CNS Tumors A. Primary Neuroglial Tumors (Gliomas) 1. Fibrillary Astrocytic Neoplasms: A. Infiltrative Growth Pattern B.

Occurs More Commonly In Adults But May Occur At Any Age. C. Sites: A. Cerebral Hemispheres B. Can Occur Anywhere In The CNS E Histologic Grade Is An Important Predictor of Biologic Behavior. F. The WHO Classification : Three Grades: A. Well Differentiated 1. Astrocytomas 2. Anaplastic Astrocytomas: Intermediate Grade 3. Glioblastoma Multiforme: Most Aggressive G. Clinical Features: A. Increased Intracranial Pressure Eg. 1. Headaches 2. Focal Abnormalities: Seizures H. Prognosis: Depends On A. Location B. Histologic Grade of the Tumor C. Age I. Treatment: A. Surgical Resection B. Radiation Therapy & Stereotactic Guided Radiotherapy C. Chemotherapy. 2. Pilocytic Astrocytomas More Common In Children But May Occur At Any Age 1. Common Sites: A.Cerebellum B. Fourth Ventricle 2. Prognosis: A. Influenced By Location 3. Excellent Prognosis: A. Surgically Resectable:Cerebellar Tumors: Excellent Prognosis B. Less Excessible Sites: Hypothalamus and Brain Stem May Cause Death Even In Absence Of Histologic Grade Of Malignancy

3. Oligodendrogliomas A. Most Common : Adulthood B. Site: Cerebral Hemispheres C. Cytoplasmic Abnormalities 1. Loss of Heterozgosity Of Long Arm Of Chrmosome 19 & Short Arm Of Chromsome 1 C. Prognosis A.Less Predictable Than For Infiltrating Astrocytomas B.Depends On Histologic Grade 4. Ependymomas: A. May Occur At Any Age. B. Most Arise Within The Ventricular Cavities Or In The Area Of The Central Canal Of The Spinal Cord C. Most Common: First 2 Decades Of Life D. Intraspinal Lesions Predominate in Adults E. Intracranial Ependymomas Occur Most Commonly: Fourth Ventricle Where They May Obstruct CSF Outflow & Lead To 1. Hydrocephalus 2. Increased Intracranial pressure F. Clinical Signs : 1. Depend On The Location Of The Neoplasm 2. Intracranial Tumors Often Associated With Hydrocephalus 3. Evidence Of Increased Intracranial Pressure.

B. Primitive Neuroepithelial Neoplasms: 1. Include A Number Of Tumors Composed Of Embryonal (Primitive) Small Cells That Occur Predominantly But Not Exclusively In Children, 2. Medulloblastomas Present : A. Increased Intracranial Pressure Such As 1. Headaches 2. Papilledema 3. Gait Abnormalities Reflecting Cerebellar Injury 4. Most Commonly In The Cerebellum C. Other Primary Intraparenchymal Neoplasms 1. Primary CNS Lymphoma 1. Have Increased In Recent Years With The Emergence of AIDs 2. Lymphoma Of The Brain Is Considered An AIDs Defining Condition In HIV Patients 3. Solitary Or Multiple 4. Hemorrhagic & Necrotic 5. Tend to Grow In & Around The Walls Of Blood Vessels 6. Usually: B Cell Line 7. Significant Number Arising In Immunocompromised Hosts Are Associated With EBV Genome & myc Oncogene Activation 2. Germ Cell Neoplasms: A. May Arise Primarily In The Intracranial Compartment. B. Most Occur In Suprasellar & Pineal Areas Particularly In Children & Young Adults 1. The Microscopic Appearance : Identical To That Of The Germ Cell Neoplasms Occurring In The Gonads 2. The Most Commonly Encountered Variants: A. Testicular Seminoma, B. Ovarian Dysgerminoma C. Teratomas. 3. Hemangioblastomas: A. Occur In The Cerebellum & Less Commonly In The Meninges B. May Occur As Solitary Lesions Or May Occur As Part Of The Von Hippel Lindau Disease C. Difficult To Distinquish From Metastatic Renal Cell Carcinoma

D. Meningiomas: 1. Source: A. Meningoepithelial Cells That Invest The Arachnoid Mater 2. Adults Predominantly 3. May Arise From A. Cranial Vault Or B. Spinal Cord 4. Predominance: Females : Spinal Cord Meningiomas A. May Be Related To Progesterone Receptors On These Cells 5. Meningiomas Frequency : A. Increased In Neurofibromatosis Type 2 . 6. Sporadic Meningiomas There Is Loss Of The NF-2 Gene & Its Product Merlin From Chromosome 22q11 A. Its Loss May Be Due To Partial Or Complete Loss Of Chromosome 22 7. Clinical Features: A. Increased Intracranial Pressure B. Seizures C. Focal Neurologic Deficits E. Metastatic Neoplasms 1. Occur Predominantly In The Elderly 2. Hematopoietic Neoplasms May Spread To The CNS In Young Or Old A. Lymphomas and Leukemias 3. Most Common Metastases: A. Carcinoma Of The Lung B. Breast Cancer C. Malignant Melanomas 4. Clinical Features: A. Increased Intracranial Pressure, B. Variable Neurologic Deficits 5. Cranial Nerve Palsies : Particularly Common In Leptomeningeal Metastases