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NEOPLASMA OTAK

FK UISU

The distribution of common


intracranial tumors.

GLIAL
Sel2 glial mempunyai fungsi suportif
utk neuron dan prosesus selulernya.
Sel2 ini memp. peranan primer >
reperasi, keseimbangan cairan
& metabolisme energi

CIRI2 TUMOR OTAK


Konsekuensi lokasi Lesi jinak Bedah

Pola Pertumbuhan histologi jinak
Infiltrasi prilaku klinis ganas
Pola Penyebaran cairan serebrospinal
( jarang metastase keluar ).

The four major classes of


brain tumors are:

Gliomas
Neuronal tumors
Poorly differentiated neoplasms
Meningiomas

GLIOMA
Gliomas derived from glial cells ;
astrocytoma
oligodendroglioma
ependymoma

Astrocytoma
fibrillary astrocytoma 80 % tumor
otak primer dewasa II/IV
anaplastic astrocytoma (III/IV)
glioblastoma (IV/IV).

HISTOLOGIS densitas inti & nekrosis


(pseudopalisading) & perdarahan

Tersusun dr inti astrositik yg neoplastikhistologis

Well-differentiated astrocytoma. A, The right frontal tumor has expanded


gyri, which led to flattening (arrows). B, Expanded white matter of the
left cerebral hemisphere and thickened corpus callosum and fornices.

Computed tomographic (CT) scan of a large tumor in the cerebral


hemisphere showing signal enhancement with contrast material and
pronounced peritumoral edema. B, Glioblastoma multiforme appearing as
a necrotic, hemorrhagic, infiltrating mass.

Glioblastoma. Foci of necrosis with


pseudopalisading of malignant nuclei

Clinical Features
Astrocytoma have a tendency to become more anaplastic
with time progress only slowly over a number of years,
with a mean survival of more than 5 years.
anaplastic features and more rapid growth of the tumor.
The prognosis for patients with glioblastoma is very poor.
With current treatment, consisting of resection when
feasible together with radiotherapy and chemotherapy, the
mean length of survival after diagnosis is only 8 to 10
months; fewer than 10% of patients are alive after 2 years.

Oligodendroglioma
5% to 15% of glioma and are most
common in the fourth and fifth
decades.
Patients may have had several years
of neurologic complaints, often
including seizures.
The lesions are found mostly in the
cerebral hemispheres, with a
predilection for white matter.

macroscopic well-circumscribed,
gelatinous, gray masses, often with
cysts, focal hemorrhage, and calcification
Microscopic composed of sheets of
regular cells with spherical nuclei
containing finely granular chromatin
(similar to normal oligodendrocytes)
surrounded by a clear halo of cytoplasm
The most common genetic alterations
in oligodendrogliomas are loss of
heterozygosity for chromosomes 1p
and 19q.

Clinical Features
have a better prognosis than do
patients with astrocytomas
Current treatment with surgery,
chemotherapy, and radiotherapy has
yielded an average survival of 5 to
10 years

Ependymoma
Tumbuh dr lap.ependimal sistem ventrikulus,
termasuk kanalis sentralis medulla spinalis.
Lokasi medulla spinalis (tumors in this
site neurofibromatosis type 2)
microscopic composed of cells with
regular, round to oval nuclei with abundant
granular chromatin. Tumor cells may form
gland-like round or elongated structures
(rosettes, canals) perivascular
pseudorosettes

While most ependymomas are


well differentiated and behave as
WHO grade II/IV lesions, anaplastic
ependymomas occur with
increased cell density, high
mitotic rates, areas of necrosis,
and less evident ependymal
differentiation. These lesions are
more aggressive (WHO grade
III/IV).

Ependymoma. A, Tumor growing into the fourth ventricle,


distorting, compressing, and infiltrating surrounding
structures. B, Microscopic appearance of ependymoma.

NEURONAL TUMORS

Ganglion Cell Tumors


Several types of CNS tumors contain matureappearing neurons (ganglion cells); these may
constitute the entire population of the lesion
(gangliocytomas). More commonly, there is an
admixture with a glial neoplasm, and the lesion is
termed a ganglioglioma. Most of these tumors are
slow growing, but the glial component occasionally
becomes frankly anaplastic, and the disease then
progresses rapidly. Lesions that contain mixtures of
neuronal and glial elements often present as a
seizure disorder; surgical resection of the tumor is
usually effective in controlling the seizures.

Ganlioglioma (WHO grade I to


II/IV lesions ) neoplasma glial dgn
campuran sel ganglion pd sel2 saraf
yg berkelompokn scr ireguler
binucleus
lobus temporalis, tumbuh lambat,
ttp kadang2 komponen
glialnyasifat anaplastik agresif
gangliositoma (grade III/IV)

Tumor lainnya dgn komponen glial &


neuronal
Dysembryoplastic neuroepithelial
tumor
o low-grade tumor of childhood
o Kejang
o Prognosa baik reseksi
o Mikros: floating neurons dlm cairan yg
kaya mukopolisakarida & glia neoplastik
tanpa gambaran anaplastik

Tumors with Only Neuronal


Elements
neuroblastomalangka ttp agresif ( anak)
roset Homer- Wright
Neurositoma low-grade neuronal neoplasm
found within and adjacent to the ventricular
system (most commonly the lateral or third
ventricles), characterized by evenly spaced,
round, uniform nuclei and often islands of
neuropil. Although in pattern and shape the cells
resemble oligodendroglioma, ultrastructural and
immunohistochemical studies reveal the
neuronal lineage of the tumor cells.

NEOPLASMA DIFF BURUK


Medulloblastoma
In children, medulloblastomas are located in the midline of the
cerebellum , but lateral locations are more often found in
adults. Rapid growth may occlude the flow of CSF, leading to
hydrocephalus. The tumor is often well circumscribed, gray,
and friable and may be seen extending to the surface of the
cerebellar folia and involving the leptomeninges.
On microscopic examination, medulloblastoma is usually
extremely cellular, with sheets of anaplastic cells ( Fig. 28-47C
). Individual tumor cells are small, with little cytoplasm and
hyperchromatic nuclei that are frequently elongated or
crescent shaped. Mitoses are abundant, and markers of
cellular proliferation, such as Ki-67, are detected in a high
percentage of the cells. The tumor has the potential to
express neuronal (neurosecretory granules or Homer Wright
rosettes, as occur in neuroblastoma

Medulloblastoma. A, CT scan showing a contrast-enhancing midline


lesion in the posterior fossa. B, Sagittal section of brain showing
medulloblastoma destroying the superior midline cerebellum. C,
Microscopic appearance of medulloblastoma.

OTHER PARENCHYMAL TUMORS


Primary CNS lymphoma (PCNSL) accounts for
2% of extranodal lymphomas and 1% of
intracranial tumors
Germ Cell Tumors (Tunas)
Pineal Parenchymal Tumors arise from the
specialized cells of the pineal gland

MENINGIOMA
predominantly benign tumors of adults
usually attached to the dura, that arise
from the meningothelial cell of the
arachnoid.
may be found along any of the
external surfaces of the brain as well as
within the ventricular system, where
they arise from the stromal arachnoid
cells of the choroid plexus

Meningioma. A coronal section of the brain shows a


dural-based tumor compressing the left parietal lobe.

Meningioma with a whorled pattern of cell


growth and psammoma bodies

Most meningioma are considered grade I/IV by the WHO classification


scheme, having a relatively low risk of recurrence or aggressive growth.

Atypical meningiomas (WHO grade II/IV) are lesions with a higher


rate of recurrence and more aggressive local growth that may require
therapy in addition to surgery. The diagnostic criteria for this category
of meningioma require either a mitotic index of four or more mitoses
per 10 high power fields or three or more of the atypical features
(increased cellularity, small cells with a high nuclear:cytoplasmic ratio,
prominent nucleoli, patternless growth, or necrosis). Certain histologic
patterns (clear cell and chordoid) are also considered to be grade II/IV
because of their more aggressive behavior.

Anaplastic (malignant) meningioma (WHO grade III/IV) is a highly


aggressive tumor that has the overall appearance of a high-grade
sarcoma, although there is usually some histologic evidence that
indicates a meningothelial cell origin. Mitotic rates are often extremely
high (>20 mitoses per 10 high power fields). Certain histologic
subtypes of meningioma are also considered to be WHO grade III/IV
tumors. Papillary meningioma (with pleomorphic cells arranged
around fibrovascular cores) and rhabdoid meningioma (with sheets of
tumor cells with hyaline eosinophilic cytoplasm containing intermediate
filaments) both have a high propensity to recur.

PERIPHERAL NERVE SHEATH


TUMORS

Schwannom aassociated with

neurofibromatosis type 2 mutations in the


NF2 gene on chromosome 22
Neurofibromakulit
Von Hippel-Lindau Disease

METASTATIC TUMORS
Metastatic lesions, mostly
carcinomas, account for
approximately a quarter to half of
intracranial tumors in hospital
patients. The five most common
primary sites are lung, breast, skin
(melanoma), kidney, and
gastrointestinal tract, accounting
for about 80% of all metastases.

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