What Is Cancer of the Nervous System?

neurologic tumors

Nervous system tumor

Primary intracranial tumors derived from parenchymal cells of the nervous system are located in the skull, but primary intracranial tumors derived from non-brain parenchymal cells are metastatic tumors. Malignant astrogliomas account for about 50% of gliomas. Common intracranial tumors in children are gliomas and medulloblastomas.

Introduction to Nervous System Tumors

neurologic tumors

(1) primary intracranial tumors derived from parenchymal cells of the nervous system, (2) primary intracranial tumors located in the skull but not derived from parenchymal cells, and (3) metastatic tumors. The incidence of primary central nervous system tumors is about 5 to 10 million. Among them, gliomas account for 40%, meningiomas account for 15%, and acoustic neuromas (schwannomas) account for about 8%. Malignant astrogliomas account for about 50% of gliomas. Common intracranial tumors in children are gliomas and medulloblastomas.

Nervous system tumors

Central nervous system tumor

The differences between primary brain tumors and tumors in other parts of the body are as follows: Even histologically benign brain tumors, such as those growing in an unresectable site (such as an ependymal tumor at the bottom of the fourth ventricle), also cause death. Generally, brain tumors growing in parenchyma, especially astrocytomas, are invasive growth, and the boundaries are not clear to the naked eye and histology. Therefore, radical removal is almost impossible. Even histologically highly malignant brain tumors rarely metastasize. Such metastases are commonly seen in glioblastoma or myeloblastoma. However, CSF transfer is common. Certain brain tumors have specific predisposition sites. For example, medulloblastoma is localized to the cerebellum. In addition, there are predominant ages, such as medulloblastoma, which is most common within 10 years of age, and malignant astrocytoma and glioblastoma are more common in middle age or older.

1. astrocytoma

This tumor accounts for about 30% of intracranial tumors and more than 80% of gliomas. Middle-aged people are the most. The incidence of anaplastic astroglioma peaks at the age of 50, and the peak of pleomorphic glioblastoma is about 10 years later.

To the naked eye, the gray-white invasive tumor with unclear boundary generally causes swelling and deformation of nearby brain tissue. The texture varies depending on the amount of glial fiber in the tumor, either hard, soft, or jelly-like, and can form a cystic cavity containing clear liquid.

Under light microscopy, tumor cells have various morphologies and can be divided into fibrous, protoplasmic, and obese glioblastomas. The former two are benign, and the latter are between good and evil.

Fibrillary astrocytoma is the most common, and its cell density ranges from low to moderate. Stellate cell nucleus is densely stained, oval and irregular, without mitosis. A large number of cell protrusions form a loose fibrous network with microcapsules. Glial Fibrillary Acidic Protein (GFAP) was positively expressed.

Astrocytoma: Tumor cells have less cytoplasm, slender protrusions, and different nucleus sizes.

Protoplasmic astrocytoma is a rare type, which is characterized by a small astrocyte cell body, few or no protrusions, and little glial fiber content. It is often superficial and cystic.

Protoplasmic astrocytoma (grade II): rich cytoplasm and dense cells

Obese astrocyte tumor (gemistocytic astrocytoma) mainly contains obese astrocytes, the tumor cells are large eosinophils, short, blunt, angular GFAP-positive protrusions form a rough fibrous network structure, the nucleus Round, oval, usually off-center.

Anaplastic astrocytoma Anaplastic astrocytoma that is focal or diffusely poorly differentiated. It has increased cell density, polymorphism, nuclear heteromorphism, and mitotic images, and is a malignant tumor. This type often appears to progress rapidly, eventually turning into a glioblastoma.

Glioblastoma multiforme (GBM), tumors are more common in the frontal and temporal white matter, and have a wide range of invasion. They often pass through the corpus callosum to the opposite side and grow in the shape of a butterfly. The tumor is often hemorrhagic and necrotic and red-brown. Under the microscope, the cells are dense and the atypia is obvious, and weird mononuclear or multinucleated giant cells can be seen. The appearance of hemorrhagic necrosis is a feature that distinguishes it from anaplastic astrocytoma. Capillary endothelial cells proliferate and swell, which can lead to lumen occlusion and thrombosis. The prognosis of this disease is poor, and most patients die within 2 years.

Hair cell type astrocytoma (pilocytic astrocytoma) occurs in children and adolescents, and grows very slowly. The tumor is located in the cerebellum, the bottom of the third ventricle. The thalamus and optic nerve. Sometimes it also occurs in the cerebral hemisphere. Macroscopically, small nodules are formed on the wall of the vesicles, which are more localized or infiltrated. Under the microscope, it is composed of moderate density and bipolar tumor cells, with slender hairy protrusions at both ends of the cells, and endothelial cells proliferate. The tumor has a very slow growth rate and has the best prognosis in brain tumors. There are patients who have survived for more than 40 years after partial tumor resection.

Hair cell type astrocyte tumor: It is composed of moderate density and bipolar tumor cells, with hairy protrusions at both ends of the cell

According to the World Health Organization's classification standards: hair cell-type astrocyte tumors, yellow-colored astrocyte tumors, and subventricular astrocyte tumors are grade , fibrous and protoplasmic astrocytes. Glioblastoma is grade , obese astrocytoma is grade -, anaplastic astrocytoma is grade , and GBM is grade . The classification of astrocyte tumors is based on the cell's atypia, biological behavior, and whether there is necrosis and angiogenesis in the tumor. However, in different regions of the same tumor, tumor cells can have different morphological characteristics and different degrees of differentiation, so typing is only of relative significance.

2. oligodendroglioma

This tumor accounts for about 50% of gliomas. It is more common in middle-aged people and almost all occur in the cerebral hemisphere. To the naked eye, it is a localized jelly-like tumor, often accompanied by bleeding, cystic changes, and calcification. Calcification has important diagnostic reference value in radiological examination. Under the microscope, the tumor cells were uniform in size, single in shape, round in shape, round in the center of the nucleus, and perinuclear halo. Cells are diffusely arranged, but tend to line up around neurons. The stroma is rich in blood vessels and can be accompanied by varying degrees of calcification and grit. Immunohistochemical staining was positive for galactosidase, carbonic acid enzyme isoenzyme CD57, and MBP (alkaline myelin). The tumor grows slowly, and its condition can last for more than ten years, and clinical manifestations often include epilepsy or partial paralysis. If the atypia of the tumor cell is obvious, it will grow rapidly and the prognosis will be poor.

Oligodendroglioma: The tumor cells have the same size, a single shape, a round shape, a circular nucleus centered, and a perinuclear halo.

3. Ependymoma

It is derived from ependymal cells and can occur anywhere in the ventricular system. The fourth ventricle is the most common. The spinal cord is more common in the lumbosacral and cauda equina. The majority of patients are children and adolescents. To the naked eye, typical cases are located in the fourth ventricle, forming papillary tumors. Although the realm is clear, most of them are difficult to completely remove because they are close to the central medulla and pontine. But the state of tumor in the spinal cord is clear, it can be completely removed, and it can be cured. Under the microscope, the tumor cells were uniform in size and morphology, spindle-shaped or carrot-shaped, rich in cytoplasm, and round or oval in nucleus. A daisy cluster is formed, that is, the cells are arranged in a glandular tube around the cavity. Or pseudo-daisy clusters are formed, that is, tumor cells are connected to the vessel wall with slender cell processes, and some form papillary structures. The disease grows slowly and can survive for 8-10 years.

4. Medulloblastoma

More common in children, followed by children and young people, the age of onset is about 10 years old, occasionally seen in adults. Tumors are often located in the cerebellar vermis and occupy the fourth ventricle, and some cases can occur in the cerebellar hemisphere.

To the naked eye, it is a gray-white tumor with a clear state. Under the microscope, the tumor consisted of round cells with deep nucleus staining, less cytoplasm, and more mitotic images. Cells are dense. It often forms a chrysanthemum cluster, that is, the tumor cells are arranged radially around the center of the slender nerve fibers. This has certain significance for the pathological diagnosis of medulloblastoma. A few cases can differentiate into nerve cells. Clinically, the patient develops hydrocephalus or progressive cerebellar symptoms (coordination of movement disorders, staggering walking). Prone to spread through the cerebrospinal fluid. Its treatment generally uses chemotherapy and whole brain irradiation. Its 5-year survival rate is about 50% and its 10-year survival rate is 25%. Longer-term survival is rare.

5. Meningioma is derived from cells (meningeal cells) of arachnoid villi buried on both sides of the superior sagittal sinus, accounting for about 20% of all primary tumors in the skull. Most of them are benign, grow slowly, and are easy to be surgically removed. This tumor has the best prognosis in central nervous system tumors. The most common sites are the sides of the superior sagittal sinus, the cerebral sickle, the sphenoid ridge, the olfactory sulcus, the cerebellopontine angle, the foramen magnum and the spinal cord. Macroscopically, it is an irregular tumor that is closely connected to the dura mater and is trapped on the surface of the brain, but there is little infiltration in the brain. The mass is solid, gray-white, granular, white calcified sand grains are seen, and occasionally bleeding. The characteristic image under the microscope is that the meningeal skin cells are not the same size as a heart-shaped vortex, and the central vessel wall is often translucent and degenerate, so that calcification forms gritoid bodies. (Membrane cell type or fusion cell typetumor cells can also be spindle-shaped, with a densely intertwined bundle structure, and some nuclei can be arranged in a fence-like pattern, with reticular or collagen fibers (vortex cell type) visible, and sometimes cysts Sexual change or differentiation into xanthoma cells, bones, and chondrocytes, but these histological types have nothing to do with prognosis. The above-mentioned tissue type meningiomas grow slowly and benign histologically. On the contrary, they show nipples Meningiomas with a structure like a malignant process. Sometimes malignant meningiomas are directly formed. At this time, there are many cell divisions, some appear infiltration in the brain, and some look like fibrosarcoma.

Meningiomas: Tumor cells are long spindle-shaped, arranged in an intertwined bundle, with reticular and collagen fibers in between, and a few meningeal cells can be seen as small islands

Nervous system tumors

There are two types of nerve sheath tumors: neurolemmoma and neurofibroma.

(A) Schwannomas

Schwannoma, also known as Schwannoma, is a benign tumor derived from Schwannoma. It can occur in peripheral nerves throughout the body, but also in nerve roots or sympathetic nerves in the skull and vertebra. Generally single shot. Occurs in the 8th pair of cranial nerves, so it is also called acoustic neuroma. Because it is located in the cerebellopontine angle, also known as cerebellopontine horn tumor. It is found next to the trigeminal nerve, and other cranial nerves are rarely affected.

To the naked eye, tumors vary in size, are round or nodular, solid, and have a complete envelope. The surrounding tissues are often pressed, but no infiltration occurs. The cut surface is grayish white or grayish yellow * color is slightly transparent, vortex structure can be seen, sometimes bleeding or cystic changes can be seen.

Under the microscope, there are two types of tissue: bundle-shaped (AntoniA type), tumor cells are slender spindle-shaped, the state is unclear, the nucleus is oblong, arranged closely and parallel to each other, showing a fence-like or incomplete spiral-like arrangement , Called Verocay body. Reticulum type (AntoniB type) cells are scarce, arranged in a loose reticular structure, there is more mucus-like liquid between cells, and small cysts are often formed, but most of them are mainly one type. Long-term tumors have fewer cells, more collagen fibers, fibrous scars, and hyaline degeneration.

(Two) neurofibromas

Neurofibroma (neurofibroma) occurs mostly under the skin and can be single or multiple. It is also called neurofibroma.

To the naked eye, the tumor had a clear realm, but it was unencapsulated, solid, and the cut surface was grayish and slightly transparent. Some cut surfaces showed swirling fibers, but degeneration, cystic cavity formation or bleeding rarely occurred.

Under the microscope, it is composed of nerve sheath cells and fibroblasts, which are bundled into small fibers and dispersed among nerve fibers, with reticular, collagen fibers, and a mucus-like matrix. Like the schwannoma described above, significant nuclear atypia can occur. Sometimes tumor giant cells appear. But these changes do not imply a poor prognosis. Nerve sheath tumors can't see nerve fibers at all. In addition to the tumor's nerve part, some are oppressed by the tumor. But in neurofibromas, nerve fibers are scattered inside the tumor, and this part of the nerve fiber bundles are all swollen. Therefore, nerve fibers in schwannoma are only compressed by the tumor and can be removed without cutting the nerve. However, in neurofibromas, all nerves are involved, which is different from schwannomas. Both can be malignant, which is characterized by dense, pleomorphic cells, increased nuclear division, angiogenesis, and tumors similar to fibrosarcoma. Malignant schwannoma can occur from young children to young people, and the course is long, usually more than 5 years.

Third, metastatic tumor

Metastatic tumors of the central nervous system account for about one fifth of all clinical tumors, and brain metastases can occur in 10% to 50% of deaths from malignant tumors. The most prone to brain metastases are lung cancer, breast cancer, melanoma, and colon cancer. Metastasis often occurs at the junction of white and gray matter and in the brain. Focal occupancy symptoms are optional. Some tumor cells diffusely infiltrate the subarachnoid space. Some diffuse perivascular tumor cell infiltration can form localized nodules. The metastatic tumor has a similar morphology to the primary tumor. Often accompanied by bleeding, necrosis, cystic degeneration, and liquefaction.

Nervous system tumor copyright information

Title: Nervous System Tumor (Chinese Oncologist Clinical Practice Guide Book Series)

Author: Chen Zhongping

Publisher: Peking University Medical Press

Published: 2009

ISBN: 9787811166019

Folio: 16

Price: 135.00 RMB

Introduction to Nervous System Tumor

"Nervous System Tumor" is one of the continuing education reference books of the Chinese Anti-Cancer Association. It is written by experts in the field of neuro-tumor related organizations organized by the Neuro-Cancer Professional Committee of the Chinese Anti-Cancer Association. It is a more detailed book from the perspective of oncology. A professional reference book describing the basic and clinical aspects of neurological tumors.

"Nervous System Tumor" includes a general section of chapters 1 to 15 and a monograph section of chapters 16 to 60. The general part introduces the basic content of neuro-oncology such as the epidemiology, molecular biology, pathology, neuroendocrinology, cell culture, animal models of neurological tumors. The general clinical contents of neuro-oncology such as imaging diagnosis, surgical treatment, radiation therapy, chemotherapy, and photodynamic therapy, immunotherapy, gene therapy, and quality of life of patients that have developed rapidly in recent years are also systematically explained. According to the common pathological types of tumors, the monographs specifically explain the characteristics, diagnosis and treatment of each tumor, and also introduce the latest research progress and developments.

"Nervous System Tumor" is rich in content, pays attention to details, and is normative and operable. The book provides a wealth of pathological and imaging pictures to help readers understand the contents of "Nervous System Tumor" more intuitively. "Nervous System Tumor" combines practicality and research, and is a reference book for clinical and basic researchers in neurological tumor related disciplines.

Nervous system tumor author profile

Chen Zhongping is from Jiangyin, Jiangsu. He graduated from Suzhou Medical College in 1982 and received a PhD in neurosurgery in 1993. Received training as a neurosurgeon specialist in the First Affiliated Hospital of Suzhou Medical College, and did postdoctoral research / FlesearchAssociate (1993-1999) in the Department of Neurosurgery and Oncology at McGill University in Canada. In 1999, he returned to China to establish neurosurgery at the Cancer Hospital of Sun Yat-sen University, and served as director, professor, and doctoral supervisor. Professor Chen Zhongping has been engaged in neurosurgical medicine, teaching and scientific research. He is good at micro neurosurgery and has rich experience in individualized comprehensive treatment of brain (neurological) tumors, especially gliomas. Intensive research has been done on the molecular mechanism of glioma resistance / radiation resistance. The basic and clinical applications of immunotherapy for malignant brain tumors (such as the development of glioma fusion tumor vaccines, local immunotherapy for gliomas with CIK cells, etc.) have also been explored. It was also first reported internationally in 2005 that gliomas also have an angiogenic mimicry (VascLJlogerIicMirnicry). Published more than 100 academic papers, more than 20 of which have been published in SCI journals. Published two monographs, "Glioma" (one of the editors) and "Brain Tumor Molecular Surgery" (Associate Editor), and participated in the compilation of "96/97 Tissue and Cell Transplantation Yearbook" and "Pituitary Tumor" focus on. He has won a number of domestic and foreign academic awards, including the WHO Young Chinese (Neuroscience) Excellent Monograph Award (1993), the Canadian Neuroscience Society Award (1998) and the Wang Zhongcheng Neurosurgeon Academic Award (2006). Professor Chen Zhongping has also done a lot of active work for the development of neuro-oncology in China. In 2001, the Guangzhou Anti-Cancer Association Neuronecology Professional Committee was established and served as the chairman of the committee. At the same time, China's first neuro-tumor academic journal-"Neuro-Oncology Newsletter" was founded, and in 2003 it was revised to "China Neuro-Oncology" He is the editor-in-chief. In 2004, he set up and established the China Cancer Society's Neuro-Oncology Professional Committee as its chairman.

Neurological tumor editor recommendation

The Chinese Cancer Physician's Guide to Clinical Practice was compiled by all the professional committees of the China Anti-Cancer Association. The aim is to make the series a professional, instructive, practical, and normative book, covering all common tumors. Series of books to standardize and guide the diagnosis and treatment of tumors, reduce the gap between the level of diagnosis and treatment between regions and hospitals, improve the overall level of diagnosis and treatment of tumors in China, and reduce cancer mortality in China. It also provides a set of authoritative, standardized, and highly clinically practical guides or reference manuals for primary medical workers nationwide and junior and intermediate doctors involved in oncology. The series will also serve as continuing education materials for the China Cancer Society.

Nervous System Tumor Directory

. General

Chapter 1. Epidemiology of Brain Tumors

Chapter 2 Molecular Genetics of Brain Tumors

Chapter 3 Imaging Diagnosis

Section CT

Section II Magnetic Resonance Imaging

The application of PET-CT in the diagnosis of brain tumors

Section 4 SPECT

Section 5 EEG

Chapter 4 Pathology

Section 1 Development History, Status Quo and Future

Section II Organization Origin, Nomenclature and Hierarchy

Pathology of central nervous system tumors

...