Brain Tumors

We divide brain tumors into brain metastases and primary brain tumors and also into adult-onset and childhood-onset tumors (because the tumor pathology frequencies change in different age groups). Brain metastases make up the majority of adult-onset brain tumors, especially lung (50% of brain mets), breast (15%), melanoma (10%), and kidney and GI tumors (<15%). Primary brain tumors are less common. The most common malignant primary brain tumors are the gliomas, most notably glioblastoma multiforme. Meningiomas are more common than the malignant gliomas, however, and they are most often benign, fortunately. Because spinal cord and peripheral nerve tumors are uncommon, we will also lump them in with brain tumors as part of a more comprehensive neuro-oncology review. In addition, we mention paraneoplastic diseases at the end, which is an increasingly recognized neurological complication of systemic cancers. They stem from paraneoplastic antibodies produce by an immune response to the systemic neoplasms. Since it's often very difficult to distinguish tumor types from radiographic imaging, it's helpful to get a sense of tumor frequency: the clinical adage "common things occur commonly" is especially true with brain tumors. The most common new brain tumor diagnosis each year in the U.S. is brain metastasis. Roughly 150,000 new cases of brain metastasis will occur in the U.S. each year, alone.

• Roughly 25% of cancer patients eventually develop brain metastases. We call these secondary secondary brain tumors because they originate from outside of the brain matter.
• There are roughly half that in new primary brain tumor diagnoses: ~ 75,000, each year. Their relative indices are:
• Meningiomas ~ 35%
• Glioblastomas ~ 16%
• Pituitary tumors ~15%
• Non-glioblastoma gliomas (eg, astrocytomas) ~ 10%

Below we provide links to the brain tumors but to learn more about the various brain tumors, review the following lectures and tutorials. Brain Tumor Evaluation - a lecture primer on brain tumors evaluation, as well as the evaluation of spinal cord and peripheral nerve tumors. Brain Tumors - a whiteboard tutorial on the most common brain tumors in adults and children. Adult-Onset Brain Tumors - a detailed review of adult-onset brain tumor neuropathology. Childhood-Onset Brain Tumors - a detailed review of childhood-onset brain tumor neuropathology. Brain Metastases Glioblastoma Multiforme Diffuse Astrocytoma & Anaplastic Astrocytoma Oligodendroglioma CNS Lymphoma Meningioma Pituitary tumor CNS Lymphoma Central Neurocytoma Dysembryoplastic neuroepithelial tumor (DNET) & Ganglioglioma/Gangliocytoma Hemangioblastoma Hemangiopericytoma Diffuse Midline Glioma Pilocytic Astrocytoma Subependymal Giant Cell Astrocytoma (SEGA) Ependymoma Medulloblastoma Atypical Teratoid/Rhabdoid Tumor (ATRT) Choroid Plexus Papilloma Craniopharyngioma Pineal Region Tumors To learn about Spinal Cord Tumors and Paraneoplastic Antibody Syndromes, see the following lectures and tutorials: Brain Tumor Evaluation - a lecture primer on brain tumors evaluation, as well as the evaluation of spinal cord and peripheral nerve tumors. Spinal Cord Tumors - a whiteboard tutorial on spinal cord tumors.

• BLT with Mayonaise and a Kosher PickLe
• B: Breast
• L: Lung
• T: Thyroid
• M: Multiple Myeloma
• K: Kidney (Renal cell)
• P: Prostate
• L: Lymphoma
• Note that this acronym omits GI malignancies: Garnish.

Paraneoplastic Disease, Part 1: Pathogenesis - a whiteboard tutorial on the pathological mechanisms of paraneoplastic disease. Paraneoplastic Disease, Part 2: Syndromes - a whiteboard tutorial on the various paraneoplastic antibody syndromes.

• Classic CNS disorders
• Limbic encephalitis
• Opsoclonus myoclonus
• Paraneoplastic cerebellar degeneration
• Paraneoplastic retinal degeneration
• Morvan syndrome
• Stiff person syndrome & PERM (Progressive Encephalomyelitis with Rigidity & Myoclonus)
• Paraneoplastic encephalomyelitis

• Classic neuromuscular disorders
• Myasthenia gravis
• Lambert-Eaton myasthenic syndrome
• Autoimmune autonomic neuropathy
• Isaacs syndrome
• Paraprotein-associated neuropathies
• Inflammatory myopathies: polymyositis & dermatomyositis

World Health Organization (WHO) Grading System for brain tumors. We divide them into four grades, from least aggressive to most:

• Grade 1 (G1) brain tumors demonstrate a low-degree of proliferation and are well-circumscribed, which makes them amenable to surgical resection.
• Grade 2 (G2) brain tumors also demonstrate a low-degree of proliferation but unlike G1 brain tumors, G2 brain tumors demonstrate a potential for infiltration, thus they tend to recur after surgical resection.
• Grade 3 (G3) brain tumors demonstrate a high degree of cellular proliferation and are highly infiltrative.
• Grade 4 (G4) are the most aggressive. Like G3, they demonstrate high proliferation. What distinguishes them is their necrosis and neovascularity and their even greater infiltrative and dissemination (metastasis) potential. Survival is generally just several months.