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medulloblastoma

low grade astrocytoma

ependymoma

metastases

gliomas

meningiomas

posterior fossa

glioblastoma
   supratentorial


especially true at older ages;

at younger ages, other types occur...
   oligodendroglioma
   low grade astrocytoma

not good...


except for...
   meningioma
   pilocytic astrocytoma  (grade I)


grade II astrocytoma:    <10 yrs
ependymoma:                craniospinal XRT  =>  considerable disability

meningioma


glioblastoma multiforme

aka  WHO grade I


cerebellum
hypothalamus
optic nerve


circumscribed growth
solid component
cystic component


eosinophilic granular bodies

aka  WHO grade II


diffuse infiltration by cytologically atypical cells

aka   GBM / WHO grade IV / astrocytoma


ring-enhancement on T1


marked cellular atypia
increased mitotic activity
microvascular proliferation
    "leaky" vessels  enhance on MRI
necrosis:
   pseudopallisading:   pallisade of nuclei around central necrosis

diffusely infiltrating glioma of cerebrum

WHO grade II                    2/3rds
WHO grade III                   1/3rd

prominent nuclear rims
prominent nucleoli
dystrophic calcification

chromosomal abnormalities in 1p & 19q          translocation
         positive prognositic indicator

adults

cerebellum
spinal cord

solid, circumscribed

WHO grade II               majority
WHO grade III


Flexner-Wintersteiner rosettes


can seed CSF
      drop metastasis

biphasic neoplasm:
   hypercellular areas           Antoni A
   hypocellular areas            Antoni B


Verocay bodies
   nuclear pallisades around acellular zone


WHO grade I

invasive
mitotically active
aggressive
   WHO grade IV

midline of midbrain

hypercellular
primitive  (embryonal) cells with neuronal features
   Homer-Wright rosettes
           peripheral pallisade of nuclei around acellular zone

chemosensitive  =>  good survival

frequently seeds CSF
    drop metastases

most common CNS tumor
     10x more common than primary CNS tumors combined

typically multiple

can be...
   intraparenchymal
   CSF dissemination
   direct / local extension
         cord compression

lung

breast

skin                          melanoma

kidney