Tumors of the CNS: Introduction

by Carlo Raj, MD

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    00:01 Here, we’ll take a look at tumors of the CNS.

    00:03 Let’s begin.

    00:06 Remember, whenever you find or if you suspect a space occupying lesion in your brain, it could be many issues.

    00:14 One of them could be tumors.

    00:17 When it is tumors though it is metastasis by far which is much more common than primary.

    00:24 But that would be for most organs.

    00:27 Metastatic disease outnumbers your primary malignancy of the brain by 5:1 or greater than 5:1 type of ratio.

    00:35 That for the most part is true for most organs in the body as we have seen.

    00:41 Most common parenchymal metastasis are the lung, the breast, melanoma, and renal cell carcinoma.

    00:49 Once again, if you are referring to metastasis to the brain parenchym, then you must know lung and breast, put those together because of the vicinity.

    01:03 And then you have melanoma and renal cell carcinoma, which may metastasize to the brain.

    01:10 Leptomeningeal metastases can occur from leukemia and lymphoma as well as from breast, melanoma and also your lung cancer.

    01:19 So once again, if we talk about leptomeningeal type of metastasis, here for the most part, you’re thinking about your WBC type of pathology, either leukemia or lymphoma.

    01:30 But in addition to that, please know that your parenchymal metastases could also be included here.

    01:38 The most common presentation as you can imagine would be headache and new onset seizures because you have a space-occupying lesion in the brain.

    01:47 There is no “characteristic” headache indicating the tumor.

    01:51 It could be dull.

    01:52 It could be rather intense.

    01:55 Incidence of seizures varies depending on the type of tumor and the location, obviously.

    02:02 Increased intracranial pressure, ICP, and focal neurologic deficit can also be seen at presentation, but not at most times, but could be a part of the syndrome of presentations that you’d be seeing with CNS tumors.

    02:17 Our topic at first, apart from metastases, now we’ll begin our official primary CNS tumors.

    02:25 Most common tumor type, we’ll talk about age groups, children and adults.

    02:32 Now for this, a primary CNS tumor in a child, then we have infratentorial tumors, are more common as our primary CNS neoplasms.

    02:42 In adults, it’s supratentorial, are more common as our metastatic lesions as well.

    02:50 So you want to know commonly where you would have locations of your CNS tumors, either your population being children or adults.

    03:00 Neuronal tumors are rare and neurons usually do not divide after birth.

    03:06 And for the most part, you must think of this as being – for your boards – as being very, very almost permanent type of cells.

    03:15 Now, obviously research is showing us that maybe perhaps division is possible after birth.

    03:20 But as far as you’re concerned, right now, division in these cells tend to be permanent in nature.

    03:28 Imaging with contrast is the best radiologic study to evaluate CNS tumors.

    03:32 Now, once again, please be careful here because if you’re referring to increased intracranial pressure.

    03:37 And if there was some kind of bleeding that’s taking place in the brain, then obviously, the contrast here will be contraindicated.

    03:44 But with tumors, the contrast would be a very good idea for you to identify the tumor itself.

    03:52 Here’s an important slide so that you can actually organize your thoughts for primary CNS tumors and begin with neuroepithelial tumors and this will be an important category.

    04:02 Under neuroepithelial tumor, we’ll take a look at astrocytic tumors and then we will further divide astrocytic tumors and it is extremely important that you pay attention to the different grades that we’ll walk through in astrocytic tumors because one of the most common brain tumors that we’ll find includes glioblastoma multiforme, which will be in this category as we shall see.

    04:27 In addition, our next classification under neuroepithelial will be oligodendrogliomas or oligodendroglial tumors And obviously you know that oligodendroglial cells are your CNS cells or manufacturing plant for myelin in the CNS.

    04:47 Ependymal tumors.

    04:48 Think about ependymal and what that means to you.

    04:51 And these cells are quite a bit responsible for production of CSF and such.

    04:59 Choroid-plexus tumors.

    05:00 So both of these, you kind of grouped together in terms of where you can expect to see it.

    05:04 So these will be important in terms of location.

    05:07 And then embryonal tumors and these tend to be medulloblastomas and that would be an incredibly important brain tumor of a child, medulloblastoma.

    05:16 We’ll walk through many of these in greater detail.

    05:20 I want you to now move into the meningeal.

    05:23 And in the meningeal region, we have meningeal tumors and specifically, the meningioma.

    05:28 Now, keep your parenchyma of the brain separate, please, from the meninges.

    05:32 So imagine now that you have a primary CNS tumor that’s developing in the meninges.

    05:37 Wow! Well, that takes a little bit of time in terms of developing and as it gets bigger, what is it going to do? Well, it may then start invading and impinging upon the brain parenchyma.

    05:51 And you have hemangioblastomas and these are important as well.

    05:54 And the reason for that, you’ll see soon enough, is that the associations including von Hippel-Lindau disease.

    06:02 You have primary CNS lymphomas as well.

    06:05 And especially if you have a patient that may have HIV, unfortunately, there’s a possibility of a lymphoma developing as a primary CNS tumor.

    06:16 And you have a classification of germ cell tumors.

    06:19 Germinoma, choriocarcinoma, teratoma are possibilities.

    06:24 Sellar region type of tumors and these include your pituitary adenomas, your craniopharyngioma in a child notably and even perhaps a pinealoblastoma.

    06:36 So here you have it in terms of organization of your thoughts in terms of locations and under these are subtypes and even under these, we have our supersubtypes.

    06:47 And we’ll get into details of these and I will point out which ones that you want to pay attention to and give you clinical pearls as to what kind of symptoms and signs that you’re looking for in your patient.

    About the Lecture

    The lecture Tumors of the CNS: Introduction by Carlo Raj, MD is from the course Tumors of the CNS. It contains the following chapters:

    • Tumors of the CNS
    • Primary CNS Tumors

    Included Quiz Questions

    1. Lymphoma
    2. Lung cancer
    3. Breast cancer
    4. Renal cell cancer
    5. Melanoma
    1. Lymphoma
    2. Renal cell carcinoma
    3. Thyroid cancer
    4. Liver cancer
    5. Colon cancer
    1. Infratentorial region
    2. Supratentorial region
    3. Pituitary gland
    4. Parietal lobe
    5. Spinal cord
    1. Primary CNS lymphoma
    2. Neuroepithelial tumors
    3. Meningeal tumors
    4. Germ cell tumors
    5. Sellar region tumors
    1. Hemangioblastoma
    2. Astrocytoma
    3. Oligodendroglioma
    4. Ependymal tumors
    5. Medulloblastoma
    1. Supratentorial tumors and metastatic lesions are most common.
    2. Infratentorial tumors and metastatic lesions are most common.
    3. Supratentorial tumors and primary CNS neoplasms are the most common.
    4. Infratentorial tumors and primary CNS neoplasms are the most common.
    5. Supratentorial tumors and infratentorial tumors are common.

    Author of lecture Tumors of the CNS: Introduction

     Carlo Raj, MD

    Carlo Raj, MD

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