FIRST AID: Brain Tumors

schwannoma

adult tumor benign tumor classically at the cerebellopontine angle involving CN VII and VIII often localized to CNVIII in internal acoustic meatus --> vestibular schwannoma (present as hearing loss, tinnitus) bilateral vestibular schwannomas in NF-2 Schwann cell origin, S-100+ dense, hyper cellular areas containing spindle cells alternating with hypo cellular, myxoid areas

meningioma

adult tumor common, typically benign; more often in females often asymptomatic, may have seizures or focal neuro defects occurs near surfaces of brain and in parasagittal regions (can compress leg area similar to ACA stroke) extra-axial (external to brain parenchyma) and may have a dural attachment/tail tumor compresses, but does not invade cortex arachnoid cell origin; spindle cells concentrically arranged in whorled pattern; psammoma bodies Men have problems with PSA

glioblastoma multiforme

adult tumor grade IV astrocytoma; highly malignant primary brain tumor pseudopalisading pleomorphic tumor cells border central areas of necrosis found in cerebral hemispheres; can cross corpus callosum (butterfly glioma) astrocyte origin = GFAP + GlioPlastoma Multiforme

oligodendroma

adult tumor relatively rare, slow growing, malignant; most often in frontal lobes (think FEF issues); seizures common calcified oligodendrocyte origin - fried egg appearance - round nuclei with clear cytoplasma chicken-wire capillary patter Ol-EGG-odendroglioma

pituitary adenoma

adult tumor may be nonfunctioning (present with mass effect - bitemporal hemianopia due to pressure on optic chiasm) or hyperfunctioning prolactinoma most common - presents as galactorrhea, amenorrhea, decreased bone density due to suppression of estrogen in women and as decreased libido and infertility in men hyperplasia of only one type of endocrine cells found in the pituitary -lactotrophs = hyperprolactinemia -somatotrophs = acromegaly, gigantism -corticotrophs = Cushing disease

hemangioblastoma

adult tumor most often cerebellar; assoc with VHL syndrome when found with retinal angiomas can produce EPO --> secondary polycythemia closely arranged, thin-walled capillaries with minimal intervening parenchyma

Pathoma divisions of tumors

CHILD: usually below tentorium pilocytic astrocytoma (B) ependymoma (M) medulloblastoma (M) ADULT: usually above tentorium meningioma (B) glioblastoma multiforme (M) oligodendroglioma (M)

pilocytic astrocytoma

child tumor low grade astrocytoma; most common primary brain tumor in childhood well circumscribed; posterior fossa (cerebellum) in children GFAP+, Rosenthal fibers - eosinophilic, corkscrew fibers imaging reveals a cystic lesion with a mural nodule (nodule growing on the wall of the cyst) Drew Rosenhaus and Houston Astros

medulloblastoma

child tumor most common malignant brain tumor in childhood commonly in cerebellum, can compress 4th ventricle causing noncommunicating hydrocephalus --> headache, papilledema can send drop metastases to spinal cord (tend to occur in lower spinal cord, cauda equina) tumor grows rapidly and spreads via CSF form primitive neuroectodermal tumor; Homer-Wright rosettes, small blue cells Blast the Homer-run

ependymoma

child tumor most commonly in 4th ventricle; can cause hydrocephalus poor prognosis; malignant ependymal origin, perivascular pseudorosettes; rod shaped blepharoplasts (basal ciliary bodies) found near nucleus

pinealoma

child tumor tumor of pineal gland - can cause Parinaud syndrome (compression of tectum (pretectal area in midbrain) - vertical gaze palsy) and obstructive hydrocephalus (compression of cerebral aqueduct) precocious puberty in males (hCG production) similar to germ cell tumors

craniopharyngioma

child tumor benign; most common childhood supratentorial tumor may be confused with pituitary adenoma - both cause bitemporal hemianopia - typically in sella turcica derived from remnants of Rathke pouch (ectoderm) calcification is common cholesterol crystals in motor oil-like fluid within tumor