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Tumor of the Nervous System

Dr Wiwit Ade FW, M.Biomed, SpPA
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Normal Cells

The principal cells of the CNS :
Neurons : functional unit of nervous
system. (axon & dendrites)
Glia : derived from neuroectoderm
(macroglia: astrocytes, oligodendrocytes,
ependyma) or from bone marrow
(microglia),
the cells that compose the meninges and
blood vessels.

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Tumors of CNS
Incidence : 10-17 per 100,00 person for
intracranial tumor.
1/2 -3/4 : primary tumor, & the rest are
metastatic.

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Primary Tumors of the Central
Nervous System
Glioma
Astrocytoma
Oligodendroglioma
Ependymoma
Neuronal lineage
Meningioma
Nerve Sheath Tumors
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Primary brain tumors: Cell
types
1. Neuron: Gangliocytoma, ganglioglioma
medulloblastoma
2. Astrocyte: Astrocytoma, glioblastoma
3. Oligodendrocyte: Oligodendroglioma
4. Ependymal cell: Ependymoma
5. Microglial cell: Tumors derived from
microglial cells
6. Meningeal cell: Meningiomas are derived
from arachnoidal cells and are usually
dural-based.
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Primary Tumours of the CNS
Tumour Cells of origin Site Age Behavior
Oligodendroglioma oligodendrocyte hemisphere adulthood Low to highgrade
Astrocytoma Astrocyte Hemisphere
Cerebellum

Adulthood
Childhood
Low to highgrade
Low grade
Glioblastoma
multiforme
Astrocyte Hemisphere Adulthood High grade
Ependymoma Ependyma IVth ventricle
Spinal cord

Adulthood
Childhoos
High grade
Low grade
Meningioma Arachnoidal Meninges Adulthood Low grade
Medulloblastoma Neuroectoderm Cerebellum Childhood High grade
Haemangioblasto
ma
Unknown Cerebellum All ages Low grade
Lymphoma Lymphocyte Hemisphere Adulthood High grade
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Gliomas
Diffusely infiltrating (not easily resected)
Histologic appearance (grade) correlates
with overall survival
May become more malignant (higher
grade) over time (especially astrocytomas
which become glioblastomas)
May spread via CSF
Rarely (never) metastasize

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GLIOMAS
ASTROCYTOMAS

OLIGODENDROGLIOMAS

EPENDYMOMAS

MIXED GLIOMAS
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Spectrum : low grade high grade
2 major categories :
1. infiltrating
2. non infiltrating : >> astrocytoma pylocitic
(grade I/IV).

ASTROCYTOMA
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ASTROCYTOMA
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ASTROCYTOMA
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Infiltrating Astrocytomas
80% of adult primary brain tumors.
Cerebral hemisphere.
Symptom : seizures, headache & focal
neurologic deficits.
Spectrum histophat diff : correlates with
clinical course & outcame.

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Spectrum of Infiltrating
Astrocytomas
Diffuse astrocytoma ( grade II/IV)
Anaplastic astrocytoma ( grade III/IV)
Glioblatoma ( grade IV/IV)

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Diffuse Astrocytoma

Macroscopic:
Poorly defined, gray, infiltrative tumor
Size : few cm- replace an entire hemisphere.
Cut surface : firm/ soft gelatinous, cystic degeneration.
well demarcated
Infiltrating beyond the outer margin : always present.

Microscopic examination :
Mild to moderate increase in glial cellularity, variable
nuclear pleomorphic, back ground a fibrillary app.
Transition between neop & normal tissue : indistinct.
Tumor cells can be seen infiltrating normal tissue.




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Diffuse Astrocytoma
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Anaplastic astrocytoma
More densely cellular, greater nuclei
pleomorphic, >> mitotic figure.

Gemistocytic astrocytoma :
astrocytoma with brightly eosinophilic
cell body.
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Astrocytoma
Features of Anaplasia


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Glioblastomas
= glioblatoma multiforme
Variation in gross app.
Firm & white, soft & yellow (necrosis),
cystic deg, hemorrhage.
Microscopic = anaplastic, malignant tumor
cells, additional :
1. necrosis with pseudopalisading app.
2. vascular / endothelial prolif.
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Glioblastoma Multiforme
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Glioblastoma Multiforme
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Pylocitic Astrocytoma
Relative benign behavior
Grow very slowly th/ by resection
Symptomatic recurrence : incomplete resection
cystic enlargement, rather than growth of the solid
areas.
Children & young adults
Located in :
- >> the cerebellum.
- floor & wall of Ventricle III
- optic nerve
- cerebral hemisphere


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Pilocytic Astrocytoma
Morphology :

>> cyctic
Solid, well demarcated, << infiltrative


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Microscopic:
Tumor is composed of bipolar cells with
long, thin hair like processes dense
fibrillary meshworks.
Rosenthal fibers
Eosinophilic granular bodies.
Biphasic areas : loose microcystic pattern
& fibrillary areas.
Necrosis & mitosis : uncommon.

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Pilocytic Astrocytoma
Rosenthal fibers Eosinophilic granular
bodies
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OLIGODENDROGLIOMA
5-10% glioma
4-5 decadce
Symptom : >> seizures
Location : >> cerebral hemisphere ( white
matter)
WHO grade II/IV

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Morphology of Oligodendroglioma
Well-circumscribed, gelatinous, gray masses, >>
cyst, focal haemorrhage, & calcification.
Microscopic :
- sheet of regular cells with spherical nuclei
containing finely granular chromatin
(=normal oligodendricytes) surrounded by
clear halo cytoplasm.
- typically contain a delicate network
anastomosing capillaries (thin walled capillaries).
- calcification : > 90% tumors (foci to massive)
- mitotic activity : <<
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Anaplastic Oligodendroglioma
WHO grade III/IV
Increased cell density, nuclear anaplasia,
mitotic activity >>, necrosis.

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OLIGODENDROGLIOMA
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EPENDYMOMA
Arise next to the ependyma line ventricular system.
Behave as WHO grade II/IV
Anaplastic ependymoma : WHO grade II/IV.
Macroscopic :
In ventricle IV : solid/ papillary mass ascending from the
floor of the ventricle.
Well demarcated.
Microscopic:
Composed of cells with regular, round to oval nuclei &
abundant granular cromathin.
Gland like round/ elongated app ( perivascular rossetes) ,
tumor cells are surrounded vessels.


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EPENDYMOMA
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NON-GLIAL TUMORS
Medulloblastoma: Malignant cerebellar
tumor of childhood
Meningioma: Benign, superficial, well-
circumscribed tumor derived from
arachnoidal cells


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MEDULLOBLASTOMA
Origin : neuroectodermal
Poorly differentiated
>> children , 20% of the brain tumor in children
Location : midline of the cerebellum (children)
lateral of the cerebellum (adult)
Rapid growth occlude the flow CSF hidrocephalus.
Macros : well circumscribed, gray.
Micros :
- extremly cellular, with sheet anaplastic cells
- individual tumor cells: small, scant cytop, hypercromatic
nuclei.
- >> mitosis
- Homer Wright rossette/ neurosecretory granules.

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Medulloblastoma
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Medulloblastoma
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MENINGIOMA
Benign tumor of adult
Location : attached to dura
Arise from the meningothelial cells of arachnoid.
Low risk of recurrence.
WHO grade I/IV
Macros :
- rounded masses, well defined dural bases that comprise
underlying brain.
- encapsulated, thin fibrous tissue.
- growth : polypoid, plaque.


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Histological pattern
Sincytial (meningothelial) : whorled clusters of cells without
visible cells membrane
Fibroblastic : elongated cells and abundant collagen
deposition between them.
Transtitional :share features between sincytial and fibroblastic
type.
Psammomatous : with psammoma bodies ( calcification of
the syncitial nest of meningothelial cells)
Secretory : PAS (+) intracytoplasmic droplets & intracellular
lumen (electron microscopy)
Microcystic : with a loose, spongy app.


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MENINGIOMA
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Sincytial (meningothelial)
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Fibroblastic
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Secondary Involvement of the
Central Nervous System
Metastatic Tumor
Melanoma
Renal cell
Lung
Contiguous involvement (pituitary
adenoma and
craniopharyngioma)
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METASTATIC MELANOMA
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