tumor cns tabrani

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Tumor of the Nervous System

Dr Wiwit Ade FW, M.Biomed, SpPA

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Normal Cells

The principal cells of the CNS :

• Neurons : functional unit of nervous

system. (axon & dendrites)

• Glia : derived from neuroectoderm

(macroglia: astrocytes, oligodendrocytes,

ependyma) or from bone marrow

(microglia),

• the cells that compose the meninges and

blood vessels.

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Tumors of CNS

• Incidence : 10-17 per 100,00 person for

intracranial tumor.

• 1/2 -3/4 : primary tumor, & the rest are

metastatic.

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Primary Tumors of the Central

Nervous System

 –Glioma

• Astrocytoma

• Oligodendroglioma

• Ependymoma

 –Neuronal lineage –Meningioma

 –Nerve Sheath Tumors

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Primary Tumours of the CNSTumour Cells of origin Site Age Behavior

Oligodendroglioma oligodendrocyte hemisphere adulthood Low to highgrade

 Astrocytoma Astrocyte Hemisphere

Cerebellum

 Adulthood

Childhood

Low to highgrade

Low grade

Glioblastoma

multiforme

 Astrocyte Hemisphere Adulthood High grade

Ependymoma Ependyma IVth ventricle

Spinal cord

 Adulthood

Childhoos

High grade

Low grade

Meningioma Arachnoidal Meninges Adulthood Low grade

Medulloblastoma Neuroectoderm Cerebellum Childhood High grade

Haemangioblasto

ma

Unknown Cerebellum All ages Low grade

Lymphoma Lymphocyte Hemisphere Adulthood

High grade

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Gliomas

• Diffusely infiltrating (not easily resected)

• Histologic appearance (grade) correlates

with overall survival

• May become more malignant (higher

grade) over time (especially astrocytomas

which become glioblastomas)

• May spread via CSF

• Rarely (never) metastasize

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GLIOMAS

• ASTROCYTOMAS

• OLIGODENDROGLIOMAS

• EPENDYMOMAS

• MIXED GLIOMAS

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• Spectrum : low grade – high grade

•  2 major categories :1. infiltrating

2. non infiltrating : >> astrocytoma pylocitic

(grade I/IV).

 ASTROCYTOMA

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 ASTROCYTOMA

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 ASTROCYTOMA

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Infiltrating Astrocytomas

• 80% of adult primary brain tumors.

• Cerebral hemisphere.

• Symptom : seizures, headache & focalneurologic deficits.

• Spectrum histophat diff : correlates with

clinical course & outcame.

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Spectrum of Infiltrating

 Astrocytomas

• Diffuse astrocytoma ( grade II/IV)

•  Anaplastic astrocytoma ( grade III/IV)

• Glioblatoma ( grade IV/IV)

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Diffuse Astrocytoma

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 Anaplastic astrocytoma

• More densely cellular, greater nuclei

pleomorphic, >> mitotic figure.

• Gemistocytic astrocytoma :

astrocytoma with brightly eosinophilic

cell body.

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 Astrocytoma

Features of Anaplasia

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Glioblastomas

• = glioblatoma multiforme

• Variation in gross app.

• Firm & white, soft & yellow (necrosis),cystic deg, hemorrhage.

• Microscopic = anaplastic, malignant tumor

cells, additional :1. necrosis with pseudopalisading app.

2. vascular / endothelial prolif.

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Glioblastoma Multiforme

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Glioblastoma Multiforme

20

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Pylocitic Astrocytoma

• Relative benign behavior

• Grow very slowly th/ by resection

• Symptomatic recurrence : incomplete resection  

cystic enlargement, rather than growth of the solid

areas.• Children & young adults

• Located in :

- >> the cerebellum.- floor & wall of Ventricle III

- optic nerve

- cerebral hemisphere

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Pilocytic Astrocytoma

Morphology :

• >> cyctic

• Solid, well demarcated, << infiltrative

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Microscopic:

• Tumor is composed of bipolar cells with

long, thin “hair like” processes dense

fibrillary meshworks.

• Rosenthal fibers

• Eosinophilic granular bodies.

• Biphasic areas : loose microcystic pattern

& fibrillary areas.

• Necrosis & mitosis : uncommon.

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Pilocytic Astrocytoma

Rosenthal fibers Eosinophilic granular

bodies24

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OLIGODENDROGLIOMA

• 5-10% glioma

• 4-5 decadce

• Symptom : >> seizures

• Location : >> cerebral hemisphere ( white

matter)

• WHO grade II/IV

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Morphology of Oligodendroglioma

• Well-circumscribed, gelatinous, gray masses, >>

cyst, focal haemorrhage, & calcification.

• Microscopic :

- sheet of regular cells with spherical nuclei

containing finely granular chromatin(=normal oligodendricytes) surrounded by

clear halo cytoplasm.

- typically contain a delicate network

anastomosing capillaries (thin walled capillaries).

- calcification : > 90% tumors (foci to massive)

- mitotic activity : <<

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Anaplastic Oligodendroglioma

• WHO grade III/IV

• Increased cell density, nuclear anaplasia,mitotic activity >>, necrosis.

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OLIGODENDROGLIOMA

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EPENDYMOMA

•  Arise next to the ependyma line ventricular system.

• Behave as WHO grade II/IV

•  Anaplastic ependymoma : WHO grade II/IV.

Macroscopic :

• In ventricle IV : solid/ papillary mass ascending from the

floor of the ventricle.

• Well demarcated. 

Microscopic:

• Composed of cells with regular, round to oval nuclei &abundant granular cromathin.

• Gland like round/ elongated app ( perivascular rossetes) ,

tumor cells are surrounded vessels.

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EPENDYMOMA

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NON-GLIAL TUMORS

• Medulloblastoma: Malignant cerebellartumor of childhood

• Meningioma: Benign, superficial, well-circumscribed tumor derived fromarachnoidal cells

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MEDULLOBLASTOMA

• Origin : neuroectodermal

• Poorly differentiated

• >> children , 20% of the brain tumor in children

• Location : midline of the cerebellum (children)

lateral of the cerebellum (adult)

• Rapid growth  occlude the flow CSF  hidrocephalus.

• Macros : well circumscribed, gray.

• Micros :

- extremly cellular, with sheet anaplastic cells- individual tumor cells: small, scant cytop, hypercromatic

nuclei.

- >> mitosis

- Homer Wright rossette/ neurosecretory granules.

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Medulloblastoma

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Medulloblastoma

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MENINGIOMA

• Benign tumor of adult• Location : attached to dura

•  Arise from the meningothelial cells of arachnoid.

• Low risk of recurrence.

• WHO grade I/IV• Macros :

- rounded masses, well defined dural bases that comprise

underlying brain.

- encapsulated, thin fibrous tissue.

- growth : polypoid, plaque.

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Histological pattern

• Sincytial (“meningothelial”) : whorled clusters of cells withoutvisible cells membrane

• Fibroblastic : elongated cells and abundant collagen

deposition between them.

• Transtitional :share features between sincytial and fibroblastictype.

• Psammomatous : with psammoma bodies ( calcification of

the syncitial nest of meningothelial cells)

• Secretory : PAS (+) intracytoplasmic droplets & intracellularlumen (electron microscopy)

• Microcystic : with a loose, spongy app.

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MENINGIOMA

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Sincytial (“meningothelial”) 

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Fibroblastic

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Secondary Involvement of the

Central Nervous System

• Metastatic Tumor

 –Melanoma

 –Renal cell –Lung

• Contiguous involvement (pituitaryadenoma and

craniopharyngioma)

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METASTATIC MELANOMA

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