1. Neurological Neoplasm FOM, KFMC 28-5-2015
Dr. Abdulrahman Sabbagh M.D., FRCS(C)
Neurosurgery, Neuro-Oncology, Consultant

4. Intracranial mass Differential diagnosis: Tumor, Pus Blood cyst,
??? Air

5. Intracranial mass primary tumors
History important for localizing and differentiating mass lesions
Tumor:
primary versus metastatic
primary tumors
benign
or malignant (rarely metastasize)

6. Presenting Symptoms local effects raised ICP consider by
dependent on site:
focal deficits,
lobe syndromes,
seizures,
headaches
raised ICP
acute or chronic depending on tumor growth rate
sudden onset of symptoms after hemorrhage (5-10%)
consider by
location (supratentorial vs. infratentorial)
age (adult vs. child)

7. Clinical presentation

8. Management Admission (?) Symptom relieving medications Investigations
Treatment

11. Classification according to cell type
Neuroepithelial
Gliomas
Astrocytoma (including Glioblastoma)
Oligodendroglioma
Ependymoma
Choroid plexus tumor
Pineal tumors
Neuronal tumors
Ganglioglioma
Neuroblastoma
Medulloblastoma

12. Classification according to cell type
Nerve sheath tumor
Vestibular schwannoma
Meningeal tumors
Meningioma
Pituitary tumors
adenoma
Germ cell tumors
Germinoma
Teratoma
Lymphoma
Metastatic tumors

13. Classification according to cell type
Mal-development origin
Craniopharyngioma
Dermoid/epidermoid cyst
Colloid cyst
Local extension
Chordoma
Glomus jugulare
Blood vessels
Hemangioblastoma

14. Astrocytoma Most common group of CNS tumors Grading (WHO)
Grade I (well differentiated)
Juvenile Pilocytic Astrocytoma
Grade II (Diffuse)
fibrillary
Grade III (Anaplastic)
Grade IV (undifferentiated)
GBM: glioblastoma multiforme

18. Metastatic Most common brain tumour seen clinically
15% of cancer patients present with cerebral mets
Source
Lung 44% (especially bronchogenic cancer)
Breast 10%
Kidney 7% (renal cell carcinoma (RCC))
GI %
Melanoma 3%
Route of spread – hematogenous
Location – 3/4 are supratentorial, often at grey-white matter junction
Diagnosis:
Metastatic work-up (CXR, CT chest/abdo, abdominal U/S)
CT with contrast (round, well-circumscribed uniformly lesion)
Biopsy (as up to 10% may not be cerebral met in patient with cancer history) and patient may not have a cancer history
Prognosis: median survival with optimal Rx weeks but varies depending on primary
Treatment: palliative
Single accessible lesion ––> surgical excision + radiation
Multiple lesions ––> whole brain radiation

20. Meningioma Mostly benign (1% malignant) Slow-growing, non-infiltrative
Common locations:
Parasagittal convexity
Sphenoid wing
Falx
Presentation: middle aged, symptoms of increased ICP, focal symptoms depend on location
Diagnosis: MRI, CT with contrast
Therapy
Conservative management for slow-growing lesions
Surgery is treatment of choice (curative if complete resection)
Radiotherapy – ineffective
Prognosis: > 90% 5-yr survival

22. Cerebral edema
@ capillary wall in normal brain, tight junctions retain protein-rich serum within the capillary
Vasogenic :
develops when tight junction maintenance is deranged, and protein-fluid leaks into the interstitium, drawing free water along with it
Cytotoxic :
develops when cellular energy metabolic failure leads to  intracellular sodium, free water follows, and tissue swells as its cells take on water

23. Paraneoplastic syndrome
A disease or symptom that is the consequence of the presence of cancer in the body, but is NOT due to the local presence of cancer cells
Mediated by humoral factors (hormones or cytokines) excreted by tumor cells or by an immune response against tumor
Most commonly present with cancers of the:
Lung
Breast
Ovaries
Lymphatic system (lymphoma)
Sometimes the symptoms of paraneoplastic syndromes show even before the diagnosis of a malignancy.

24. Paraneoplastic syndrome
divided into 4 main categories of syndromes:
Endocrine
Neurological
Mucocutaneous
Hematological

25. Paraneoplastic Neurological Disorders (PND)
Affect the central or peripheral nervous system and they are degenerative.
Symptoms of paraneoplastic neurological disorders may include:
Ataxia
Dizziness
Nystagmus
Loss of
Muscle tone
Coordination
Memory
Slurred speech
Vision problems
Dementia
Seizures

26. Paraneoplastic Neurological Disorders (PND)
The most common cancers associated with paraneoplastic neurological disorders are:
Breast
Ovarian
Lung cancer
Treatment options include:
Eliminate the underlying cancer such as chemotherapy, radiation and surgery
Reduce or slow neurological degeneration.
Rapid diagnosis and treatment are critical for the patient to have the best chance of recovery.