamartomas
-

hypothalamic
bodies

often

Sx

MRI
-

Tltc
TZ

iso
:

no

Gnnlt

of

intense

benign

located

51W

mamillay

progressive

often

cog

&

to

clean

freq

so

encountered
LH

may

there

in

children

FSH

appear

on

normal

Cohex

grow

or

to

matter

gray

enhance

NOT

IT

infancy

in

puberty

fun

Composed

do

early

precocious

occurs

serves

central

hamarhma

unereum

chiasm

occur

gelashc

optic

tuber

cerebral

cortex

enhancement

hyrwintenk

higher prupwhm of

glial

cells

hyhr

TZ

signal