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__NOTOC__
<br />__NOTOC__
{{Infobox_Disease
{{Infobox_Disease
  | Name          = Brain tumor
  | Name          = Brain tumor
  | Image          = Brain met.jpg
  | Image          = Hirnmetastase_MRT-T1_KM.jpg
  | Caption        = [[Computed tomography|CT scan]] of brain showing brain cancer to left [[parietal lobe]] in the [[ventricular system|peri-ventricular]] area.
  | Caption        = [[Computed tomography|CT scan]] of brain showing brain cancer to left [[parietal lobe]] in the [[ventricular system|peri-ventricular]] area.https://en.wikipedia.org/wiki/File:Hirnmetastase_MRT-T1_KM.jpg
| DiseasesDB    = 30781
| ICD10          = C71, D33.0-D33.2
| ICD9          = {{ICD9|191}}, {{ICD9|225.0}}
| ICDO          =
| OMIM          =
| MedlinePlus    = 007222
| MedlinePlus_mult = 000768
| MeshID        =
}}
}}
{{Brain tumor}}
{{Brain tumor}}
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


{{CMG}}  '''Assosciate editor(s)-In-Chief''' [[User :Prashanthsaddala|Prashanthsaddala]]
{{CMG}}  '''Assosciate editor(s)-In-Chief''' {{Fs}}, [[Prashanth Saddala]], {{SR}}


{{SK}} Brain tumour; glioblastoma multiforme; Ependymoma; Glioma; Astrocytoma; Medulloblastoma; Neuroglioma; Oligodendroglioma; Lymphoma; Vestibular schwannoma (acoustic neuroma); Meningioma; Cancer - brain tumor; intracranial tumor
{{SK}} Brain tumour; brain cancer; intracranial tumor; astrocytoma; glioblastoma; oligodendrocytoma; meningioma; ependymoma; craniopharyngioma.


==[[Brain tumor overview|Overview]]==
==[[Brain tumor overview|Overview]]==


==[[Brain tumor classification|Classification]]==
==[[Brain tumor classification|Classification]]==
Brain tumors can be classified as follows:
{{Family tree/start}}
{{Family tree | | | | | | | | | | | | A01 | | | | | | | | | | | | A01=Brain tumors}}
{{Family tree | | | | | | |,|-|-|-|-|-|+|-|-|-|-|-|.| | | | | | | }}
{{Family tree | | | | | | B01 | | | | B02 | | | | B03 | | | | | | B01=Adult primary brain tumor|B02=Childhood primary brain tumor|B03=Brain metastase}}
{{Family tree | | | | | | |!| | | | | |!| | | | | |!| | | | | | | }}
{{Family tree |boxstyle=text-align: left; | | | | | C01 | | | | C02 | | | | | C03 | | | | | | C01=<br>•Glioblastoma multiforme<br>•Oligodendroglioma<br>•Meningioma<br>•Hemangioblastoma<br>•Pituitary adenoma<br>•Schwannoma<br>•Primary CNS lymphoma|C02=<br>•Pilocytic astrocytoma<br>•Medulloblastoma<br>•Ependymoma<br>•Craniopharyngioma<br>•Pinealoma|C03=<br>•Lung cancer<br>•Breast cancer<br>•Melanoma<br>•Gastrointestinal tract cancer<br>•Renal cell carcinoma<br>•Osteosarcoma<br>•Head and neck cancer<br>•Neuroblastoma<br>•Lymphoma<br>•Prostate cancer}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{Family tree/end}}
<br />


==[[Brain tumor historical perspective|Historical Perspective]]==
==[[Brain tumor causes|Causes]]==
The exact cause of brain tumor is not known.
 
==[[Brain tumor differential diagnosis|Differentiating Brain Tumor from other Diseases]]==
On the basis of [[seizure]], [[visual disturbance]], and constitutional symptoms, brain tumors must be differentiated from [[Arteriovenous malformation|AV malformation]], [[brain aneurysm]], [[bacterial]] [[brain]] [[abscess]], [[tuberculosis]], [[toxoplasmosis]], [[hydatid cyst]], [[CNS]] [[cryptococcosis]], [[CNS]] [[aspergillosis]], and [[brain metastasis]].
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" |Diseases
| colspan="5" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="3" rowspan="2" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold<br>standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immunohistopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Head-<br>ache
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Seizure
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Visual disturbance
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Constitutional
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Focal neurological deficit
|-
! colspan="11" style="background: #7d7d7d; color: #FFFFFF; padding: 5px; text-align: center;" |Adult primary brain tumors
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Glioblastoma multiforme]]<br>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
* [[Supratentorial]]
* Irregular ring-nodular enhancing lesions
* Central [[necrosis]]
* Surrounding [[vasogenic edema]]
 
* Cross [[corpus callosum]] ([[butterfly glioma]])
| style="background: #F5F5F5; padding: 5px;" |
* [[Astrocyte]] origin
 
* [[Pleomorphism|Pleomorphic]] cell
 
* Pseudopalisading appearance
 
* [[GFAP]] +
 
* [[Necrosis]] +
 
* [[Hemorrhage]] +
 
* [[Vascular]] prolifration +
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* Highest [[incidence]] in fifth and sixth decades of life
* Most of the time, focal [[neurological]] deficit is the presenting [[Sign (medical)|sign]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Oligodendroglioma]]<br>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px;" |
* Almost always in [[Cerebral hemisphere|cerebral hemisphers]] ([[Frontal lobe|frontal lobes]])
 
* Hypointense on T1
* Hyperintense on T2
* [[Calcification]]
 
* Chicken wire capillary pattern
| style="background: #F5F5F5; padding: 5px;" |
* [[Oligodendrocyte]] origin
 
* [[Calcification]] +
 
* Fried egg cell appearance
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* Highest [[incidence]] is between 40 and 50 years of age.
* Most of the time, [[epileptic seizure]] is the presenting [[Sign (medicine)|sign]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Meningioma]]<br>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px;" |
* Well circumscribed
* Extra-axial [[mass]]
 
* [[Meninges|Dural]] attachment
* [[CSF]] [[vascular]] cleft sign
* Sunburst appearance of the [[Vessel|vessels]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Arachnoid]] origin
 
* [[Psammoma body|Psammoma bodies]]


==[[Brain tumor pathophysiology|Pathophysiology]]==
* Whorled spindle cell pattern
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* Highest [[incidence]] is between 40 and 50 years of age.
* Most of the time, focal [[neurological]] deficit and [[epileptic seizure]] are the presenting [[signs]].


==[[Brain tumor epidemiology and demographics|Epidemiology and Demographics]]==
* May be associated with [[Neurofibromatosis type II|NF-2]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemangioblastoma]]<br>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px;" |
* [[Infratentorial]]


==[[Brain tumor risk factors|Risk Factors]]==
* [[Cyst|Cystic]] lesion with a solid enhancing mural [[nodule]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Blood vessel]] origin


==[[Brain tumor causes|Causes]]==
* [[Capillary|Capillaries]] with thin walls
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* Might secret [[erythropoietin]] and cause [[polycythemia]]
* May be associated with [[Von Hippel-Lindau Disease|von hippel-lindau syndrome]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pituitary adenoma]]<br><ref name=":0" />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + [[Bitemporal hemianopia]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px;" |
* [[Endocrine]] abnormalities as a result of [[Pituitary adenoma|functional adenomas]] or pressure effect of non-functional [[Adenoma|adenomas]]
| style="background: #F5F5F5; padding: 5px;" |
* Isointense to normal [[pituitary gland]] in T1
| style="background: #F5F5F5; padding: 5px;" |
* [[Endocrine]] cell [[hyperplasia]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* It is associated with [[MEN1]] disease.
 
* Initialy presents with upper bitemporal quadrantanopsia followed by [[Bitemporal hemianopia|bitemporal hemianopsia]] (pressure on [[Optic chiasm|optic chiasma]] from below)
 
*
 
*
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Schwannoma]]<br>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px;" |
* Split-fat sign
* Fascicular sign
* Often have areas of [[hemosiderin]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Schwann cell]] origin
 
* S100+
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* It causes [[hearing loss]] and [[tinnitus]]
 
* May be associated with [[Neurofibromatosis type II|NF-2]] (bilateral [[Schwannoma|schwannomas]])
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Primary central nervous system lymphoma|Primary CNS lymphoma]]<br>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px;" |
* Usually deep in the [[white matter]]
 
* Single [[mass]] with ring enhancement
| style="background: #F5F5F5; padding: 5px;" |
* [[B cell]] origin
 
* Similar to [[Non-Hodgkin lymphoma|non hodgkin lymphoma]] ([[Diffuse large B cell lymphoma|diffuse large B cell]])
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* Usually in young [[immunocompromised]] patients ([[HIV]]) or old [[immunocompetent]] person.
 
*
|-
! colspan="11" style="background: #7d7d7d; color: #FFFFFF; padding: 5px; text-align: center;" |Childhood primary brain tumors
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pilocytic astrocytoma]]<br>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px;" |
* [[Infratentorial]]
 
* Solid and [[Cyst|cystic]] component
* Mostly in [[posterior fossa]]
* Usually in [[Cerebellar hemisphere|cerebellar hemisphers]] and [[Cerebellar vermis|vermis]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Glial cell]] origin
*Solid and [[Cyst|cystic]] component
 
* [[GFAP]] +
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* Most of the time, [[Cerebellum|cerebellar]] dysfunction is the presenting [[signs]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Medulloblastoma]]<br>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px;" |
* [[Infratentorial]]
 
* Mostly in [[cerebellum]]
 
* Non communicating [[hydrocephalus]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Neuroectoderm]] origin
 
* Homer wright rosettes
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Drop metastasis]] ([[metastasis]] through [[CSF]])
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ependymoma]]<br><ref name=":0" />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px;" |
* [[Infratentorial]]
 
* Usually found in [[Fourth ventricle|4th ventricle]]
* Mixed [[Cyst|cystic]]/solid [[lesion]]
 
* Hydrocephalus
| style="background: #F5F5F5; padding: 5px;" |
* [[Ependymal cell]] origin


==[[Brain tumor differential diagnosis|Differentiating Brain Tumor]]==
* Peri[[vascular]] pseudorosette
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* Causes an unusually persistent, continuous [[headache]] in children.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Craniopharyngioma]]<br><ref name=":0" />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + [[Bitemporal hemianopia]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Hypopituitarism]] as a result of pressure effect on [[pituitary gland]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Calcification]]
* Lobulated contour
* Motor-oil like fluid within [[tumor]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Ectoderm|Ectodermal]] origin ([[Rathke's pouch|Rathkes pouch]])


==[[Brain tumor natural history|Complications & Prognosis]]==
* [[Calcification]] +
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* Initialy presents with lower bitemporal quadrantanopsia followed by [[Bitemporal hemianopia|bitemporal hemianopsia]] (pressure on [[Optic chiasm|optic chiasma]] from above)
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pinealoma]]<br>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + vertical gaze palsy
| style="background: #F5F5F5; padding: 5px;" |
* B-hCG rise leads to [[precocious puberty]] in [[Male|males]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Hydrocephalus]] (compression of [[cerebral aqueduct]])
| style="background: #F5F5F5; padding: 5px;" |
* Similar to [[testicular seminoma]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* May cause prinaud syndrome ([[Vertical gaze center|vertical gaze]] palsy, pupillary light-near dissociation, lid retraction and convergence-retraction [[nystagmus]]
|-
! colspan="11" style="background: #7d7d7d; color: #FFFFFF; padding: 5px; text-align: center;" |Vascular
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Arteriovenous malformation|AV malformation]]<br><ref name=":0" />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px;" |
* [[Supratentorial]]: ~85%
* Flow voids on T2 weighted images
| style="background: #F5F5F5; padding: 5px;" |
* We do not perform [[biopsy]] for [[AVM]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Angiography]]
| style="background: #F5F5F5; padding: 5px;" |
* We may see bag of worms appearance in [[CT angiography]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain aneurysm]]<br>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px;" |
* In [[magnetic resonance angiography]], we may see [[aneurysm]] mostly in anterior circulation (~85%)
| style="background: #F5F5F5; padding: 5px;" |
* We do not perform [[biopsy]] for [[brain aneurysm]]
| style="background: #F5F5F5; padding: 5px;" |
* MRA and CTA
| style="background: #F5F5F5; padding: 5px;" |
* It is associated with [[autosomal dominant polycystic kidney disease]], [[Ehlers-Danlos syndrome]], [[pseudoxanthoma elasticum]] and [[Bicuspid aortic valve]]
* ([[Angiography]] is reserved for patients who have negative [[Magnetic resonance angiography|MRA]] and [[CT angiography|CTA]])
|-
! colspan="11" style="background: #7d7d7d; color: #FFFFFF; padding: 5px; text-align: center;" |Infectious
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Bacterial [[brain abscess]]<br>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Leukocytosis]]
* Elevated [[ESR]]
* [[Blood culture]] may be positive for underlying [[organism]]
| style="background: #F5F5F5; padding: 5px;" |
* Central hypodense signal and surrounding ring-enhancement in T1
* Central hyperintense area surrounded by a well-defined hypointense capsule with surrounding [[edema]] in T2
| style="background: #F5F5F5; padding: 5px;" |
* We do not perform [[biopsy]] for [[brain abscess]]
| style="background: #F5F5F5; padding: 5px;" |
* History/ imaging
| style="background: #F5F5F5; padding: 5px;" |
* The most common causes of [[brain abscess]] are [[Streptococcus]] and [[Staphylococcus]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tuberculosis]]<br><ref name=":0" />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Positive [[acid-fast bacilli]] ([[AFB]]) smear in [[CSF]] specimen
* Positive [[CSF]] [[nucleic acid]] amplification testing
* [[Hyponatremia]] (inappropriate secretion of [[antidiuretic hormone]])
* Mild [[anemia]]
* [[Leukocytosis]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Hydrocephalus]] combined with marked basilar [[Meninges|meningeal]] enhancement
| style="background: #F5F5F5; padding: 5px;" |
* We do not perform [[biopsy]] for [[brain]] [[tuberculosis]]
| style="background: #F5F5F5; padding: 5px;" |
* Lab data/ Imaging
| style="background: #F5F5F5; padding: 5px;" |
* It is associated with [[HIV]] [[infection]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Toxoplasmosis]]<br>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Normal [[CSF]]
| style="background: #F5F5F5; padding: 5px;" |
* Multifocal [[Mass|masses]] with ring enhancement
* Mostly in [[basal ganglia]], [[thalami]], and corticomedullary junction.
| style="background: #F5F5F5; padding: 5px;" |
* We do not perform [[biopsy]] for brain [[toxoplasmosis]]
| style="background: #F5F5F5; padding: 5px;" |
* History/ imaging
| style="background: #F5F5F5; padding: 5px;" |
* It is associated with [[HIV]] [[infection]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hydatid cyst]]<br><ref name=":0" />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
* Positive [[serology]] ([[Antibody]] detection for [[E. granulosus]]'')''
| style="background: #F5F5F5; padding: 5px;" |
* Honeycomb appearance
* [[Necrotic]] area
| style="background: #F5F5F5; padding: 5px;" |
* We do not perform [[biopsy]] for [[Hydatid cyst|hydatid cysts]]
| style="background: #F5F5F5; padding: 5px;" |
* Imaging
| style="background: #F5F5F5; padding: 5px;" |
* [[Brain]], [[eye]], and [[Spleen|splenic]] [[Cyst|cysts]] may not produce detectable amount of [[antibodies]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[CNS]] [[cryptococcosis]]<br>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Positive [[CSF]] [[antigen]] testing ([[coccidioidomycosis]])
* [[CSF]] [[Lymphocyte|lymphocytic]] [[pleocytosis]]
* Elevated [[CSF]] [[Protein|proteins]] and [[lactate]]
* Low [[CSF]] [[glucose]]
*
| style="background: #F5F5F5; padding: 5px;" |
* Dilated peri[[vascular]] spaces
* [[Basal ganglia]] [[Pseudocyst|pseudocysts]]


==Diagnosis==
* Soap bubble brain lesions ([[cryptococcus neoformans]])
[[Brain tumor history and symptoms|History and Symptoms]] | [[Brain tumor physical examination|Physical Examination]] | [[Brain tumor staging|Staging]] | [[Brain tumor laboratory tests|Laboratory tests]] | [[Brain tumor chest x ray|X Ray]] | [[Brain tumor CT|CT]] | [[Brain tumor MRI|MRI]] | [[Brain tumor biopsy|Biopsy]] | [[Brain tumor echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Brain tumor other imaging findings|Other imaging findings]] | [[Brain tumor other diagnostic studies|Other Diagnostic Studies]]
*
| style="background: #F5F5F5; padding: 5px;" |
* We may see numerous acutely branching septate [[Hypha|hyphae]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Laboratory|Lab]] data/ Imaging
| style="background: #F5F5F5; padding: 5px;" |
* It is the most common [[brain]] [[fungal infection]]


==Treatment==
* It is associated with [[HIV]], [[Immunosuppressive therapy|immunosuppressive therapies]], and [[Organ transplant|organ transplants]]
* In may happen in [[immunocompetent]] patients undergoing invasive procedures ( [[neurosurgery]]) or exposed to [[Contamination|contaminated]] devices or [[drugs]]
* Since [[brain]] [[Biopsy|biopsies]] are highly invasive and may may cause [[neurological]] deficits, we [[diagnose]] [[CNS]] [[fungal]] [[Infection|infections]] based on [[laboratory]] and imaging findings
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[CNS]] [[aspergillosis]]<br>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Positive [[galactomannan]] [[antigen]] testing ([[aspergillosis]])
* [[CSF]] [[Lymphocyte|lymphocytic]] [[pleocytosis]]
* Elevated [[CSF]] [[Protein|proteins]] and [[lactate]]
* Low [[CSF]] [[glucose]]
| style="background: #F5F5F5; padding: 5px;" |
* Multiple [[Abscess|abscesses]]
* Ring enhancement
* Peripheral low signal intensity on T2
| style="background: #F5F5F5; padding: 5px;" |
* We may see numerous acutely branching septate [[Hypha|hyphae]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Laboratory|Lab]] data/ Imaging
| style="background: #F5F5F5; padding: 5px;" |
* It is associated with [[HIV]], [[Immunosuppressive therapy|immunosuppressive therapies]], and [[Organ transplant|organ transplants]]
* In may happen in [[immunocompetent]] patients undergoing invasive procedures ( [[neurosurgery]]) or exposed to [[Contamination|contaminated]] devices or [[drugs]]
* Since [[brain]] [[Biopsy|biopsies]] are highly invasive and may may cause [[neurological]] deficits, we [[diagnose]] [[CNS]] [[fungal]] [[Infection|infections]] based on [[laboratory]] and imaging findings
|-
! colspan="11" style="background: #7d7d7d; color: #FFFFFF; padding: 5px; text-align: center;" |Other
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain metastasis]]<br><ref name=":0" />
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | −
| style="background: #F5F5F5; padding: 5px;" |
* Multiple [[Lesion|lesions]]
* [[Vasogenic edema]]
*
| style="background: #F5F5F5; padding: 5px;" |
* Based on the primary [[cancer]] type we may have different immunohistopathology findings.
| style="background: #F5F5F5; padding: 5px;" |
* History/ imaging
| style="background: #F5F5F5; padding: 5px;" |
* Most common primary [[Tumor|tumors]] that [[metastasis]] to [[brain]]:
** [[Lung cancer]]
** [[Renal cell carcinoma]]
** [[Breast cancer]]
** [[Melanoma]]
** [[Gastrointestinal tract]]
* If there is any uncertainty about [[etiology]], [[biopsy]] should be performed
|}
'''ABBREVIATIONS'''


[[Brain tumor medical therapy|Medical therapy]] | [[Brain tumor Radiation therapy|Radiation therapy]] | [[Brain tumor surgery|Surgery]] | [[Brain tumor future or investigational therapies|Future therapies]]
[[CNS]]=[[Central nervous system]], AV=Arteriovenous, [[CSF]]=[[Cerebrospinal fluid]], [[NF-2]]=[[Neurofibromatosis type 2]], [[MEN1|MEN-1]]=[[Multiple endocrine neoplasia]], [[GFAP]]=[[Glial fibrillary acidic protein]], [[HIV]]=[[Human Immunodeficiency Virus|Human immunodeficiency virus]], BhCG=[[Human chorionic gonadotropin]], [[ESR]]=[[Erythrocyte sedimentation rate]], [[AFB]]=Acid fast bacilli, [[Magnetic resonance angiography|MRA]]=[[Magnetic resonance angiography]], [[CT angiography|CTA]]=[[CT angiography]]


== References ==
[[fr:Tumeur du cerveau]]
[[fr:Tumeur du cerveau]]
[[ja:脳腫瘍]]
[[ja:脳腫瘍]]
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[[Category:Oncology]]
[[Category:Oncology]]
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[[Category:Up-To-Date]]
[[Category:Medicine]]
[[Category:Neurosurgery]]

Latest revision as of 20:41, 29 July 2020


Brain tumor
CT scan of brain showing brain cancer to left parietal lobe in the peri-ventricular area.https://en.wikipedia.org/wiki/File:Hirnmetastase_MRT-T1_KM.jpg

Brain tumor Microchapters

Patient Information

Overview

Classification

Adult brain tumors
Glioblastoma multiforme
Oligodendroglioma
Meningioma
Hemangioblastoma
Pituitary adenoma
Schwannoma
Primary CNS lymphoma
Childhood brain tumors
Pilocytic astrocytoma
Medulloblastoma
Ependymoma
Craniopharyngioma
Pinealoma
Metastasis
Lung cancer
Breast cancer
Melanoma
Gastrointestinal tract cancer
Renal cell carcinoma
Osteoblastoma
Head and neck cancer
Neuroblastoma
Lymphoma
Prostate cancer

Causes

Differentiating Brain Tumor from other Diseases

For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Assosciate editor(s)-In-Chief Fahimeh Shojaei, M.D., Prashanth Saddala, Sujit Routray, M.D. [2]

Synonyms and keywords: Brain tumour; brain cancer; intracranial tumor; astrocytoma; glioblastoma; oligodendrocytoma; meningioma; ependymoma; craniopharyngioma.

Overview

Classification

Brain tumors can be classified as follows:

 
 
 
 
 
 
 
 
 
 
 
Brain tumors
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Adult primary brain tumor
 
 
 
Childhood primary brain tumor
 
 
 
Brain metastase
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

•Glioblastoma multiforme
•Oligodendroglioma
•Meningioma
•Hemangioblastoma
•Pituitary adenoma
•Schwannoma
•Primary CNS lymphoma
 
 
 

•Pilocytic astrocytoma
•Medulloblastoma
•Ependymoma
•Craniopharyngioma
•Pinealoma
 
 
 
 

•Lung cancer
•Breast cancer
•Melanoma
•Gastrointestinal tract cancer
•Renal cell carcinoma
•Osteosarcoma
•Head and neck cancer
•Neuroblastoma
•Lymphoma
•Prostate cancer
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Causes

The exact cause of brain tumor is not known.

Differentiating Brain Tumor from other Diseases

On the basis of seizure, visual disturbance, and constitutional symptoms, brain tumors must be differentiated from AV malformation, brain aneurysm, bacterial brain abscess, tuberculosis, toxoplasmosis, hydatid cyst, CNS cryptococcosis, CNS aspergillosis, and brain metastasis.

Diseases Clinical manifestations Para-clinical findings Gold
standard
Additional findings
Symptoms Physical examination
Lab Findings MRI Immunohistopathology
Head-
ache
Seizure Visual disturbance Constitutional Focal neurological deficit
Adult primary brain tumors
Glioblastoma multiforme
+ +/− +/− +
  • Pseudopalisading appearance
Oligodendroglioma
+ + +/− +
  • Chicken wire capillary pattern
  • Fried egg cell appearance
Meningioma
+ +/− +/− +
  • Well circumscribed
  • Extra-axial mass
  • Whorled spindle cell pattern
  • May be associated with NF-2
Hemangioblastoma
+ +/− +/− +
Pituitary adenoma
[1]
+ Bitemporal hemianopia
  • It is associated with MEN1 disease.
Schwannoma
+
  • Split-fat sign
  • Fascicular sign
  • Often have areas of hemosiderin
  • S100+
Primary CNS lymphoma
+ +/− +/− +
  • Single mass with ring enhancement
Childhood primary brain tumors
Pilocytic astrocytoma
+ +/− +/− +
Medulloblastoma
+ +/− +/− +
  • Homer wright rosettes
Ependymoma
[1]
+ +/− +/− +
  • Hydrocephalus
  • Causes an unusually persistent, continuous headache in children.
Craniopharyngioma
[1]
+ +/− + Bitemporal hemianopia +
Pinealoma
+ +/− +/− + vertical gaze palsy
  • May cause prinaud syndrome (vertical gaze palsy, pupillary light-near dissociation, lid retraction and convergence-retraction nystagmus
Vascular
AV malformation
[1]
+ + +/− +/−
Brain aneurysm
+ +/− +/− +/−
  • MRA and CTA
Infectious
Bacterial brain abscess
+ +/− +/− + +
  • Central hypodense signal and surrounding ring-enhancement in T1
  • Central hyperintense area surrounded by a well-defined hypointense capsule with surrounding edema in T2
  • History/ imaging
Tuberculosis
[1]
+ +/− +/− + +
  • Lab data/ Imaging
Toxoplasmosis
+ +/− +/− +
  • History/ imaging
Hydatid cyst
[1]
+ +/− +/− +/− +
  • Imaging
CNS cryptococcosis
+ +/− +/− + +
  • We may see numerous acutely branching septate hyphae
  • Lab data/ Imaging
CNS aspergillosis
+ +/− +/− + +
  • Multiple abscesses
  • Ring enhancement
  • Peripheral low signal intensity on T2
  • We may see numerous acutely branching septate hyphae
  • Lab data/ Imaging
Other
Brain metastasis
[1]
+ +/− +/− + +
  • Based on the primary cancer type we may have different immunohistopathology findings.
  • History/ imaging

ABBREVIATIONS

CNS=Central nervous system, AV=Arteriovenous, CSF=Cerebrospinal fluid, NF-2=Neurofibromatosis type 2, MEN-1=Multiple endocrine neoplasia, GFAP=Glial fibrillary acidic protein, HIV=Human immunodeficiency virus, BhCG=Human chorionic gonadotropin, ESR=Erythrocyte sedimentation rate, AFB=Acid fast bacilli, MRA=Magnetic resonance angiography, CTA=CT angiography

References


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