most common CNS tumor in adults
glioblastoma
supratentorial
especially true at older ages;
at younger ages, other types occur...
oligodendroglioma
low grade astrocytoma
supratentorial
especially true at older ages;
at younger ages, other types occur...
oligodendroglioma
low grade astrocytoma
prognoses for CNS tumors
not good...
except for...
meningioma
pilocytic astrocytoma (grade I)
grade II astrocytoma: <10 yrs
ependymoma: craniospinal XRT => considerable disability
except for...
meningioma
pilocytic astrocytoma (grade I)
grade II astrocytoma: <10 yrs
ependymoma: craniospinal XRT => considerable disability
CNS tumor with best prognosis
CNS tumor with worst prognosis
CNS tumor with worst prognosis
meningioma
glioblastoma multiforme
glioblastoma multiforme
pilocytic astrocytoma
aka WHO grade I
cerebellum
hypothalamus
optic nerve
circumscribed growth
solid component
cystic component
eosinophilic granular bodies
cerebellum
hypothalamus
optic nerve
circumscribed growth
solid component
cystic component
eosinophilic granular bodies
diffuse astrocytoma
aka WHO grade II
diffuse infiltration by cytologically atypical cells
diffuse infiltration by cytologically atypical cells
glioblastoma
aka GBM / WHO grade IV / astrocytoma
ring-enhancement on T1
marked cellular atypia
increased mitotic activity
microvascular proliferation
"leaky" vessels enhance on MRI
necrosis:
pseudopallisading: pallisade of nuclei around central necrosis
ring-enhancement on T1
marked cellular atypia
increased mitotic activity
microvascular proliferation
"leaky" vessels enhance on MRI
necrosis:
pseudopallisading: pallisade of nuclei around central necrosis
oligodendroglioma
diffusely infiltrating glioma of cerebrum
WHO grade II 2/3rds
WHO grade III 1/3rd
prominent nuclear rims
prominent nucleoli
dystrophic calcification
chromosomal abnormalities in 1p & 19q translocation
positive prognositic indicator
adults
WHO grade II 2/3rds
WHO grade III 1/3rd
prominent nuclear rims
prominent nucleoli
dystrophic calcification
chromosomal abnormalities in 1p & 19q translocation
positive prognositic indicator
adults
ependymoma
cerebellum
spinal cord
solid, circumscribed
WHO grade II majority
WHO grade III
Flexner-Wintersteiner rosettes
can seed CSF
drop metastasis
spinal cord
solid, circumscribed
WHO grade II majority
WHO grade III
Flexner-Wintersteiner rosettes
can seed CSF
drop metastasis
Schwannoma
biphasic neoplasm:
hypercellular areas Antoni A
hypocellular areas Antoni B
Verocay bodies
nuclear pallisades around acellular zone
WHO grade I
hypercellular areas Antoni A
hypocellular areas Antoni B
Verocay bodies
nuclear pallisades around acellular zone
WHO grade I
medulloblastoma
invasive
mitotically active
aggressive
WHO grade IV
midline of midbrain
hypercellular
primitive (embryonal) cells with neuronal features
Homer-Wright rosettes
peripheral pallisade of nuclei around acellular zone
chemosensitive => good survival
frequently seeds CSF
drop metastases
mitotically active
aggressive
WHO grade IV
midline of midbrain
hypercellular
primitive (embryonal) cells with neuronal features
Homer-Wright rosettes
peripheral pallisade of nuclei around acellular zone
chemosensitive => good survival
frequently seeds CSF
drop metastases
CNS metastases
most common CNS tumor
10x more common than primary CNS tumors combined
typically multiple
can be...
intraparenchymal
CSF dissemination
direct / local extension
cord compression
10x more common than primary CNS tumors combined
typically multiple
can be...
intraparenchymal
CSF dissemination
direct / local extension
cord compression
most frequent primary sites of intraparenchymal metastases
lung
breast
skin melanoma
kidney
breast
skin melanoma
kidney
