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CNS tumors

LEARNING OBJECTIVES
Classify CNS tumors
Describe general characteristics of CNS
tumors
Identify tumor type in relation to age and
site of tumor
Describe primary peripheral nerve sheath
neoplasms with clinical relevance
FACTS
Tumors in adults are more commonly
based in anterior fossa/ supratentorial
location whereas childhood tumors are
more commonly posterior fossa/
infratentorial in location
CNS tumors do not metastasize outside
the brain and spinal cord.
Even benign tumors can be sinister
according to location.
Tumor origin

Tumor origin
Neuronal
Glial
Nerve sheath
Meningeal
Others
Metastatic
CNS TUMOR CLASSIFICATION
Primary tumors- 1/2 --3/4
th

Metastatic tumors- 1/4
In primary tumors,WHO grading is done
according to biologic behaviour into
grade I to IV (depending on risk of
recurrence)
Under current classification scheme, lesions
of different grades are given distinct
names
CNS TUMOR CLASSIFICATION
PRIMARY TUMORS
Gliomas
Neuronal and glioneuronal tumors
Poorly differentiated tumors
Other parenchymal tumors
Primary lymphomas 1% of intracranial tumors
Germ cell tumors 0.2-1%
Pineal tumors

Tumors of meninges
Meningiomas

Nerve sheath tumors
Schwannomas
Neurofibromas




PRIMARY TUMORS

1-Gliomas
Astrocytomas (80% adult primary tumors)
Oligodendrogliomas
Ependymomas and other paraventricular lesions

Grading
Astrocytomas
Pilocytic astrocytoma(Non infiltrating)Grade I
Diffuse astrocytoma- Grade II
Anaplastic astrocytoma- Grade III
Glioblastoma multiforme- Grade IV
Oligodendrogliomas
Most Grade II
Anaplastic Grade III
Ependymomas
Most Grade II
Anaplastic Grade III

Gliomas
SITES and AGE group
Astrocytoma
Pilocytic (Children , posterior fossa)
Infiltrating (Adults, Cerebral hemispheres)
Oligodendroglioma
Adults 4
th
-5
th
decade, cerebral hemispheres
Ependymoma (2 groups)
4
th
ventricle, children
Intraspinal, adults
Low grade vs High grade glioma
Glioblastoma
Cystic/ Pilocytic astrocytoma
Gliomas in children,are most common in
the posterior fossa. Most childhood brain
tumors arise below the tentorium, which is
the reverse of the adult.
OLIGODENDROGLIOMA
Ependymoma
Ependymoma arising from the ependymal lining
of the fourth ventricle above the brainstem and
bulging toward the cerebellum. Ependymomas
are benign histologically.
Ependymoma
This horizontal
section of the
brain reveals a
large
ependymoma of
the fourth
ventricle.
Ependymoma
Undifferentiated tumors
Medulloblastoma
Predominantly in children (20% of brain
tumors in children)
Posterior fossa/ cerebellum
Highly malignant but radiosensitive
Atypical teratoid/ rhabdoid tumor
Children less than 5 yrs
Dismal prognosis
Medulloblastoma
irregular
posterior fossa
mass near the
midline of the
cerebellum and
extending into
the fourth
ventricle in a
child.
CNS TUMOR CLASSIFICATION
METASTATIC TUMORS
to of brain tumors
Mainly mtastatic carcinomas
5 common primaries accounting for 80% mets
Breast
Lung
Skin (melanoma)
Kidney
GIT
Metastasis from a lung
carcinoma.
Metastases most often
appear at the border of
the grey and white matter
in the distribution of the
middle cerebral artery,
MENINGEAL
TUMORS
Meningiomas-Grade I
Atypical meningiomas- Grade II
Anaplastic meningiomas-Grade III
Meningioma
Peripheral nerve sheath tumors
Schwaanomas
Neurofibromas
Malignant peripheral nerve sheath tumors/
MPNST
Schwaanomas/
Acoustic
neuroma
The mass lesion here
is arising in the
acoustic (eighth
cranial) nerve at the
cerebellopontine
angle. This is a
schwannoma. Patients
may present with
hearing loss. These
benign neoplasms can
be removed.
SUMMARY (Common tumors)
Childhood tumors
Medulloblastomas, high grade
Pilocytic astrocytomas, Grade I
Ependymomas, posterior fossa(4
th
ventricle)
Choroid plexus papillomas, lateral ventricles

Adult tumors
Gliomas
Spinal ependymomas, oligodendrogliomas


TUMORS of PNS
Neurofibroma
Cutaneous
Plexiform
Schwaanoma
Malignant peripheral nerve sheath tumors

NEUROFIBROMA
PLEXIFORM NEUROFIBROMA
PLEXIFORM
NEUROFIBROMA