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Astrocytic Tumors
A powerpoint over several astrocytic tumors, with a focus on glioblastomas.
From kristofferleon
ILAI
From kughaprian
INTRA-AXIAL
1. Supratentorial
2. Infratentorial
Types of Gliomas
\ue000Astrocytoma
o
astrocytes
\ue000Oligodendrogliomas
o
oligodendrocytes
\ue000Ependymomas
o
ependymal cells
\ue000Choroid plexus pappilomas/carcinomas
Astrocytoma Subtypes
1. Low grade astrocytoma
2. Anaplastic astrocytoma
3. Glioblastoma multiforme
Astrocytoma
-
25 \u2013 30% of adult cerebral hemispheric gliomas
-
30% of gliomas in children
-
in adults, the peak age of incidence is 20-50 years old
-
the histopathologic classification of glial tumors is based on the prevalent cell type present and the grading of the tumor by the most malignant portion present
-
On MR:
o
Relatively homogeneous masses without much peritumoral
edema
o
The margins of the lesion are often clearly defined on MR
o
Low grade astrocytomas not infrequently involve both the white
matter and adjacent cortex
\ue001
This appearance may stimulate an infarct. If the lesion does not conform to a vascular territory or there is marked enhancement, tumor should be suspected
\ue001
Occasionally, a follow-up scan is necessary in order to
differentiate a tumor from an infarct
o
contrast enhancement is variable in astrocytomas
o
generally, higher grade tumors demonstrate moremarked
enhancement than lower grade tumors, but there are many
exceptions
o
low grade astrocytomas often show no or minimal enhancement;
no edema
o
calcification is not uncommon in low grade astrocytomas (seen
in approximately 20% of cases on CT)
o
CT detects calcification much better than MR
A 22-year old male with headache
The abnormal signal involves both white matter and cortex, but does not conform to an expected vascular distribution suggesting tumor rather than infarct.
I. Low grade astrocytoma
Post contrast T1-weighted axial shows no enhancement
Bilateral Thalamic Glioma (Astrocytoma)
Obstruction of 3rd ventricle; hydrocephalus
II. Anaplastic
-
necrosis, vascular proliferation, and cyst formation common
-
significant edema and inhomogenicity
MR Characteristics
-
considerable inhomogenicity
-
hypointensity on T1
-
hyperintensity on T2
-
surrounding edema
-
most show gadolinium enhancement
45-year old male complaining headache
There is a large amount of vasogenic edema in superior fronto-parietal- occipital hemisphere. After contrast administration, there is an irregular ringlike structures.
III. GBM
-
a highly malignant type of astrocytoma
-
the most common and most malignant glioma
-
account for 15-20% of primary CNS neoplasms in adults, and
are rare in children
-
Glioblastoma multiforme occurs most commonly between ages
40-60 and is rare in childhood.
-
Glioblastoma most commonly arises in the frontal and temporal lobes, but may occur in any region of the brain and can spread rapidly.
-
It commonly crosses the corpus callosum to involve both cerebral hemispheres. Glioblastoma may also spread through the ventricles and subarachnoid space.
S/Sx
-
elevated intracranial pressure are usually present (headache,
nausea, vomiting, papilledema, visual disturbances)
-
headache and seizure are the most common presentation
-
focal deficits may result from local invasion of the tumor
-
intracranial hemorrhage may result in acute onset of symptoms
DDx
-
arteriovenous malformations
-
other astrocytomas
-
abscess
-
CNS lymphoma
-
cavernous malformation
-
oligodendroglioma
-
metastasis
53-year old male with superior quadrant visual loss and dizziness
Glioblastoma Multiforme (GBM)
Subependymal Giant Cell Astrocytoma
-
common locations: lateral ventricle attached to caudate head
-
associations: most patients have tuberous sclerosis, of those with TS,
6-16% will develop this tumor
-
demographics: children, young adults (first two decades)
-
histology: large cells that variously resemble astrocytes, although
may express neuronal markers
-
radiology: usually seen with other features of tuberous sclerosis (cortical tubers, calcified subependymal tubules, white matter streaks). May obstruct foramen of Monroe and cause hydrocephalus. Enhancement and calcification are both common.
Oligodendroglioma
Bakit wala nito? Sige, pagtyagaan ang notes:
-
90% with calcification
-
relatively avascular
-
ring enhancement
INFRATENTORIAL
\u2022
cerebellar astrocytoma
\u2022
medulloblastoma
\u2022
ependymoma
Juvenile Pilocytic Astrocytoma
\u2022
the most common astrocytomas in children
\u2022
occur most often in patients younger than 25 years old
\u2022
astrocytoma is the most common and most malignant
glioma
\u2022
astrocytomas are responsible for 50 % of primary
pediatric CNS tumors
\u2022
accounts for 80-85% of cerebellar astrocytomas and
60% of optic gliomas
\u2022
JPAs usually present in older-aged children as opposed
to medulloblastomas
\u2022
most frequently arises in the cerebellar hemispheres, along the optic tracts, and around the third ventricle, but may also be found in the cerebral hemispheres or anywhere else astrocytes are present
\u2022
usually well-demarcated lesions associated with cyst
formation
\u2022
usually indolent lesions and rarely transform to a high-
grade malignancy
Signs and Symptoms
\u2022
related to obstructive hydrocephalus and mass effect including nausea, vomiting, visual disturbances, headache, irritability, ataxia
Differential Diagnosis
\u2022
other astrocytomas, brain metastases, ependymoma,
oligodendroglioma,
medulloblastoma,
high-grade
glioma
Case\u2022
7 \u00bd y/o with nausea, vomiting, and headache
\u2022
Precontrast solid and cystic portions of centrally
positioned cerebellar mass. Postcontrast showed a
solid portion enhancing
Medulloblastoma
\u2022
primarily a pediatric tumor with a peak age of
incidence of 3-5 years
\u2022
15% of childhood brain tumors
\u2022
Only 0.4-1% of adult brain tumors
\u2022
the tumor most commonly arises in the posterior fossa of the brain between the brainstem and the cerebellum although supratentorial origins have been reported
\u2022
in children, the most common site affected is the
cerebellar vermis while in adults the lateral
hemispheres of the cerebellum are most often involved
\u2022
patient presentation can be attributed to increased
intracranial pressure (ICP) and cerebellar dysfunction
\u2022
increased ICP causes headache, nausea and vomiting,
and cranial nerve VI palsy
\u2022
cerebellar symptoms are due to midline infiltration
causing progressive truncal ataxia
\u2022
complications include hydrocephalus, secondary to
compression of the CSF pathways, and leptomeningeal
dissemination, with subsequent weakness from spinal
cord compression
Imaging
\u2022
the diagnostic test of choice is MRI with and without
gandolium
\u2022
t1-weighted images typically demonstrate a
hypointense lesion while
\u2022
t2-weighted images reveal a hyperintense mass with
surrounding edema
\u2022
the tumor contrast enhances homogeneously on
gandolium administration
\u2022
leptomeningeal dissemination occurs in up to 40% of patients and so pre-surgical spinal MRI should also be obtained
Case\u2022
12 y/o presenting with 2-mo history of headache
\u2022
Hypointense posterior fossa mass in the region of
cerebellar vermis extending exophytically into 4th
ventricle. The 3rd ventricle and aqueduct show
dilatation secondary to obstructive hydrocephalus.
MR post-gandolium mass shows heterogeneous
enhancement
of 00
CNS Tumors and Infections Part3
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| Upload Date: | 02/20/2009 |
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