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The focus of this chapter is to provide you with a general overview of tumors involving the nervous system. It will be important to know their prognosis and treatment options.
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Also, keep in mind some of the “buzz-words” that describe histopathological hallmarks of each type of tumor.
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Metastatic brain tumors are 10 times more common than primary malignant brain tumors and therefore the most common brain tumor overall.
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Pilocytic Astrocytoma (PA)
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Patients: more common in childhood
Location: cerebellum, optic chiasm (associated with NF1), hypothalamus, periventricular
Imaging: enhancing mural nodule with a cystic component
Microscopy: pilocytic elongated cells, Rosenthal fibers (Fig. 12-1)
Treatment: surgical resection
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KEY FACT
Optic glioma is a grade 1 PA that arises from glial cells of optic pathway. Surgical resection if symptomatic; radiotherapy if unresectable. Patients will continue to have visual impairment.
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Glioblastoma Multiforme
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Patients: adults (peak incidence—64-year-old)
Location: cerebral hemispheres
Imaging: heterogeneously enhancing lesion with vasogenic edema and necrotic core; may cross midline (butterfly glioma)
Microscopy: pseudopalisading with necrosis
Treatment: radiation and chemotherapy (temozolomide), resection to delay disease progression
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WARDS TIP
GBM is a fast growing and invasive brain tumor. More common in men, survival is less than 20% after 2 years.
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Patients: adults (around age 40)
Location: frontal lobes (seizures, personality change)
Imaging: variable
Microscopy: “fried egg” appearance with clear cytoplasm (Fig. 12-2)
Treatment: resection and radiation
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WARDS TIP
GBM is the most common form of malignant primary brain tumor.
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Patients: more common in children, associated with NF2
Location: posterior fossa/ventricular system (children), spinal cord (adults) arises from ependymal lining of ventricles
Imaging:
Intracranial tumors—heterogeneous, slightly enhancing
Spinal tumors—homogeneous, brightly enhancing
Microscopy: perivascular pseudorosettes, GFAP+ (Fig. 12-3)
Treatment: resection
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WARDS TIP
If ependymoma affects affecting ventricular system, expect noncommunicating hydrocephalus.
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WARDS TIP
Von Hippel-Lindau syndrome is an autosomal dominant cancer syndrome associated with cerebellar and spinal cord hemangioblastomas, renal cell carcinoma, pheochromocytoma, and retinal angiomas.
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