tumor cns tabrani
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8/12/2019 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
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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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