Difference between revisions of "Brain tumor"

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Revision as of 11:11, 15 October 2019


Brain tumor
Brain met.jpg
CT scan of brain showing brain cancer to left parietal lobe in the peri-ventricular area.

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
•Hmeangioblastoma
•Pitutary adenoma
•Schwannoma
•Primary CNS lymphoma
 
 
 

•Pilocytic astrocytoma
•Medulloblastoma
•Ependymoma
•Craniopharyngioma
•Pinealoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


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


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