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Brain tumor

A brain tumor or brain tumour, is an intracranial solid neoplasm, a tumor within the brain.

Brain tumors include all tumors inside the human skull (cranium) or in the central spinal canal. They are created by an abnormal and uncontrolled cell division, usually in the brain itself, but also in lymphatic tissue, in blood vessels, in the cranial nerves, in the brain envelopes (meninges), skull, pituitary gland, or pineal gland.

Classification

Brain tumors show considerable phenotypic and genetic heterogeneity.

Primary and metastatic brain tumors comprise a heterogeneous group of CNS malignancies, varying in histological features 1) phenotypic presentation 2) ,cell origin, and tumor grade as designated by the World Health Organization Classification of Tumors of the Central Nervous System.

Within the brain itself, the involved cells may be neurons or glial cells (which include astrocytes, oligodendrocytes, and ependymal cells). Brain tumors may also spread from cancers primarily located in other organs (metastatic tumors).


Adult Brain Tumors

Pediatric Brain Tumors

Epidemiology

Each year, over 15 000 patients undergo resection of brain tumors in the United States 3).

The facts and statistics include brain and central nervous system tumors (including spinal cord, pituitary and pineal gland tumors).

see The Central Brain Tumor Registry of the United States

Pathophysiology

The complex pathophysiology of brain tumor is dependent on various factors, including histology, molecular and chromosomal aberration, tumor-related protein expression, primary versus secondary origin, and host factors 4) 5) 6) 7).

Clinical Features

20-40 % will have had a seizure.

Neuropsychiatric disorder

Very few studies have utilized specific criteria to assess mental disorders in brain tumor patients, and from them, they are mainly descriptive.

Depression as well as anxious and OCD psychopathology were shown to be prevalent signs among patients with brain tumor. Diagnosis of symptoms were totally based on DSM-IV criteria and these disorders and the percentiles don't seem to be related to each other. Due to high variability of tumor stages, statistical analysis of whether the mentioned psychiatric symptoms get worsen at the later stages of the tumor genesis was not feasible. Although not measured directly, psychiatric symptoms seem to get worsen at the later stages of the brain tumor. The associated factors are tumor location, patient's premorbid psychiatric status, cognitive symptoms and adaptive or maladaptive response to stress 8).

Diagnosis

Neuroimaging plays an ever evolving role in the diagnosis, treatment planning, and post-therapy assessment of brain tumors.

The review of Villanueva-Meyer et al. provides an overview of current magnetic resonance imaging (MRI) methods routinely employed in the care of the brain tumor patient. Specifically, they focus on advanced techniques including diffusion, perfusion, spectroscopy, tractography, and functional MRI as they pertain to noninvasive characterization of brain tumors and pretreatment evaluation. The utility of both structural and physiological MRI in the post-therapeutic brain evaluation is also reviewed with special attention to the challenges presented by pseudoprogression and pseudoresponse 9).

Volume

Robust methodology that allows objective, automated, and observer-independent measurements of brain tumor volume, especially after resection, is lacking.

The volumetric method had the strongest agreement with regard to radiological response (κ = 0.96) when compared with 2D (κ = 0.54) or 1D (κ = 0.46) methods 10).

Treatment

The recommended first-line treatment for most brain tumors is undelayed aggressive resection 11).

see brain tumor surgery

1)
Burger PC, Green SB: Patient age, histologic features, and length of survival in patients with glioblastoma multiforme. Cancer 59:1617–1625, 1987
2)
Bigner DD, Bigner SH, Pontén J, Westermark B, Mahaley MS, Ruoslahti E, et al.: Heterogeneity of genotypic and phenotypic characteristics of fifteen permanent cell lines derived from human gliomas. J Neuropathol Exp Neurol 40:201–229, 1981
3)
Barker FG, Curry WT, Carter BS. Surgery for primary supratentorial brain tumors in the United States, 1988 to 2000: the effect of provider caseload and centralization of care. Neuro Oncol. 2005;7(1):49–63
4)
Burger PC, Vogel FS. The brain: tumors. In: Burger PC, Vogel FS, editors. Surgical pathology of the central nervous system and its coverings. 2nd ed. New York: Wiley 1982;223–266.
5)
Burger PC, Vogel FS, Green SB, Strike TA. Glioblastoma multiforme and anaplastic astrocytoma: pathologic criteria and prognostic implications. Cancer 1985;56:1106 –1111.
6)
Kleihues P, Sobin LH. World Health Organization classification of tumors. Cancer 2000;88:2887.
7)
Kleihues P, Ohgaki H. Phenotype vs genotype in the evolution of astrocytic brain tumors. Toxicol Pathol 2000;28:164 –170.
8)
Seddighi A, Seddighi AS, Nikouei A, Ashrafi F, Nohesara S. Psychological aspects in brain tumor patients: A prospective study. Hell J Nucl Med. 2015 Sep-Dec;18 Suppl 1:63-67. PubMed PMID: 26665213.
9)
Villanueva-Meyer JE, Mabray MC, Cha S. Current Clinical Brain Tumor Imaging. Neurosurgery. 2017 May 9. doi: 10.1093/neuros/nyx103. [Epub ahead of print] PubMed PMID: 28486641.
10)
Kanaly CW, Mehta AI, Ding D, Hoang JK, Kranz PG, Herndon JE 2nd, Coan A, Crocker I, Waller AF, Friedman AH, Reardon DA, Sampson JH. A novel, reproducible, and objective method for volumetric magnetic resonance imaging assessment of enhancing glioblastoma. J Neurosurg. 2014 Sep;121(3):536-42. doi: 10.3171/2014.4.JNS121952. Epub 2014 Jul 18. PubMed PMID: 25036205.
11)
Sanai N, Berger MS. Glioma extent of resection and its impact on patient outcome. Neurosurgery 2008;62(4):753-764. ((Lee CH, Kim DG, Kim JW, et al. The role of surgical resection in the management of brain metastasis: a 17-year longitudinal study. Acta Neurochir (Wien) 2013;155(3):389-397.
brain_tumor.txt · Last modified: 2017/05/10 08:34 by administrador