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Brain Tumors Maria Rountree

Brain Tumors Maria Rountree. Most common types of brain tumors. The most common childhood tumors are: 1. Astrocytoma 2. Medulloblastoma 3. Ependymoma The most common adult tumors are: 1. Metastatic brain tumors from lung, breast, melanoma, and other cancers

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Brain Tumors Maria Rountree

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  1. Brain TumorsMaria Rountree

  2. Most common types of brain tumors • The most common childhood tumors are: • 1. Astrocytoma • 2. Medulloblastoma • 3. Ependymoma • The most common adult tumors are: • 1. Metastatic brain tumors from lung, breast, melanoma, and other cancers • 2. Glioblastoma Multiforme • 3. Anaplastic (Malignant) Astrocytoma • 4. Meningioma

  3. Incidence of brain tumors • Annual incidence ~15–20 cases per 100,000 people. Annual incidence primary brain cancer in children is about 3 per 100,000. • Leading cause of cancer-related death in patients younger than age 35. • Primary brain tumors /secondary ~ 50/50 • ~17,000 people in the United States are diagnosed with primary cancer each year. Secondary brain cancer occurs in 20–30% of patients with metastatic disease.

  4. Clinical Presentation of brain tumors • Headaches • Seizures • Nausea & vomiting • Loss of consciousness • Cognitive dysfunction • Neurological dysfx- weakness, sensory loss, aphasia, visual spatial dysfunction

  5. Cognitive dysfunction • Includes memory problem, mood or personality disorders • It is the presenting symptom in 30-35% of patients with brain metastasis. • Patients symptoms often subtle, complain of fatigue, urge to sleep and loss of interest in daily activities. Confused with depression. • Consider neuroimaging in patients who present with new onset of depressive symptoms or without obvious cause.

  6. Case: • 76 yo old female presented with increased irritability with her family, sleeplessness and reckless spending. • PMH: HTN, breast cancer • PE, labs –wnl • MSE notable for loud rapid speech, flight of ideas, no delusions or hallucinations • CT revealed a 3 cm intraventricular lesion • Meningioma was removed and sxs slowly abated

  7. Brain Meningioma CT

  8. Meningioma MRI /T2

  9. Neuroimaging of brain tumors • Major diagnostic modality. Useful for preoperative planning • The diagnosis of a primary brain tumor is best made by cranial MRI. This should be the first test obtained in a patient with signs or symptoms suggestive of an intracranial mass. The MRI scan should always be obtained both with and without contrast material (gadolinium). • MRI superior to CT scan for evaluating meninges, subarachnoid space, posterior fossa and defining the vascular abnormality of the lesion

  10. Neuroimaging • High-grade or malignant gliomas appear as contrast-enhancing mass lesions, which arise in white matter and are surrounded by edema • Multifocal malignant gliomas are seen in ~ 5% of patients. • Low-grade gliomas typically are nonenhancing lesions that diffusely infiltrate brain tissue and may involve a large region of brain. Low-grade gliomas are usually best appreciated on T2-weighted MRI scans.

  11. Neuroimaging • A contrast-enhanced CT scan may be used if MRI is unavailable. CT may be false-negative in patients with a low-grade tumor and can have significant artifact through the posterior fossa, which may obscure a lesion in this area. • Calcification, which may suggest the diagnosis of an oligodendroglioma, is often better appreciated on CT than on MRI. • CT useful if there is a question of bone or vascular involvement, or for detecting mets to skull base. Also, in ER situation or if MRI is contraindicated.

  12. Radiologic features of metastatic disease • -Multiple lesions • -Localization at the grey-white junction • -More circumscribed margins • -Relatively large amount of edema compared to size of lesion

  13. Sources • Wen, Patrick Y. Overview of Brain Metastases. UptoDate version 13.3. • Wong, Eric T. Clinical presentation and diagnosis of brain tumors. UptoDate version 13.3. • Ma, Julie. Mania Resulting from Brain Tumor. Clinical Vignette UCLA Department of Medicine.

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