Table Of ContentD.G.T. Thomas and DJ. Graham (Eds)
Malignant
Brain Tumours
With 135 Figures
including 40 Calaur Plates
Springer-Verlag
London Berlin Heidelberg New York
Paris Tokyo Hong K.ong
Barcelona Budapest
David G.T. Thomas, MA, FRCP(G), FRCS Ed.
Professor, Institute of Neurology, Gough-Cooper Department of
Neurological S urge ry, The National HospitaL Queen Square,
London WCIN 3BG
David I. Graham, MBBCh, PhD, FRCPath, FRS(Ed)
Professor, Department of Neuropathology, Institute of
Neurological Sciences, Southern General HospitaL Glasgow
G514TF
ISBN-13: 978-1-4471-1879-4 e-ISBN-13: 978-1-4471-1877-0
DOI: 10.1007/ 978-1-4471-1877-0
British Library Cataloguing in Publication Data
Malignant Brain Tumours
I. Thomas, D.G.T. n. Graham, David I.
616.99
Library of Congress Cataloging-in-Publication Data
A catalog re cord for this book is available from the Library of Congress
Apart from any fair dealing for the purposes of research or private study, or crit
icism or review, as permitted under the Copyright, Designs and Patents Act
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© Springer-Verlag London Limited 1995
Softeover reprint of the hardeover 1st edition 1995
The publisher makes no representation, express or implied, with regard to the
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Contents
Preface ... . xv
Contributors . xvii
1 Cellular and Molecular Approaches to the Study
of Gliomas and Glial Development
M. Noble, K. Bevan and D. Venter. . . . . . . . 1
Glial eelI development in the rat optic nerve . 1
Control of self-renewal in the 0-2A lineage . 3
Glial and neuronal deveIopment in the retina and
eortex . . . . . . . . . . . . . . . . . . . . . 4
Ramifieations of eurrent development studies for
neuropathology . . . . . . . . . . . . . . . 5
A serological analysis of gliomas ....... 6
Glioma-derived eelIs ean be divided into two
superfamilies on the basis of antigen expression 6
Antigenic and morphological analyses of gliomas
yieId eonflieting classifieation systems 7
Potential for positive feedbaek loops as
eontributors to growth of gliomas 8
Conclusion 9
Referenees . . . . . . . . . . . . . 10
2 Molecular Genetics of Brain Tumours
e.E. Jones and A.E. Harding ....... 13
Genetie teehniques in studies of brain tumours 13
Moleeular basis of tumorigenesis ...... 16
Moleeular genetics of benign brain tumours 18
Cytogenetic and moleeular genetic studies of
malignant brain tumours: gliomas 20
Oneogenes and gliomas ....... 22
Moleeular genetics of neuroblastomas 25
Conclusion 26
Referenees . . . . . . . . . . . . . . 27
vi Contents
3 Current Concepts of the Histopathological
Classification of Tumours of the Central Nervous
System
S.R. VandenBerg, R.B. HessIer and M.B.S. Lopes 29
Introduction. . . . . . . . . . . . 29
Tumours of neuroepithelial tissue. . . . . . 32
Astroeytic tumours . . . . . . . . . . . . 32
Astroeytomas: fibrillary; protoplasmic;
gemistoeytic (neuroimaging eorrelations) . 33
Anaplastic astroeytoma . . . . . . . . . . . 38
Glioblastoma multiforme: giant eelI glioblastoma;
gliosarcoma . . . . . . . . . . 41
Piloeytic astroeytoma ......... 45
Pleomorphic xanthoastroeytoma . . . 46
Subependymal giant eelI astroeytoma 48
Oligodendroglial tumours . . . 49
Oligodendroglioma ..... 49
Anaplastic oligodendroglioma 51
Ependymal tumours . . . . 53
Ependymoma . . . . . . . . 53
Anaplastic ependymoma 55
Myxopapillaryependymoma 55
Subependymoma . . . . 57
Mixed gliomas . . . . . . . . . 58
Mixed oligo-astroeytoma .. 58
Malignant oligo-astroeytoma 59
Choroid plexus tumours . . . 59
Choroid plexus papilloma . . 59
Choroid plexus earcinoma . . 60
Neuronal and mixed neuronal-glial tumours 60
Ganglioeytoma. . . . . . . . . . . . . . . 60
Dysplastic ganglioeytoma of the eerebellum . 61
Desmoplastic infantile ganglioglioma . . . 62
Dysembryoplastic neuroepithelial tumour . 63
Ganglioglioma . . . . . . 65
Malignant ganglioglioma. . 66
Central neurocytoma. . . . 68
Pineal parenehymal tumours . 68
Pineoeytoma . . . . . . . . 70
Pineoblastoma . . . . . . . 72
Mixed pineoeytoma/pineoblastoma 74
Embryonal tumours (neuroimaging eorrelations) 74
Medulloepithelioma 76
Neuroblastoma. . . 77
Ependymoblastoma 78
Retinoblastoma .. 79
Medulloblastoma . 81
Tumours of the meninges . . . . . 84
Tumours of meningothelial eelIs . . . . . . . . .. 84
Contents vii
Meningioma . . . . . . . . . . . . . 86
Atypical meningioma ........ 88
Anaplastic (malignant) meningioma 89
Papillary meningioma . . . . . . . . 91
Mesenchymal, non-meningothelial tumours . 91
Haemangiopericytoma . . . . . 92
Tumours of uncertain histogenesis 93
Haemangioblastoma . . . . . . 93
References . . . . . . . . . . . . . . 96
Colour plate section appears between pages 42 and 43
4 General Introduction to the Clinical Features of
Malignant Brain Tumours
M.F. Pell and D.G.T. Thomas. . . . . . . . . . . 109
Epidemiology . . . . . . . . . . . . . . . . . . 109
Clinical presentation of primarv malignant brain
tumours ................... 110
Symptoms and signs of raised intracranial pressure 111
Epilepsy. . . . . . . . 111
Focal signs ....... 112
Speeific dinical syndromes 112
Glioblastoma 113
References . . . . . . . . . 114
5 Complications of Primarv Malignant Brain
Tumours
N. V. Todd and D.I. Graham . . . . . 115
Complications of the tumour itself 115
Raised intracranial pressure 115
Clinical effects . . 115
Brain complianee 117
Tumour volume 118
Brain oedema 118
Hydrocephalus . . 119
Pathology of intracranial expanding lesions 120
Supratentorial expanding lesions: supracallosal
hernia; tentorial hernia; central transtentorial
hernia; haemorrhage and infarction in the
midbrain and pons .............. 120
Infratentorial expanding lesions: tonsillar hernia . 123
Other features: pressure effects up on the skull;
external herniation; pituitary 124
Focal or site-speeific complications 124
Epilepsy ......... 124
Focal neurological defieit 125
Spontaneous haemorrhage . 126
Metastasis of primarv brain tumours 128
Complications of treatment . . . . . . 131
viii Contents
Surgery . . . . . . . 131
Risks and benefits 131
Freehand biopsy . 132
Stereotaxic biopsy 132
InternaI decompression of tumour . 133
Radiotherapy . . . . . . . 134
Acute reaetions . . . . . . . . . . . 135
Early delayed reactions ...... 135
Late delayed reactions: radionecrosis; diffuse
leucoencephalopathy; intellectual deficits;
hypothalamic-pituitary dysfunction; blindness;
induction of brain tumours; alternative
techniques of focused radiation . . . . . . . . 136
Chemotherapy: systemic complications;
CNS complications; acute cerebellar syndrome;
acute encephalopathy; chronic encephalopathy;
neuropathology of disseminated necrotizing
leucoencephalopathy; osmotic blood-brain
barrier opening; other complications of
antineoplastic agents . 141
Steroids 144
References . . . . . . 145
6 Low-grade Gliomas
J. Koivukangas . . . . 151
Introduction . . . . . . . . . . . 151
Low-grade cerebral astrocytoma . 151
Incidence . . . . . . 152
Patient series . . . . 153
Clinical presentation 153
Special features . . . 155
Development of malignancy. 155
Infiltration of astrocytomas. . . . . . . . . . . . .156
Neurosurgical management 156
Expectant management. 157
Biopsy. . . . . . . . 157
Stereotaxic biopsy 158
Open biopsy . . . 158
Removal of tumour . 159
Stereotaxic resection of low-grade astrocytoma 161
Non-stereotaxic resection of low-grade
astrocytoma: rehearsal of surgical procedure;
placement of craniotomy; ultrasound imaging;
microsurgical dissection 161
Evaluation of surgical results 166
Future Considerations 168
Acknowledgements 168
References . . . . . . 169
Contents ix
7 Management of Brain Tumours in Childhood
J. Punt . . . . . . . . . . . . . . . . . . . . 171
Introduction: the sites; the cells; the patients 171
Primitive neuroectodermal tumour (PNET) 173
Surgery . . . . . . 173
Radiation therapy . 174
Chemotherapy . 175
Brain stern glioma . 176
Craniopharyngioma 177
Surgery . . . . . 177
Radiation therapy . 179
Chemotherapy 180
Conclusion 180
Ependymoma . . 181
Surgery . . . . 181
Radiation therapyand chemotherapy 182
Pineal region tumours . . . . . . . . . . 183
Radiation therapyand chemotherapy 185
Conclusion . 185
References . . . . . . . . . . . . . . . . 186
8 Central Nervous System Neoplasms in Acquired
Immunodeficiency Syndrome
Y. T. So, R.L. Davis and J.H. Beckstead 193
Introduction . . . . . . . 193
Primary CNS lymphoma . 193
Clinieal manifestations 194
Pathology . . . . . . . 194
Treatment and prognosis 195
Systemie non-Hodgkin's lymphoma . 196
Clinieal manifestations . 197
Pathology . . . . . . . . 198
Treatment and prognosis 199
Kaposi's sareoma ..... 199
Pathogenesis of neoplasms in immune deficiency . 199
References . . . . . . . . . . . . . . . . . . . .. 200
9 Metastatic Brain Tumours
K. Takakura 203
Introduction . . . . 203
General aspects .. 203
Primary tumours 203
Sites of metastatie involvement . 205
Histologieal diagnosis 206
Age and sex . . . . . . . 206
Signs and symptoms . . . . 209
Neurological symptoms . 209
x Contents
Time of ons et . . . . . . . . 210
Investigations . . . . . . . . . 211
Computed tomography sean 211
Magnetie resonanee imaging 214
Angiography . . . . . . . . 215
Eleetroeneephalography .. 216
Cytologieal examination of eerebrospinal fluid . 216
Tumour markers 217
Treatment . . . 217
Surgery . . . . . 217
Indication 217
Preoperative management 218
Surgieal technique 218
Postoperative eare 218
Radiotherapy . . . . 218
Chemotherapy . . . 219
Biological resp ons e modifiers 219
Outeome of treatment 219
Referenees . . . . . . . . . . . 220
10 Diagnostic Imaging of Brain Tumours
E.E. Kendal! and J. V. Hunter 221
Introduction . . . . . . . . . . . . . . . . 221
Deteetion of an abnormality . . . . . . . . 221
Computed tomography and magnetie resonanee
imaging. . 221
Fluid . . . . . 222
Calcifieation . 223
Haemorrhage . 223
Oedema 224
Contrast enhaneement 224
Mass effeet of tumours 226
Loealization and assessment of extent of abnormality. 230
Supratentorial masses. 230
Cerebellar masses . . . . 230
Brain stem tumours. . . 231
Charaeterization of a lesion 231
Gl ial tumours . . . . . . 231
Infaretion . . . . . . . . 233
Intraeerebral haemorrhage 233
Cerebral abseess. . . . 235
Granuloma . . . . . . . . 235
Opportunistie infeetion . . 237
Progressive multifoealleueoeneephalopathy . 237
Herpes simplex virus eneephalitis . 237
Parasitie infeetions 238
Hydatidosis . 238
Cystieereosis . . 238
Contents xi
Paragonimiasis, schistosomiasis 238
Extrinsie tumours 239
Meningioma . . . . . . 239
Epidermoid. . . . . . . 241
Cholesterol granuloma . 241
Dermoid . . . . . . . . 243
Parasellar tumours (intrinsie and extrinsie) 243
Chordoma, chondroma, chondrosarcoma 244
Neurinoma . . . . . . 244
Paraganglioma . . . . 244
Extrinsie malignancies 245
Sphenoid mucocele. . 245
Subdural and extradural empyema 245
Meningeal infiltration . . . . . . . 245
Intracerebral metastasis. . . . . . . . 245
Imaging characteristies of intrinsie tumours . 249
Anaplastie or malignant astrocytoma - grades III
and IV ... . . . . . . . . . . . . 250
Benign astrocytoma - grades I and II . 251
Subependymal giant cell astrocytoma. 251
Lhermitte-Duclos disease . 254
Ganglioglioma . 255
Hamartoma . . . . 255
Ependymoma . . . 255
Oligodendroglioma 256
Malignant lymphoma . 256
Primitive neuroectodermal tumour . 257
Classieal meduHoblastoma . . 257
Adult meduHoblastoma. . . . . . 258
Congenital meduHoblastoma . . . 258
Supratentorial neuroectodermal tumour 258
Colloid cyst . . . . . . . . . . 258
Choroid plexus papiHoma. . . 258
Intraventricular meningioma . 259
Pineal region tumour 259
Germinoma. . . 259
Pineal teratoma. . 260
Pineocytoma . . . 260
Pineal astrocytoma 260
Haemangioblastoma. 260
Multiple primary brain tumours 260
Cavernous haemangioma. . . . 261
Neuroblastoma . . . . . . . . . 261
Facilitation of treatment and further surgieal
planning. . . . . . . . . . . . . . . . . . 261
Monitoring of therapyand outeüme of treatment . 262
Surgery . . . 262
Radiotherapy 262
References . . . 263
