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'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
<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        =
}}
}}
{{SI}}
{{Brain tumor}}
{{CMG}}
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


{{Editor Help}}
{{CMG}}  '''Assosciate editor(s)-In-Chief''' {{Fs}}, [[Prashanth Saddala]], {{SR}}


==Overview==
{{SK}} Brain tumour; brain cancer; intracranial tumor; astrocytoma; glioblastoma; oligodendrocytoma; meningioma; ependymoma; craniopharyngioma.


A '''brain tumor''' is any [[cranium|intracranial]] [[tumor]] created by abnormal and uncontrolled [[Mitosis|cell division]], normally either in the [[brain]] itself ([[neuron]]s, [[glia]]l cells ([[astrocyte]]s, [[oligodendrocyte]]s, [[ependymal cell]]s), [[lymph]]atic tissue, [[blood vessel]]s), in the [[cranial nerve]]s ([[myelin]]-producing [[Schwann cell]]s), in the brain envelopes ([[meninges]]), [[skull]], [[pituitary]] and [[pineal gland]], or spread from [[cancer]]s primarily located in other organs ([[metastasis|metastatic tumors]]). Primary (true) brain tumors are commonly located in the [[posterior cranial fossa]] in [[children]] and in the anterior two-thirds of the [[cerebral hemispheres]] in adults, although they can affect any part of the [[brain]]. In the United States in the year 2005, it was estimated that there were 43,800 new cases of brain tumors (Central Brain Tumor Registry of the United States, Primary Brain Tumors in the United States, Statistical Report, 2005 - 2006) <ref name="r1">Greenlee RT, Murray T, Bolden S, Wingo PA. ''Cancer statistics, 2000.'' CA Cancer J Clin 2000;50:7-33. [http://caonline.amcancersoc.org/cgi/reprint/50/1/7.pdf PDF]. PMID 10735013.</ref>, which accounted for 1.4 percent of all cancers, 2.4 percent of all cancer deaths<ref name="r2">[http://www.cancer.org/ American Cancer Society]. Accessed June 2000.</ref>, and 20&ndash;25 percent of pediatric cancers<ref name="r2" /><ref>Chamberlain MC, Kormanik PA. ''Practical guidelines for the treatment of malignant gliomas.'' West J Med 1998;168:114-120. PMID 9499745.</ref>. Ultimately, it is estimated that there are 13,000 deaths/year as a result of brain tumors<ref name="r1" />.
==[[Brain tumor overview|Overview]]==


==Classification==
==[[Brain tumor classification|Classification]]==
===Primary tumors===
Brain tumors can be classified as follows:
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{{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 | | | | | | | | | | | | | | | | | | | | | | | | | | }}
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{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{Family tree/end}}
<br />


Tumors occurring in the brain include:  [[astrocytoma]], [[pilocytic astrocytoma]], [[dysembryoplastic neuroepithelial tumor]], [[oligodendrogliomas]], [[ependymoma]], [[glioblastoma multiforme]], [[mixed gliomas]], [[oligoastrocytomas]], [[medulloblastoma]], [[retinoblastoma]], [[neuroblastoma]], [[germinoma]] and [[teratoma]].
==[[Brain tumor causes|Causes]]==
The exact cause of brain tumor is not known.


Most primary brain tumors originate from [[glial cells|glia]] ([[glioma]]s) such as astrocytes ([[astrocytomas]]), oligodendrocytes ([[oligodendrogliomas]]), or ependymal cells ([[ependymoma]]). There are also mixed forms, with both an astrocytic and an oligodendroglial cell component. These are called [[mixed gliomas]] or [[oligoastrocytomas]]. Plus, mixed glio-neuronal tumors (tumors displaying a neuronal, as well as a glial component, e.g. [[ganglioglioma]]s, [[disembryoplastic neuroepithelial tumor]]s) and tumors originating from neuronal cells (e.g. [[gangliocytoma]], central gangliocytoma) can also be encountered.
==[[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]]


Other varieties of primary brain tumors include: [[primitive neuroectodermal tumor]]s (PNET, e.g. medulloblastoma]], medulloepithelioma, [[neuroblastoma]], [[retinoblastoma]], [[ependymoblastoma]]), tumors of the [[pineal gland|pineal]] [[parenchyma]] (e.g. pineocytoma, pineoblastoma), [[ependyma]]l cell tumors, [[choroid plexus]] tumors, neuroepithelial tumors of uncertain origin (e.g. [[gliomatosis cerebri]], astroblastoma), etc.
* Cross [[corpus callosum]] ([[butterfly glioma]])
| style="background: #F5F5F5; padding: 5px;" |
* [[Astrocyte]] origin


From a histological perspective, astrocytomas, oligondedrogliomas, oligoastrocytomas, and teratomas may be benign or malignant. [[Glioblastoma multiforme]] represents the most aggressive variety of malignant glioma. At the opposite end of the spectrum, there are so-called [[pilocytic astrocytoma]]s, a distinct variety of astrocytic tumors. The majority of them are located in the [[posterior cranial fossa]], affect mainly children and young adults, and have a clinically favorable course and prognosis.  [[Teratoma]]s and other [[germ cell tumor]]s also may have a favorable prognosis, although they have the capacity to grow very large.
* [[Pleomorphism|Pleomorphic]] cell


Another type of primary intracranial tumor is [[primary cerebral lymphoma]], also known as primary CNS lymphoma, which is a type of non-Hodgkin's lymphoma that is much more prevalent in those with severe immunosuppression, e.g. [[AIDS]].
* Pseudopalisading appearance


In contrast to other types of [[cancer]], primary brain tumors rarely metastasize, and in this rare event, the tumor cells spread within the [[skull]] and [[spinal canal]] through the [[cerebrospinal fluid]], rather than via bloodstream to other organs.
* [[GFAP]] +


There are various classification systems currently in use for primary brain tumors, the most common being the [[World Health Organization]] (WHO) brain tumor classification, introduced in 1993.
* [[Necrosis]] +


===Secondary tumors and non-tumor lesions===
* [[Hemorrhage]] +
Secondary or [[metastasis|metastatic brain tumors]] originate from [[malignant tumors]] (cancers) located primarily in other organs. Their incidence is higher than that of primary brain tumors. The most frequent types of metastatic brain tumors originate in the [[lung]], [[skin]] ([[malignant melanoma]]), [[kidney]] ([[hypernephroma]]), [[breast]] ([[breast carcinoma]]), and [[colon (anatomy)|colon]] ([[colon carcinoma]]). These tumor cells reach the brain via the blood-stream.


Some non-tumoral masses and lesions can mimic tumors of the [[central nervous system]]. These include [[tuberculosis]] of the brain, [[cerebral abscess]] (commonly in [[toxoplasmosis]]), and [[hamartomas]] (for example, in [[tuberous sclerosis]] and [[von Recklinghausen neurofibromatosis]]).
* [[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]])


Symptoms of brain tumors may depend on two factors: tumor size (volume) and tumor location. The time point of symptom onset in the course of disease correlates in many cases with the nature of the tumor ("benign", i.e. slow-growing/late symptom onset, or malignant (fast growing/early symptom onset).
* Hypointense on T1
* Hyperintense on T2
* [[Calcification]]


Many low-grade (benign) tumors can remain [[asymptomatic]] (symptom-free) for years and they may accidentally be discovered by imaging exams for unrelated reasons (such as a minor trauma).
* Chicken wire capillary pattern
| style="background: #F5F5F5; padding: 5px;" |
* [[Oligodendrocyte]] origin


New onset of [[epileptic seizures|epilepsy]]<ref>Lopez MBS, Laws ER Jr. Neurosurgical Focus 12(2), Article 1, 2002. <!--PMID not yet indexed--></ref> is a frequent reason for seeking medical attention in brain tumor cases.
* [[Calcification]] +


Large tumors or tumors with extensive perifocal swelling [[edema]] inevitably lead to elevated [[intracranial pressure]] ([[intracranial hypertension]]), which translates clinically into [[headaches]], [[vomiting]] (sometimes without [[nausea]]), altered state of [[consciousness]] ([[somnolence]], [[coma]]), dilatation of the pupil on the side of the lesion ([[anisocoria]]), [[papilledema]] (prominent [[optic disc]] at the funduscopic examination). However, even small tumors obstructing the passage of [[cerebrospinal fluid]] (CSF) may cause early signs of increased [[intracranial pressure]]. Increased [[intracranial pressure]] may result in [[herniation]] (i.e. displacement) of certain parts of the brain, such as the [[cerebellar tonsils]] or the temporal [[uncus]],  resulting in lethal [[brainstem]] compression. In young children, elevated [[intracranial pressure]] may cause an increase in the diameter of the [[skull]] and bulging of the [[fontanelle]]s.
* 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]]


Depending on the tumor location and the damage it may have caused to surrounding [[brain]] structures, either through compression or infiltration, any type of focal neurologic symptoms may occur, such as [[cognitive]] and [[behavioral]] impairment, [[Wiktionary:personality|personality]] changes, [[hemiparesis]], (hemi) [[hypesthesia]], [[aphasia]], [[ataxia]], [[visual field]] impairment, [[facial paralysis]], [[double vision]], [[tremor]] etc. These symptoms are not specific for brain tumors - they may be caused by a large variety of neurologic conditions (e.g. [[stroke]], [[traumatic brain injury]]). What counts, however, is the location of the lesion and the functional systems (e.g. motor, sensory, visual, etc.) it affects.
* [[Meninges|Dural]] attachment
* [[CSF]] [[vascular]] cleft sign
* Sunburst appearance of the [[Vessel|vessels]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Arachnoid]] origin


A bilateral temporal [[visual field]] defect ([[bitemporal hemianopia]]&mdash;due to compression of the [[optic chiasm]]), often associated with endocrine disfunction&mdash;either [[hypopituitarism]] or hyperproduction of pituitary [[hormones]] and [[hyperprolactinemia]] is suggestive of a pituitary tumor.
* [[Psammoma body|Psammoma bodies]]


== Brain tumors in infants and children ==
* 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]].


In 2000 approximately 2.76 children per 100,000 will be affected by a [[brain tumor|CNS tumor]] in the United States each year.  This rate has been increasing and by 2005 was 3.0 children per 100,000.  This is approximately 2,500-3,000 pediatric brain tumors occurring each year in the US.  The tumor incidence is increasing by about 2.7% per year.
* May be associated with [[Neurofibromatosis type II|NF-2]]
The [[Central Nervous System|CNS]] Cancer survival rate in children is approximately 60%.<ref>[http://seer.cancer.gov/publications/childhood/cns.pdf  See Table 11.2 Survival Rate]</ref>  However, this rate varies with the age of onset (younger has higher mortality) and cancer type.
|-
| 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]]


In children under 2, about 70% of brain tumors are [[medulloblastoma]], [[ependymoma]], and low-grade [[glioma]].  Less commonly, and seen usually in infants, are [[teratoma]] and [[ATRT|atypical teratoid rhabdoid tumor]].<ref>[http://www.childhoodbraintumor.org/InfantileBrainTumors.html ''Infantile Brain Tumors'' by Brian Rood for The Childhood Brain Tumor Foundation] (accessed July 2007)</ref>
* [[Cyst|Cystic]] lesion with a solid enhancing mural [[nodule]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Blood vessel]] origin


==Diagnosis==
* [[Capillary|Capillaries]] with thin walls
Although there is no specific clinical symptom or sign for brain tumors, slowly progressive [[focal neurologic signs]] and signs of elevated intracranial pressure, as well as epilepsy in a patient with a negative history for epilepsy should raise red flags. However, a sudden onset of symptoms, such as an [[epilepsy|epileptic seizure]] in a patient with no prior history of epilepsy, sudden [[intracranial hypertension]] (this may be due to bleeding within the tumor, brain swelling or obstruction of [[cerebrospinal fluid]]'s passage) is also possible.  
| 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.


Symptoms include phantom [[odor]]s and [[taste]]s. Often, in the case of metastatic tumors, the smell of vulcanized rubber is prevalent.
* Initialy presents with upper bitemporal quadrantanopsia followed by [[Bitemporal hemianopia|bitemporal hemianopsia]] (pressure on [[Optic chiasm|optic chiasma]] from below)


Imaging plays a central role in the diagnosis of brain tumors. Early imaging methods&mdash;invasive and sometimes dangerous&mdash;such as [[pneumoencephalography]] and cerebral [[angiography]], have been abandoned in recent times in favor of  non-invasive, high-resolution modalities, such as [[computed tomography]] (CT) and especially [[magnetic resonance imaging]] (MRI). Benign brain tumors often show up as hypodense (darker than brain tissue) mass lesions on cranial CT-scans. On MRI, they appear either hypo- (darker than brain tissue) or isointense (same intensity as brain tissue) on T1-weighted scans, or hyperintense (brighter than brain tissue) on T2-weighted MRI. Perifocal edema also appears hyperintense on T2-weighted MRI. [[Contrast agent]] uptake, sometimes in characteristic patterns, can be demonstrated on either CT or MRI-scans in most malignant primary and metastatic brain tumors.  This is due to the fact that these tumors disrupt the normal functioning of the [[blood-brain barrier]] and lead to an increase in its [[permeability]].
*


Electrophysiological exams, such as [[electroencephalography]] (EEG) play a marginal role in the diagnosis of brain tumors.
*
|-
| 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


The definitive [[diagnosis]] of brain tumor can only be confirmed by [[histology|histological examination]] of [[tumor]] [[Biological tissue|tissue]] samples obtained either by means of brain [[biopsy]] or open [[surgery]]. The histologic examination is essential for determining the appropriate treatment and the correct [[prognosis]].
* S100+
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* It causes [[hearing loss]] and [[tinnitus]]  


==Treatment and prognosis==
* May be associated with [[Neurofibromatosis type II|NF-2]] (bilateral [[Schwannoma|schwannomas]])
[[Meningiomas]], with the exception of some tumors located at the skull base, can be successfully removed surgically, but the chances are less than 50%. In more difficult cases, [[stereotactic]] [[radiosurgery]], such as [[Gamma Knife]] [[radiosurgery]], remains a viable option.
|-
| 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]]


Most [[pituitary adenoma]]s can be removed surgically, often using a minimally invasive approach through the [[nasal cavity]] and skull base (trans-nasal, trans-sphenoidal approach). Large [[pituitary adenoma]]s require a [[craniotomy]] (opening of the skull) for their removal. Radiotherapy, including [[stereotactic]] approaches, is reserved for the inoperable cases.
* Single [[mass]] with ring enhancement
| style="background: #F5F5F5; padding: 5px;" |
* [[B cell]] origin


Although there is no generally accepted therapeutic management for primary brain tumors, a surgical attempt at tumor removal or at least cytoreduction (that is,  removal of as much tumor as possible, in order to reduce the number of tumor cells available for proliferation) is considered in most cases<ref>Nakamura M, Konishi N, Tsunoda S, Nakase H, Tsuzuki T, Aoki H, Sakitani H, Inui T, Sakaki T. ''Analysis of prognostic and survival factors related to treatment of low-grade astrocytomas in adults.'' Oncology 2000;58:108-16. PMID 10705237.</ref>. However, due to the infiltrative nature of these lesions, tumor recurrence, even following an apparently complete surgical removal, is not uncommon. Postoperative radiotherapy and chemotherapy are integral parts of the therapeutic standard for malignant tumors. Radiotherapy may also be administered in cases of "low-grade" gliomas, when a significant tumor burden reduction could not be achieved surgically.
* 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.


Survival rates in primary brain tumors depend on the type of tumor, age, functional status of the patient, the extent of surgical tumor removal, to mention just a few factors<ref>Nicolato A, Gerosa MA, Fina P, Iuzzolino P, Giorgiutti F, Bricolo A. ''Prognostic factors in low-grade supratentorial astrocytomas: a uni-multivariate statistical analysis in 76 surgically treated adult patients.'' Surg Neurol 1995;44:208-21; discussion 221-3. PMID 8545771.</ref>.
*
|-
! 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]]


Patients with benign gliomas may survive for many years<ref>Janny P, Cure H, Mohr M, Heldt N, Kwiatkowski F, Lemaire JJ, Plagne R, Rozan R. ''Low grade supratentorial astrocytomas. Management and prognostic factors.'' Cancer 1994;73:1937-45. PMID 8137221.</ref><ref>Piepmeier J, Christopher S, Spencer D, Byrne T, Kim J, Knisel JP, Lacy J, Tsukerman L, Makuch R. ''Variations in the natural history and survival of patients with supratentorial low-grade astrocytomas.'' Neurosurgery 1996;38:872-8; discussion 878-9. PMID 8727811.</ref>
* Solid and [[Cyst|cystic]] component
while survival in most cases of [[glioblastoma multiforme]] is limited to a few months after diagnosis.
* 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


The main treatment option for single metastatic tumors is surgical removal, followed by radiotherapy and/or chemotherapy. Multiple metastatic tumors are generally treated with radiotherapy ''and'' chemotherapy. [[Stereotactic]] [[radiosurgery]], such as [[Gamma Knife]] [[radiosurgery]], remains a viable option.
* [[GFAP]] +
However, the prognosis in such cases is determined by the primary tumor, and it is generally poor.
| 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]]


A shunt operation is used not as a cure but to relieve the symptoms.[http://www.emedicinehealth.com/normal_pressure_hydrocephalus/page9_em.htm] The [[hydrocephalus]] caused by the blocking drainage of the [[cerebrospinal fluid]] can be removed with this operation.
* Mostly in [[cerebellum]]


==References==
* Non communicating [[hydrocephalus]]
<references />
| 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
 
* 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]])
 
* [[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]]
 
* Soap bubble brain lesions ([[cryptococcus neoformans]])
*
| 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]]


{{Tumors}}
* It is associated with [[HIV]], [[Immunosuppressive therapy|immunosuppressive therapies]], and [[Organ transplant|organ transplants]]
{{Nervous tissue tumors}}
* In may happen in [[immunocompetent]] patients undergoing invasive procedures ( [[neurosurgery]]) or exposed to [[Contamination|contaminated]] devices or [[drugs]]
{{SIB}}
* 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'''


[[Category:Disease state]]
[[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]]
[[Category:Brain]]
[[Category:Oncology]]
[[Category:Neurology]]
[[Category:Mature chapter]]


[[de:Hirntumor]]
== References ==
[[fr:Tumeur du cerveau]]
[[fr:Tumeur du cerveau]]
[[it:Tumore cerebrale]]
[[el:Εγκεφαλικός Όγκος]]
[[he:סרטן המוח]]
[[ms:Tumor otak]]
[[nl:Hersentumor]]
[[ja:脳腫瘍]]
[[ja:脳腫瘍]]
[[no:Hjernesvulst]]
[[pt:Tumor cerebral]]
[[pt:Tumor cerebral]]
[[ru:Опухоли мозга]]
[[ru:Опухоли мозга]]
[[sq:Tumori i trurit]]
[[fi:Aivokasvain]]
[[sv:Hjärntumör]]
[[tr:Beyin tümörü]]
[[tr:Beyin tümörü]]
[[ur:دماغی سرطان]]
[[zh:腦癌]]
[[zh:腦癌]]


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[[Category:Disease]]
[[Category:Brain]]
[[Category:Oncology]]
[[Category:Neurology]]
[[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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