Differential diagnosis of a brain mass
|
Primary brain tumors |
Glioma, Meningioma, Pituitary adenoma, Vestibular schwannoma, Primary central nervous system lymphoma |
|
Metastatic brain tumors |
|
|
Cerebral hemorrhage |
Vascular anomaly, Hypertensive, Intratumoral |
|
Cerebral infarct |
Embolus, Thrombosis |
|
Infections |
Abscess, Viral infection, Progressive multifocal leukoencephalopathy |
|
Inflammatory |
Multiple sclerosis, Post-infectious encephalomyelitis |
<brain tumors>
Adult: 70% supratentorium, 以GBM, Meningioma, acoustic neuroma為主
Child: 70% infratentorium, 以Astrocytoma, Medulloblastoma(PENT), Ependymoma , and Craniopharyngioma為主
Gliomas
over 80 percent of primary CNS malignancies.
Including astrocytes, oligodendrocytes, ependymoma, and Schwannoma
Astrocytic tumors
Classification
1. Fibrillary: adult, cerebral, diffuse, solid
2. Pilocytic: child, cerebellar, local, cyst
Grading
Grade 1: low grade astrocytic tumors, well-differentiated well-defined margin, include pilocytic astrocytomas and diffuse astrocytomas.
Grade 2: well-differentiated, diffuse infiltration
Grade 3: Anaplastic astrocytomas, high mitotic activity but no endothelial proliferation or necrosis.具侵犯性,預後差
Grade 4: Glioblastomas (glioblastoma multiforme, GBM), high mitotic activity and either endothelial proliferation or necrosis. 非常惡性，butterfly tumor.
Treatment:
Low-grade: 外科切除
High-grade/未全切除易復發者: 手術+放射線治療
GBM: 手術切片, 放射治療+化療
Oligodendroglial tumors
Benign, frontal lobe, calcification, satellitosis.
On light microscopy as round cells with perinuclear halos (a "fried-egg" appearance) and an acutely branching (chicken-wire) capillary pattern.
Treatment:
Low grade glioma: 外科手術切除
High grade glioma: 手術切除+ 放射治療
Ependymal tumors
arise from ependymal cells lining the ventricular system.
好發第3.4腦室,較常發生於女性,有一半以上的病人小於3歲,會經CSF擴散至中樞神經其他部位
Treatment:
先以手術切除腫瘤, 再追加放射線治療; 若已有脊髓轉移之室管膜瘤, 應照射全腦及整個脊髓部份,若小於3歲,則以化療為主
Meningiomas(15~25%)
Meningiomas arise from the arachnoidal cap cell, a type of meningothelial cell in the arachnoid membrane.
好發於中年女性 .良性,生長緩慢.分化良好.最常見於Parasagital region.
Medulloblastomas (primitive neuroectodermal tumors, PNETs)
Medulloblastomas are small, blue, round cell embryonal tumors typically arising in children in the roof of the fourth ventricle.
起源於神經管下方, 接著生長至第四腦室,浸潤週邊腦組織(e.g.腦幹), 約50%會經CSF擴散至蜘蛛網膜下腔及中樞神經其他部位
In the current WHO framework, medulloblastomas are categorized with other tumors of different sites but similar appearance under "embryonal tumors".
Treatment:
先以手術儘可能切除腫瘤,緩解腦脊液阻塞造成的水腦, 再追加放射線治療或化療,若小於3歲,以化療為主
Craniopharyngioma
Arising in Child in the Ranthke’s pouch. 視交叉, 腦下垂體.下視丘附近
Treatment:
先以手術切除腫瘤, 再追加放射線治療或化療
Pituitary adenoma
1. Functional: 製造過多的荷爾蒙,而造成巨人症,肢端肥大症,泌乳素分泌過多,庫欣氏症等症狀,由於有症狀,腺瘤通常不大,採Transsphenoidal hypophysectomy經蝶竇腺體切除術即可
2. Non- Functional: 非功能性的腫瘤通常較大, 等到長至壓迫視神經時才有視力的症狀出現, 或有可能侵犯海綿竇cavernous sinus,造成動眼神經的問題,此時就需採放射線治療較佳
3. Pituitary Adenomas產生的臨床症候群
|
製造的荷爾蒙 |
臨床症候群 |
|
Prolactin |
Amenorrhea and galactorrhea, impotence |
|
GH |
Gigantism and acromegaly |
|
ACTH |
Cushing's disease, Nelson's syndrome(following adrenalectomy) |
|
TSH |
Hyperthyroidism |
Acoustic neuromas
benign,生長緩慢,常見於50歲以上,患側聽力障礙,也可能影響CN7,造成facial palsy
treatment:
一般以外科手術做全切除,少數輔以放射線治療
更多詳細資料: http://cancer.idv.tw/chapter/chapter-13.htm
留言列表
