Tumors

of the
Central Nervous System
Gonzalo B. Roman Jr.,MD.,FPSP

HOW COMMON ARE BRAIN

TUMORS?

Brain tumors
Incidence is low (10-17 per 100,000
persons)
About half are primary; the other half are
metastatic
Occur at all age group.
In children , are the second most common
kind of malignancy.

What are the risk factors?

Risk factors
Most brain tumors are random
Only known risk factor is irradiation of
children
Some hereditary syndromes are
associated with increase incidence of brain
tumor:
Neurofibromatosis
Von Hippel Lindau syndrome
Li-Fraumeni sydrome
Tuberous sclerosis

SPECIAL CONCERNS
Distinction between benign and malignant
is less evident
The ability to surgically resect infiltrating
glial neoplasm without compromising
neurologic function is limited.
The anatomic site can have lethal
consequence irrespective of histologic
classification.
Pattern of spread differs.

Major Classes
GLIOMAS
NEURONAL TUMORS
POORLY DIFFERENTIATED
NEOPLASMS
MENINGIOMAS

Topographical classification
SUPRATENTORIAL
Above the tentorium cerebelli
Usually in adults

INFRATENTORIAL
Underneath the tentorium cerebelli
Cerebellar tumors and brain stem tumors
Most tumors of children

SPINAL CORD TUMORS

How do CNS tumors cause

disease?

PATHOGENESIS

COMPRESSION
DESTRUCTION
INFARCTION AND HEMORRHAGE
CEREBRAL EDEMA
OBSTRUCTION OF CEREBROSPINAL
FLUID FLOW
CHANGES IN CSF COMPOSITION

ASTROCYTOMA
80% of all adult primary brain tumors
Usually in cerebral hemisphere
Most common signs seizures, headache
and focal neurologic deficits
Different grades (1 3)
Morphologic types:
Fibrillary
gemistocytic

OLIGODENDROGLIOMA

5 15% of gliomas
Fourth and fifth decade of life
White matter of cerebral hemisphere
Gross well circumscribed, gelatinous
masses often with cysts, hemorrhage and
calcification
Micro: spherical nuclei with halo of
cytoplasm
Better prognosis than astrocytoma

EPENDYMOMA
Most often at ependyma-lined ventricular
system.
First two decade of life fourth ventricle
In adults spinal cord
Prognosis is poor
Often manifest with hydrocephalus
CSF dissemination is common
Variants: myxopapillary, subependymomas and
choroid plexus papilloma

NEURONALTUMORS
GANGLIOCYTOMAS
Well circumscribed with focal calcification and small
cysts
Floor of 3rd ventricle, hypothalamus, temporal lobe
Clumps of ganglion cells separated by a relatively
acellular stroma

GANGLIOGLIOMA
Usually in temporal lobe

NEUROBLASTOMA

POORLY DIFFERENTIATED
NEOPLASMS
MEDULLOBLASTOMA
In children
Cerebellum
Rapid growth (highly malignant)
radiosensitive

PRIMARY BRAIN LYMPHOMA

1% of intracranial tumors
Most common CNS neoplasm in
immunosuppressed
Often with multiple tumor masses
Majority are of B-cell origin

MENINGIOMAS
Benign
Arise from meningothelial cells of the
arachnoid
Compress underlying brain
Histologic patterns: syncytial, fibroblastic,
transitional, psammomatous, secretory,
microcystic, papillary
Malignant form extremely rare

METASTATIC TUMORS
Mostly carcinomas
Most common primary site: lung, breast,
skin (melanoma), kidney and GIT

PERIPHERAL NERVE SHEATH

TUMORS
SCHWANNOMA
Asso. with neurofibromatosis type 2
2 growth patterns: Antoni A and Antoni B
Most common location: -cerebellopontine angle

NEUROFIBROMA
Cutaneous neurofibroma
Solitary (plexiform) neurofibroma

MALIGNANT PERIPHERAL NERVE SHEATH

TUMOR (MALIGNANT SCHWANNOMA)