Brain Tumors

Maria Rountree
Most common types of brain tumors
The most common childhood tumors are:
1. Astrocytoma
2. Medulloblastoma
3. Ependymoma
The most common adult tumors are:
1. Metastatic brain tumors from lung, breast, melanoma, and
other cancers
2. Glioblastoma Multiforme
3. Anaplastic (Malignant) Astrocytoma
4. Meningioma
Incidence of brain tumors
Annual incidence ~1520 cases per 100,000 people.
Annual incidence primary brain cancer in children is
about 3 per 100,000.
Leading cause of cancer-related death in patients
younger than age 35.
Primary brain tumors /secondary ~ 50/50
~17,000 people in the United States are diagnosed with
primary cancer each year. Secondary brain cancer
occurs in 2030% of patients with metastatic disease.
Clinical Presentation of brain tumors
Headaches
Seizures
Nausea & vomiting
Loss of consciousness
Cognitive dysfunction
Neurological dysfx- weakness, sensory loss, aphasia,
visual spatial dysfunction
Cognitive dysfunction
Includes memory problem, mood or personality
disorders
It is the presenting symptom in 30-35% of patients with
brain metastasis.
Patients symptoms often subtle, complain of fatigue,
urge to sleep and loss of interest in daily activities.
Confused with depression.
Consider neuroimaging in patients who present with
new onset of depressive symptoms or without obvious
cause.
Case:
76 yo old female presented with increased irritability
with her family, sleeplessness and reckless spending.
PMH: HTN, breast cancer
PE, labs wnl
MSE notable for loud rapid speech, flight of ideas, no
delusions or hallucinations
CT revealed a 3 cm intraventricular lesion
Meningioma was removed and sxs slowly abated
Brain Meningioma CT
Meningioma MRI /T2

Figure 1a. CT scan showing an
astrocytic lesion (arrows), one of
the glial tumors, in the left frontal
lobe.

Figure 1b. Intraoperative
photograph of exposed brain
tumor showing the pale lesion
pouting out of the brain surface
after opening the overlying dura.

Figure 1c. Photomicrograph of a
smear preparation showing
astrocytic hypercellularity (more
cells than normal) and nuclear
pleomorphism (abnormal
variability of the nuclei in cells), in
keeping with a malignant
astrocytoma.


Neuroimaging of brain tumors
Major diagnostic modality. Useful for preoperative
planning
The diagnosis of a primary brain tumor is best made by
cranial MRI. This should be the first test obtained in a
patient with signs or symptoms suggestive of an
intracranial mass. The MRI scan should always be
obtained both with and without contrast material
(gadolinium).
MRI superior to CT scan for evaluating meninges,
subarachnoid space, posterior fossa and defining the
vascular abnormality of the lesion

Neuroimaging
High-grade or malignant gliomas appear as contrast-
enhancing mass lesions, which arise in white matter and
are surrounded by edema
Multifocal malignant gliomas are seen in ~ 5% of
patients.
Low-grade gliomas typically are nonenhancing lesions
that diffusely infiltrate brain tissue and may involve a
large region of brain. Low-grade gliomas are usually
best appreciated on T2-weighted MRI scans.


Neuroimaging
A contrast-enhanced CT scan may be used if MRI is
unavailable. CT may be false-negative in patients with a
low-grade tumor and can have significant artifact
through the posterior fossa, which may obscure a lesion
in this area.
Calcification, which may suggest the diagnosis of an
oligodendroglioma, is often better appreciated on CT
than on MRI.
CT useful if there is a question of bone or vascular
involvement, or for detecting mets to skull base. Also,
in ER situation or if MRI is contraindicated.

Radiologic features of metastatic
disease
-Multiple lesions
-Localization at the grey-white
junction
-More circumscribed margins
-Relatively large amount of
edema compared to size of
lesion

Sources
Wen, Patrick Y. Overview of Brain Metastases.
UptoDate version 13.3.
Wong, Eric T. Clinical presentation and
diagnosis of brain tumors. UptoDate version
13.3.
Ma, Julie. Mania Resulting from Brain Tumor.
Clinical Vignette UCLA Department of
Medicine.