Transcript WHO Histologic Classification of CNS tumors

WHO Histologic Classification of CNS tumors
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Astrocytic tumors
Oligodemdroglial tumors
Ependymal tumors
Mixed gliomas
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Embryonal tumors
Tumors of
cranial/spinal
nerves
Mesenchymal
tumors, benign
Mesenchymal
tumors, malignant
Uncertain
histogenesis
Hemopoietic
neoplasms
Cysts/tumorlike
lesions
Sellar tumors
• Incidence of primary brain tumors
(benign or malignant) 12.8/100,000
• 10%–15% of cancer patients develop
brain metastases
• Primary – unknown
• Genetic – hereditary
• Metastatic
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35% - lung
20% - breast
10% - kidney
5% - gastrointestinal tract
• Often unknown
• Under investigation:
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Genetic changes
Heredity
Errors in fetal development
Ionizing radiation
Electromagnetic fields (including cellular phones)
Environmental hazards (including diet)
Viruses
Injury or immunosuppression
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Tissue of origin
Location
Primary or secondary (metastatic)
Grading
• Depends on location, size, and type of tumor
• Neurological deficit 68%
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45% motor weakness
Mental status changes
• HA 54%
• Seizures 26%
• General
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Cerebral edema
Increased intracranial pressure
Focal neurologic deficits
Obstruction of flow of CSF
Pituitary dysfunction
Papilledema (if swelling around optic disk)
• Cerebral Tumors
o
o
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Headache
Vomiting unrelated to food intake
Changes in visual fields and acuity
Hemiparesis or hemiplegia
Hypokinesia
Decreased tactile discrimination
Seizures
Changes in personality or behavior
• Brainstem tumors
o
o
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Hearing loss (acoustic neuroma)
Facial pain and weakness
Dysphagia, decreased gag reflex
Nystagmus
Hoarseness
Ataxia (loss of muscle coordination) and dysarthria (speech
muscle disorder) (cerebellar tumors)
• Cerebellar tumors
o
Disturbances in coordination and equilibrium
• Pituitary tumors
Endocrine
dysfunction
o Visual deficits
o Headache
o
• Frontal Lobe
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Inappropriate behavior
Personality changes
Inability to concentrate
Impaired judgment
Memory loss
Headache
Expressive aphasia
Motor dysfunctions
• Parietal lobe
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Sensory deficits
 Paresthesia
 Loss of 2 pt discrimination
 Visual field deficits
• Temporal lobe
o
Psychomotor seizures – temporal lobe-judgment,
behavior, hallucinations, visceral symptoms, no
convulsions, but loss of consciousness
• Occipital lobe
o
Visual disturbances
CLASSIFICATION OF CNS TUMOURS
1. Intrinsic
tumours – account for
2. Extrinsic
tumours – arising from
virtually all tumours in children and
60% of primary CNS tumours in adults
cranial and spinal nerves and dura.
3.
Tumours arising from adjacent
structures i.e pituitary gland and
metastatic tumours.
• Gliomas
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Astrocytoma (Grades I & II)
Anaplastic Astrocytoma
Glioblastoma Multiforme
Oligodendroglioma
Ependymomas
Medulloblastoma
CNS Lymphoma
• Grade I
• Non-infiltrating
• Grade II
• Infiltrating
• Slow growing
• Grade III
• Infiltrating
• Aggressive
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Grade IV
Highly infiltrative
Rapidly growing
Areas of necrosis
• Grades II-IV
• Mixed astro/glio
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Slow growing
Benign
HCP/ICP
Surgery, RT, Chemo
• Small cell embryonal
neoplasms
• Malignant
• HCP/ICP
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Primary CNS lymphoma
B lymphocytes
Increased ICP
Brain destruction
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Meningioma
Metastatic
Acoustic neuromas (Schwannoma)
Pituitary adenoma
Neurofibroma
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Usually benign
Slow growing
Well circumscribed
Easily excisable
• Peritumoral edema
• Necrotic center
• Benign
• Schwannoma cells
• CN VIII
• Benign
• Anterior pituitary
• Endocrine dysfxn
• Cystic tumor
• Hypothalamic-pituitary axis dysfunction
• Radiological Imaging
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Computed Tomography scan (CT scan) with/without
contrast
Magnetic Resonance Imaging (MRI) with/without
contrast
Plain films
Myelography
Positron Emission Tomography scan (PET scan)
• LP/CSF analysis
• Pathology
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Resection
Craniotomy
Stereotaxis Surgery
Biopsy
Transsphenoidal
http://youtu.be/d95K3unaNCs
• Drug therapy – Palliative
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Done for symptom treatment and to prevent
complications
 NSAIDs
 Analgesics – Vicodin, Lortab, MS Contin
 Steroids (Decadron, medrols, prednisone)
 Anti-seizure medications (phenytoin) Dilantin &
Cerebyx
 Histamine blockers
 Anti-emetics
 Muscle relaxers (for spasms)
 Mannitol for ICP –New Hypertonic saline
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Damages DNA of rapidly dividing cells
4000–6000 Gy total dose
Duration of 4–8 weeks
Brachytherapy
Stereotactic radiosurgery
Incomplete surgery
 Deep seated tumor: midbrain, pons
 Radiosensitive tumor: medulloblastoma
 Pituitary adenoma
 Palliation: metastatic lesions
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• Slows cell growth
• Cytotoxic drugs
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CCNU, BCNU, PCV, Cisplatin, Etoposide,
Vincristine, Temozolomide (Temodar)
• Gliadel wafers
• Ommaya Reservoir
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Ineffective Tissue Perfusion
Ineffective Airway Clearance
Impaired Communication
Decreased Intracranial Adaptive Capacity
Activity Intolerance
Disturbed Sensory disturbance
Acute Confusion

A patient is being directly admitted to
the medical-surgical unit for evaluation
of a brain mass seen in the frontal lobe
on a diagnostic CT scan. Which of the
following signs and symptoms would the
patient most likely present with?
a.
b.
c.
d.
Personality changes
Visual field cuts
Difficulty hearing
Difficulty swallowing
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The nurse is evaluating the status of a
client who had a craniotomy 3 days ago.
The nurse would suspect the client is
developing meningitis as a complication
of surgery if the client exhibits
a. A positive Brudzinski’s sign
b. A negative Kernig’s sign
c. Absence of nuchal rigidity
d. A Glascow Coma Scale score of 15
• AANN Core Curriculum for Neuroscience Louis,
MO. Nursing, 4th Ed. 2004. Saunders. St.
• Greenberg, Mark. (2006). Handbook of
Neurosurgery. Greenberg Graphics,
Tampa, Florida.