Brain tumor: Types, Symptoms, Diagnosis and Treatment

Brain tumour could be primary or metastatic. Brain metastatic tumors are three times more common than all primary brain tumors combined. Metastasis to the leptomeninges and epidural space of the spinal cord occur in 3-5% of patients with systemic cancer which is also a major cause of neurologic disability.

Brain tumor Types

Primary Brain Tumor

• Intrinsic Malignant primary tumors:
  • Diffuse Gliomas
  • Astrocytomas
  • Oligodendrogliomas
  • Ependymomas ( From ependymal cells of ventricular lining)
  • Gangliogliomas and pleomorphic xanthoastrocytomas
  • Primary CNS Lymphoma
  • Medulloblastomas
  • Pineal Region Tumors

                                                EPENDYMYOMA

• Extrinsic Benign Tumors
  • Meningiomas: It is a primary benign tumor which arises from meningoepithelial cells. It occurs mostly in middle aged to elderly women. Patient will feel headaches or neurological defects along with seizures.
  • Schwannomas ( Most common are Acoustic Neuromas)
  • Pituitary Tumors
  • Craniopharyngiomas
  • Other benign tumors like Epidermoid cysts, dermoid cysts

Metastatic Brain tumors

• It is the most common intracranial brain tumor.
• It presents as Solitary or multiple at the grey-white junction.
• There are some organ cancers which mostly metastasize to the brain. The order of preference is Lung> Breast > Unknown primary > Melanoma> Colon.
• The primary Solitary Brain metastasis are from Breast, Colon and Renal Cell Carcinoma.
• The multiple Brain metastasis are from Lung Cancer and Malignant Melanoma. The cancers like Prostate cancer, Esophageal cancer, Oropharyngeal cancer , Hepatocellular cancer etc. rarely metastasize to the Brain.

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Brain Tumor Clinical Symptoms

The symptoms occur when the enlarging tumor causes increase in an intracranial pressure or compression of cerebrospinal fluid circulation leading to Hydrocephalous. These are:

• Headache , with or without nausea or vomiting . It predominates in the morning and improves during the day.
• Cognitive difficulties
• Personality changes like apathy, withdrawl from social situations and  mimicking depression.
• Gait disorders
• Focal or Lateralizing symptoms like hemiparesis, aphasia or visual field defect.
• Seizures- It is common with brain metastasis or malignant gliomas.

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Brain Tumor Diagnosis

• The most important and common diagnostic method is Neuroimaging. MRI with Gadolinium contrast is the preferred diagnostic test for any patient suspected of having a brain tumor.
• In Meningioma, MRI will show extra axial well circumscribed or round homogenously enhancing dura based mass. On histology, Psammoma bodies are seen.
• Sella masses like pituitary adenoma , craniopharyngioma are incidentally found on CT/MRI head most of the time.
• Glioblastoma multiformae will be presented as Butterfly appearance with central necrosis which crosses the midline. Histologically, Pseudopallisading tumor cells surrounded by necrosis and hemorrhage are found.

                                GLIOBLASTOMA MULTIFORMAE                 

• Primary CNS lymphoma is caused by EBV mainly therefore CSF titres of EBV DNA should be done. On MRI it will present as  a weakly ring-enhancing mass that is solitary and periventricular.
• Oligodendroglioma are famously diagnosed on MRI as “fried-egg appearance” with perinuclear clearing on MRI.
• Medulloblastoma are highly cellular tumors which on staining presents as round nuclei and rosette formation also called as Homer-Wright rosettes.
• CT is done for patients who are unable to undergo the MRI.
• For metastatic tumour MRI brain is done and Chest Xray or CT scan is done for the primary tumor sign.

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Brain Tumor Prognosis

Favorable survival outcome if:

• Age<65 years
• Good functional performance status
• Stable extracranial disease

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Brain Tumor Treatment

• Glucocorticoids are given to reduce the vasogenic edema.
• In case of single brain metstasis in a surgically accessible location, the surgical resection is done followed by stereotactic radiosurgery or whole brain radiation therapy.
• In case of Surgically inaccessible or small metastasis (<3cm) , stereotactic radiosurgery is required.
• If the patient has multiple brain metastasis or poor performance status then whole brain radiation surgery or supportive care is required.
• Brachytherapy is done if the patient has any recurrence of the brain tumors. It is done with insertion of radioactive source into the intracerebral mass or surgical activity.

Also Read: Metachromatic Leukodystrophy: Cases, Symptoms, Diagnosis and Treatment

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