PATHOLOGY OF BRAIN TUMORS Presented By : Dr Amit Thapa CONTENTS EPIDEMIOLOGY (cid:132) CLASSIFICATION (cid:132) PATHOPHYSIOLOGY IN BRIEF (cid:132) PATHOLOGY OF INDIVIDUAL TUMOR GROUPS (cid:132) DIAGNOSTIC APPROACH (cid:132) RADIOLOGICAL (cid:132) TUMOR MARKERS (cid:132) CYTOLOGY (cid:132) INTRAOPERATIVE (cid:132) FROZEN SECTION (cid:132) Fluorescent imaging (Chemical probe) (cid:132) HISTOLOGY (cid:132) MODERN METHODS (cid:132) IMMUNOHISTOCHEMICAL (cid:132) MOLECULAR (cid:132) PROGNOSTIC MARKERS (cid:132) Pathology of brain tumors -Dr AmitThapa Epidemiology incidence Primary cerebral malignancy- 4 to 10/Lac general population 1.6% of all primary tumors 2.3% of all cancer related deaths Francis Ali-Osman, 2005 2nd most common cancer in children 20% of all cancers in children <15 yrs Pathology of brain tumors -Dr AmitThapa Epidemiological incidence of individual tumor Classification Incidence / 100,000 population/yr Metastatic 6 Astrocytoma 1.5 Glioblastoma 3 Meningioma 3 Primary CNS lymphoma Immunocompetent 0.3 Overall 0.8-6.8 Medulloblastoma 0.5 Germ cell tumor 0.2 Pinealoma/ pineoblastoma 0.1 Parkin, 1997 Epidemiology comparative incidence ALL INTRACRANIAL TUMORS MENINGIOMA 12% SCHWANNOMA 6% NEUROEPITHELIAL PITUITARY TUMORS TUMORS 34% 8% VASCULAR MALFORMATIONS 3% METASTASIS OTHERS 21% 16% Pathology of brain tumors -Dr Amit Thapa Epidemiology Relative incidence at AIIMS (2002-2007) Astrocytoma 985 21% Oligodendroglioma 238 5% Others Ependymoma 2418 170 51% 4% Mixed glioneuronal tumor Meningioma 72 Lymphoma 577 1% Melanoma 58 12% 5 1% Embryonal type 0% 164 Germ cell Tumor 3% 23 Hemangioblastoma 0% Pineal tumors 61 19 n= 5076 patients 1%Hemangiopericytoma 0% 46 1% Pathology of brain tumors -Dr AmitThapa Epidemiology comparative incidence INTRACRANIAL NEUROEPITHELIAL TUMORS, ALL AGES PRIMARY NEUROEPITHELIAL TUMORS OF CHILDHOOD GLIOBLASTOMA AND ANAPLASTIC ASTROCYTOMA 5% PNET OTHERS PNET 6% ASTROCYTOMA 9% 25% 20% EPENDYMOMA 16% GLIOBLASTOMA EPENDYMOMA AND ANAPLASTIC 6% ASTROCYTOMA 57% OTHERS ASTROCYTOMA 6% 45% OLIGODENDROGLI OMA 5% Pathology of brain tumors -Dr AmitThapa Epidemiological profile… age wise distribution 100 90 80 70 60 Cerebellarhemisphere Relative Glioblastoma 50 Anaplastic astroyctoma incidence Anaplastic 40 Oligodendroglioma Posterior fossa Cerebellarhemisphere Metastatic carcinoma 30 Medulloblastoma Diffuse astrocytoma Lymphoma Ependymoma Anaplasticastroyctoma Other sites Pilocyticastrocytoma Oligodendroglioma 20 Meningioma Other sites Ependymoma Cranopharyngioma Other sites Schwannoma 10 Chorioidplexus tumorus Meningioma Pituitary adenoma 0 0 10 20 30 40 50 60 70 Age (years) Pathology of brain tumors -Dr AmitThapa Common tumors according to age distribution Pathology of brain tumors -Dr AmitThapa Epidemiology Gender •Males are more likely to be diagnosed with brain tumors than females-( 1.5:1 ) •Meningiomas and pituitary adenomas are slightly more common in women than in men. Pathology of brain tumors -Dr AmitThapa