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.
02:58
Neuronal tumors are rare.
03:01
And neurons usually
do not divide after birth.
03:04
And for the most part,
you must think of this as being
for your boards as being very, very,
almost permanent type of cells.
03:12
Now, obviously,
research is showing us that
maybe perhaps division
is possible, after birth,
but as far as
you're concerned right now,
division in these cells tend
to be permanent in nature.
03:25
Imaging at contrast,
is the best radiologic study
to evaluate to CNS tumors.
03:30
Here's an important slide
so that you can actually organize
your thoughts for primary CNS tumors
and begin with
neuroepithelial tumors.
03:39
And this will be
an important category.
03:41
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 will walk through
an astrocytic tumor.
03:55
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.
04:05
In addition, our next classification
under neuroepithelial
will be oligodendrogliomas,
or oligodendroglial tumors.
04:16
And obviously, you know
that oligodendroglial cells
are your CNS cells
or manufacturing plant
for myelin in the CNS.
04:26
Ependymal tumors,
think about ependymal,
and what that means to you.
04:30
And these cells are quite
a bit responsible for
production of CSF and such.
04:37
Choroid-plexus tumors
so both of these you
kind of grouped together
in terms of
where you can expect to see it.
04:43
So these will be important
in terms of location.
04:46
And then embryonal tumors, and
these tend to be medulloblastomas.
04:50
And that would be an incredibly
important brain tumor of a child
medulloblastoma,
and walk through
many of these in great detail.
04:59
I want you to now
move in to the meningeal.
05:02
And in the meningeal region
we have meningeal tumors
and specifically the meningioma.
05:07
Now, keep your parenchyma
of the brain separate
please from the meninges.
05:11
So imagine now that you have
a primary CNS tumor
that's developing in the meninges.
05:16
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.
05:29
Any if have a hemangioblastoma,
and these are important as well.
05:33
And the reason for that you'll see
soon enough, is that associations,
including with
Von Hippel-Lindau disease,
A primary CNS lymphomas as well.
05:44
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.
05:55
Then you have a classification
of germ-cell tumors.
05:58
A germinoma, choriocarcinoma,
teratoma are possibilities.
06:02
Sellar region type of tumors
and these include
your pituitary adenomas,
your craniopharyngioma
in a child, notably,
and even perhaps
a pinealoblastoma.
06:15
So here you have it, in terms
of organization of your thoughts,
in terms of locations,
and under these subtypes.
06:21
And even under these
we have our super subtypes.
06:25
And we'll get into details of these.
06:27
And I will point out which ones
that you want to pay attention to
and give you clinical pearls,
as to which,
what kind of
symptoms and signs
that you're looking for
in your patient?