Primary brain tumours are a diverse group of neoplasm arising from different cells of the central nervous system.
It accounts for about 2% of all cancers with an overall annual incidence of 22 per 1,00,000 population.
Most common brain tumour in adults is Brain Metastasis.
2. INTRODUCTION
⢠Primary brain tumours are a diverse group of neoplasm arising from
different cells of the central nervous system.
⢠It accounts for about 2% of all cancers with an overall annual
incidence of 22 per 1,00,000 population.
⢠Most common brain tumour in adults is Brain Metastasis.
⢠Meningiomas are the most common non-maliganant primary brain
tumour f/b Pituitary and nerve sheath tumours.
⢠Gliomas accounts for 75% of malignant brain tumours, in which more
than half are glioblastomas.
7. ADULTS (20 + YEARS OLD)
⢠Metastatic,50%
⢠Primary,50%
⢠Meningioma,18%
⢠Glioblastoma,7%
⢠Pituitary, 7%
⢠Nerve sheath tumour,4%
⢠Other astrocytoma, 3%
⢠Lymphoma ,2%
⢠Oligodendroglioma, 2%
⢠All other, 7%
⢠Most brain tumours have male predominance except meningioma and low grade astrocytoma.
8. RISK FACTORS
Established
⢠Ionizing radiation
⢠Genetic predisposition
Not established
⢠Head trauma
⢠Electromagnetic field radiation
⢠Radiofrequency and cellular phones
⢠N-nitroso compounds
⢠Vitamin C and E
⢠Allergies/infection association
⢠Tea and coffee
⢠Occupational
⢠Tobacco, alcohol consumption.
9. CLASSIFICATION
⢠Brain tumors are classified according to the WHO CNS tumours
grading system.
⢠Previously, primary CNS tumours were defined on the basis of
histological criteria & assigned a grade ( from I to IęŚ)
⢠In 2016, the classification was revised from the 2007 classification to
incorporate signature molecular genetic alterations to the classic
histology.
10. WHO Gradings:-only for Glioma
⢠WHO grade I â low proliferative potential. possible care with surgery
alone.
⢠WHO grade II- infiltrating but low in mitotic activity. Can recur and
progress to other grades.
⢠WHO grade III- Histologic evidence of malignancy( mitotic
activity),infiltrative,anaplastic.
⢠WHO gradeIęŚ- mitotically active, necrosis,rapid pre and post surgical
progression.
11. CLINICAL FEATURES
⢠Generalized
ďHeadache
ďNausea and vomiting
ďSyncope
ďMental status and behavioral
changes
ďSeizure
⢠Focal
ď Focal motor weakness
ď Ataxia
ď Seizure
ď Aphasia
ď Visual dysfunction
12. HEADACHE
⢠50-70% patients
⢠Bifrontal and tension-like, with constant, dull pressure type
⢠Classic brain tumour headache occur in the early morning with
nausea and vomiting and improve over the course of the day
⢠Only occur in 5-17% of all brain tumour patients, 42% of whom have
posterior fossa tumour
⢠More common in brain metastases and glioblastomas (90%).
13. Diagnostic investigations
⢠MRI Brain with Contrast is the investigation of choice.
⢠Diffusion-weighted imaging, diffusion tensor imaging, MR perfusion &
MR spectroscopy are used to better characterize the tumour
cellularity, vascularity and metabolism respectively.
⢠Can distinguish tumour, from non neoplastic processes,including
treatment effect.
⢠Surgical biopsy
14. CT HEAD:-
Intra axial tumours- usually low attenuation
high attenuation areas within a tumour
calcification, hemorrhage and lymphoma
Extra axial: bone erosion and hyperostosis
MRI Brain:-
TIWI: low signal intensity
T2WI/ FLAIR: High signal intensity
ď
ď
15. ď LOW SIGNAL INTENSITY IN T2WI:
1.CNS Lymphoma
2.PNET
3.Metastasis( melanoma)
4.GBM (less common)
5.Meningioma( less common)
ď ENHANCEMENT: Almost all tumors except
Low grade glioma (WHO II & III)
CYSTIC NON-tumoral lesions:
1. Dermoid cyst
2. Epidermoid cyst
3. Arachnoid cyst
16. ďą Homogeneous enhancement seen in:
1.Metastases
2.Lymphoma
3.Germinoma And Other Pineal Gland Tumours
4.Pituitary Astrocytoma And Hemangioblastoma
5.Ganglioglioma
6.Meningioma and schwannoma
ďą Patchy enhancement seen in:
1.Metastases
2.Glioblastoma multiforme
3.Radiation necrosis
39. Mixed Neuronal-Glial Tumours-
Ganglioglioma
⢠Sezure are the most common manifestation.
⢠MC location-supratentorial(temporal>frontal)
⢠Children and young adults
⢠30-50% calcification
⢠Presenting as cyst-mural enhancing nodule
⢠Gross total resection results in survival ranging from 7 to 17 years.
⢠Adjuvant irradiation for incompletely resected or anaplastic progression (survival
of 3years or less)
40.
41. CHOROID PLEXUS TUMOUR :
⢠Includes papilloma and carcinoma
⢠Tumour of childhood
⢠In adults it account for only 0.2% of all intracranial neoplasm.
⢠Located in
1. Lateral ventricle(mc)
2. the cerebello-pontine angle
3. fourth ventricles.
42.
43. Meningeal tumours- Meningioma
⢠Most common primary intracranial tumours
⢠Older adult
⢠Incidentally found asymptomatic meningiomas( lacking mass effect or
compression of a venous sinus)
⢠When seizure occur ,tumour grow or focal signs emerge
⢠Surgical can be curative ,especially in meningioma overlying the
hemisphere.
44.
45.
46.
47. PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA
⢠An uncommon variant of Extranodal Non-Hodgkin Lymphoma.
⢠Involves the Brain (periventricular), leptomeninges, eyes or spinal
cord without evidence of systemic disease.
⢠Most cases are diagnosed in patients between 45 and 65 year of age,
median age( fifth decade) ( non-HIV related PCNSL)
⢠Homogenous enhancement and diffusion restriction.
⢠The most notable risk factor is immunodeficiency
⢠Highly aggressive tumour.
⢠Left untreated, most patients succumb within 6 months.
48.
49. ⢠Methotrexate- based chemotherapy given in high doses (HD MTX
,above 3.5g/m2 )
⢠F/b Leucovorin rescue has been shown to be the single most effective
treatment for PCNSL.
⢠For PCNSL in AIDS patients, WBRT has been the standard treatment
resulting in poor and non durable response.
50.
51.
52.
53. Conclusion
⢠Primary brain tumors remain difficult and challenging disease to
manage despite substantial progress in understanding their genesis.
⢠Treatments and better outcomes for primary brain tumors have long
lagged behind those of other tumours.
⢠Combinational regimens will be required to achieve a broad and
durable antitumor benefit.
⢠New advances in cell engineering technologies and infusion of exvivo
prepared immune cells are promising strategies.
⢠The present challenge is to translate this better understanding of the
pathophysiology into effective therapies.
54. REFERENCES
⢠Bradelyâ˛s Neurology in clinical practice, 8th edition.
⢠Osbornâ˛s Diagnostic Brain Imaging, 3rd edition.
⢠Louis DN, Ohgaki H, Wiestler OD CW.(2016) WHO classification of Tumours
of the central nervous system( revised 4th edition).WHO Lyon ,2016
⢠Ostrom QT , Gittleman H,LiaoP, et al.CBTRUS stastical report.
⢠Primary brain and other central nervous system tumours diagnosed in the
united states in 2010-2014.neuro Oncol 2017;19:1-8
⢠Weller M, van den Bent M, Tonn jc,et al.European Association for Neuro-
oncology(EANO) guideline on the diangnosis and treatment of adult
astrocytic and oligodendroglial gliomas.Rev Lancet Oncol 2017;18:315-29.
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