Brain Terms and Definitions
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Central Nervous System Cancers Panel Members Can Be Found on Page 1151
1114 NCCN David Tran, MD, PhD; Nam Tran, MD, PhD; Frank D. Vrionis, MD, MPH, PhD; Patrick Y. Wen, MD; Central Nervous Nicole McMillian, MS; and Maria Ho, PhD System Cancers Overview In 2013, an estimated 23,130 people in the United Clinical Practice Guidelines in Oncology States will be diagnosed with primary malignant brain Louis Burt Nabors, MD; Mario Ammirati, MD, MBA; and other central nervous system (CNS) neoplasms.1 Philip J. Bierman, MD; Henry Brem, MD; Nicholas Butowski, MD; These tumors will be responsible for approximately Marc C. Chamberlain, MD; Lisa M. DeAngelis, MD; 14,080 deaths. The incidence of primary brain tumors Robert A. Fenstermaker, MD; Allan Friedman, MD; Mark R. Gilbert, MD; Deneen Hesser, MSHSA, RN, OCN; has been increasing over the past 30 years, especially in Matthias Holdhoff, MD, PhD; Larry Junck, MD; elderly persons.2 Metastatic disease to the CNS occurs Ronald Lawson, MD; Jay S. Loeffler, MD; Moshe H. Maor, MD; much more frequently, with an estimated incidence ap- Paul L. Moots, MD; Tara Morrison, MD; proximately 10 times that of primary brain tumors. An Maciej M. Mrugala, MD, PhD, MPH; Herbert B. Newton, MD; Jana Portnow, MD; Jeffrey J. Raizer, MD; Lawrence Recht, MD; estimated 20% to 40% of patients with systemic cancer Dennis C. Shrieve, MD, PhD; Allen K. Sills Jr, MD; will develop brain metastases.3 Abstract Please Note Primary and metastatic tumors of the central nervous system are The NCCN Clinical Practice Guidelines in Oncology a heterogeneous group of neoplasms with varied outcomes and (NCCN Guidelines®) are a statement of consensus of the management strategies. -
Malignant Glioma Arising at the Site of an Excised Cerebellar Hemangioblastoma After Irradiation in a Von Hippel-Lindau Disease Patient
DOI 10.3349/ymj.2009.50.4.576 Case Report pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 50(4): 576-581, 2009 Malignant Glioma Arising at the Site of an Excised Cerebellar Hemangioblastoma after Irradiation in a von Hippel-Lindau Disease Patient Na-Hye Myong1 and Bong-Jin Park2 1Department of Pathology, Dankook University College of Medicine, Cheonan; 2Department of Neurosurgery, Kyunghee University Hospital, Seoul, Korea. We describe herein a malignant glioma arising at the site of the resected hemangioblastoma after irradiation in a patient with von Hippel-Lindau disease (VHL). The patient was a 25 year-old male with multiple heman- gioblastomas at the cerebellum and spinal cord, multiple pancreatic cysts and a renal cell carcinoma; he was diagnosed as having VHL disease. The largest hemangioblastoma at the right cerebellar hemisphere was completely removed, and he received high-dose irradiation postoperatively. The tumor recurred at the same site 7 years later, which was a malignant glioma with no evidence of hemangioblastoma. The malignant glioma showed molecular genetic profiles of radiation-induced tumors because of its diffuse p53 immunostaining and the loss of p16 immunoreactivity. The genetic study to find the loss of heterozygosity (LOH) of VHL gene revealed that only the cerebellar hemangioblastoma showed allelic losses for the gene. To the best of our knowledge, this report is the first to show a malignant glioma that developed in a patient with VHL disease after radiation therapy at the site of an excised hemangioblastoma. This report also suggests that radiation therapy should be performed very carefully in VHL patients with hemangioblastomas. -
Charts Chart 1: Benign and Borderline Intracranial and CNS Tumors Chart
Charts Chart 1: Benign and Borderline Intracranial and CNS Tumors Chart Glial Tumor Neuronal and Neuronal‐ Ependymomas glial Neoplasms Subependymoma Subependymal Giant (9383/1) Cell Astrocytoma(9384/1) Myyppxopapillar y Desmoplastic Infantile Ependymoma Astrocytoma (9412/1) (9394/1) Chart 1: Benign and Borderline Intracranial and CNS Tumors Chart Glial Tumor Neuronal and Neuronal‐ Ependymomas glial Neoplasms Subependymoma Subependymal Giant (9383/1) Cell Astrocytoma(9384/1) Myyppxopapillar y Desmoplastic Infantile Ependymoma Astrocytoma (9412/1) (9394/1) Use this chart to code histology. The tree is arranged Chart Instructions: Neuroepithelial in descending order. Each branch is a histology group, starting at the top (9503) with the least specific terms and descending into more specific terms. Ependymal Embryonal Pineal Choro id plexus Neuronal and mixed Neuroblastic Glial Oligodendroglial tumors tumors tumors tumors neuronal-glial tumors tumors tumors tumors Pineoblastoma Ependymoma, Choroid plexus Olfactory neuroblastoma Oligodendroglioma NOS (9391) (9362) carcinoma Ganglioglioma, anaplastic (9522) NOS (9450) Oligodendroglioma (9390) (9505 Olfactory neurocytoma Ganglioglioma, malignant (()9521) anaplastic (()9451) Anasplastic ependymoma (9505) Olfactory neuroepithlioma Oligodendroblastoma (9392) (9523) (9460) Papillary ependymoma (9393) Glioma, NOS (9380) Supratentorial primitive Atypical EdEpendymo bltblastoma MdllMedulloep ithliithelioma Medulloblastoma neuroectodermal tumor tetratoid/rhabdoid (9392) (9501) (9470) (PNET) (9473) tumor -
Central Nervous System Tumors General ~1% of Tumors in Adults, but ~25% of Malignancies in Children (Only 2Nd to Leukemia)
Last updated: 3/4/2021 Prepared by Kurt Schaberg Central Nervous System Tumors General ~1% of tumors in adults, but ~25% of malignancies in children (only 2nd to leukemia). Significant increase in incidence in primary brain tumors in elderly. Metastases to the brain far outnumber primary CNS tumors→ multiple cerebral tumors. One can develop a very good DDX by just location, age, and imaging. Differential Diagnosis by clinical information: Location Pediatric/Young Adult Older Adult Cerebral/ Ganglioglioma, DNET, PXA, Glioblastoma Multiforme (GBM) Supratentorial Ependymoma, AT/RT Infiltrating Astrocytoma (grades II-III), CNS Embryonal Neoplasms Oligodendroglioma, Metastases, Lymphoma, Infection Cerebellar/ PA, Medulloblastoma, Ependymoma, Metastases, Hemangioblastoma, Infratentorial/ Choroid plexus papilloma, AT/RT Choroid plexus papilloma, Subependymoma Fourth ventricle Brainstem PA, DMG Astrocytoma, Glioblastoma, DMG, Metastases Spinal cord Ependymoma, PA, DMG, MPE, Drop Ependymoma, Astrocytoma, DMG, MPE (filum), (intramedullary) metastases Paraganglioma (filum), Spinal cord Meningioma, Schwannoma, Schwannoma, Meningioma, (extramedullary) Metastases, Melanocytoma/melanoma Melanocytoma/melanoma, MPNST Spinal cord Bone tumor, Meningioma, Abscess, Herniated disk, Lymphoma, Abscess, (extradural) Vascular malformation, Metastases, Extra-axial/Dural/ Leukemia/lymphoma, Ewing Sarcoma, Meningioma, SFT, Metastases, Lymphoma, Leptomeningeal Rhabdomyosarcoma, Disseminated medulloblastoma, DLGNT, Sellar/infundibular Pituitary adenoma, Pituitary adenoma, -
Adrenal Neuroblastoma Mimicking Pheochromocytoma in an Adult With
Khalayleh et al. Int Arch Endocrinol Clin Res 2017, 3:008 Volume 3 | Issue 1 International Archives of Endocrinology Clinical Research Case Report : Open Access Adrenal Neuroblastoma Mimicking Pheochromocytoma in an Adult with Neurofibromatosis Type 1 Harbi Khalayleh1, Hilla Knobler2, Vitaly Medvedovsky2, Edit Feldberg3, Judith Diment3, Lena Pinkas4, Guennadi Kouniavsky1 and Taiba Zornitzki2* 1Department of Surgery, Hebrew University Medical School of Jerusalem, Israel 2Endocrinology, Diabetes and Metabolism Institute, Kaplan Medical Center, Hebrew University Medical School of Jerusalem, Israel 3Pathology Institute, Kaplan Medical Center, Israel 4Nuclear Medicine Institute, Kaplan Medical Center, Israel *Corresponding author: Taiba Zornitzki, MD, Endocrinology, Diabetes and Metabolism Institute, Kaplan Medical Center, Hebrew University Medical School of Jerusalem, Bilu 1, 76100 Rehovot, Israel, Tel: +972-894- 41315, Fax: +972-8 944-1912, E-mail: [email protected] Context 2. This is the first reported case of an adrenal neuroblastoma occurring in an adult patient with NF1 presenting as a large Neurofibromatosis type 1 (NF1) is a genetic disorder asso- adrenal mass with increased catecholamine levels mimicking ciated with an increased risk of malignant disorders. Adrenal a pheochromocytoma. neuroblastoma is considered an extremely rare tumor in adults and was not previously described in association with NF1. 3. This case demonstrates the clinical overlap between pheo- Case description: A 42-year-old normotensive woman with chromocytoma and neuroblastoma. typical signs of NF1 underwent evaluation for abdominal pain, Keywords and a large 14 × 10 × 16 cm left adrenal mass displacing the Adrenal neuroblastoma, Neurofibromatosis type 1, Pheo- spleen, pancreas and colon was found. An initial diagnosis of chromocytoma, Neural crest-derived tumors pheochromocytoma was done based on the known strong association between pheochromocytoma, NF1 and increased catecholamine levels. -
Deconstructing Spinal Interneurons, One Cell Type at a Time Mariano Ignacio Gabitto
Deconstructing spinal interneurons, one cell type at a time Mariano Ignacio Gabitto Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy under the Executive Committee of the Graduate School of Arts and Sciences COLUMBIA UNIVERSITY 2016 © 2016 Mariano Ignacio Gabitto All rights reserved ABSTRACT Deconstructing spinal interneurons, one cell type at a time Mariano Ignacio Gabitto Abstract Documenting the extent of cellular diversity is a critical step in defining the functional organization of the nervous system. In this context, we sought to develop statistical methods capable of revealing underlying cellular diversity given incomplete data sampling - a common problem in biological systems, where complete descriptions of cellular characteristics are rarely available. We devised a sparse Bayesian framework that infers cell type diversity from partial or incomplete transcription factor expression data. This framework appropriately handles estimation uncertainty, can incorporate multiple cellular characteristics, and can be used to optimize experimental design. We applied this framework to characterize a cardinal inhibitory population in the spinal cord. Animals generate movement by engaging spinal circuits that direct precise sequences of muscle contraction, but the identity and organizational logic of local interneurons that lie at the core of these circuits remain unresolved. By using our Sparse Bayesian approach, we showed that V1 interneurons, a major inhibitory population that controls motor output, fractionate into diverse subsets on the basis of the expression of nineteen transcription factors. Transcriptionally defined subsets exhibit highly structured spatial distributions with mediolateral and dorsoventral positional biases. These distinctions in settling position are largely predictive of patterns of input from sensory and motor neurons, arguing that settling position is a determinant of inhibitory microcircuit organization. -
Delineating the Diversity of Spinal Interneurons in Locomotor Circuits
The Journal of Neuroscience, November 8, 2017 • 37(45):10835–10841 • 10835 Mini-Symposium Delineating the Diversity of Spinal Interneurons in Locomotor Circuits Simon Gosgnach,1 Jay B. Bikoff,2 XKimberly J. Dougherty,3 Abdeljabbar El Manira,4 XGuillermo M. Lanuza,5 and Ying Zhang6 1Department of Physiology, University of Alberta, Edmonton, Alberta T6G 2H7, Canada, 2Department of Neuroscience, Columbia University, New York, New York 10032, 3Department of Neurobiology and Anatomy, Drexel University, Philadelphia, Pennsylvania 19129, 4Department of Neuroscience, Karolinska Institutet, Stockholm SE-171 77, Sweden, 5Department of Developmental Neurobiology, Fundacion Instituto Leloir, Buenos Aires C1405BWE, Argentina, and 6Department of Medical Neuroscience, Dalhousie University. Halifax, Nova Scotia B3H 4R2, Canada Locomotion is common to all animals and is essential for survival. Neural circuits located in the spinal cord have been shown to be necessary and sufficient for the generation and control of the basic locomotor rhythm by activating muscles on either side of the body in a specific sequence. Activity in these neural circuits determines the speed, gait pattern, and direction of movement, so the specific locomotor pattern generated relies on the diversity of the neurons within spinal locomotor circuits. Here, we review findings demon- strating that developmental genetics can be used to identify populations of neurons that comprise these circuits and focus on recent work indicating that many of these populations can be further subdivided -
The Spinal Cord Is a Nerve Column That Passes Downward from Brain Into the Vertebral Canal
The spinal cord is a nerve column that passes downward from brain into the vertebral canal. Recall that it is part of the CNS. Spinal nerves extend to/from the spinal cord and are part of the PNS. Length = about 17 inches Start = foramen magnum End = tapers to point (conus medullaris) st nd and terminates 1 –2 lumbar (L1-L2) vertebra Contains 31 segments à gives rise to 31 pairs of spinal nerves Note cervical and lumbar enlargements. cauda equina (“horse’s tail”) –collection of spinal nerves at inferior end of vertebral column (nerves coming off end of spinal cord) Meninges- cushion and protected by same 3 layers as brain. Extend past end of cord into vertebral canal à spinal tap because no cord A cross-section of the spinal cord resembles a butterfly with its wings outspread (gray matter) surrounded by white matter. GRAY MATTER or “butterfly” = bundles of cell bodies Posterior (dorsal) horns=association or interneurons (incoming somatosensory information) Lateral horns=autonomic neurons Anterior (ventral) horns=cell bodies of motor neurons Central canal-found within gray matter and filled with CSF White Matter: 3 Regions: Posterior (dorsal) white column or funiculi – contains only ASCENDING tracts à sensory only Lateral white column or funiculi – both ascending and descending tracts à sensory and motor Anterior (ventral) white column or funiculi – both ascending and descending tracts à sensory and motor All nerve tracts made of mylinated axons with same destination and function Associated Structures: Dorsal Roots = made -
Spinal Cord Organization
Lecture 4 Spinal Cord Organization The spinal cord . Afferent tract • connects with spinal nerves, through afferent BRAIN neuron & efferent axons in spinal roots; reflex receptor interneuron • communicates with the brain, by means of cell ascending and descending pathways that body form tracts in spinal white matter; and white matter muscle • gives rise to spinal reflexes, pre-determined gray matter Efferent neuron by interneuronal circuits. Spinal Cord Section Gross anatomy of the spinal cord: The spinal cord is a cylinder of CNS. The spinal cord exhibits subtle cervical and lumbar (lumbosacral) enlargements produced by extra neurons in segments that innervate limbs. The region of spinal cord caudal to the lumbar enlargement is conus medullaris. Caudal to this, a terminal filament of (nonfunctional) glial tissue extends into the tail. terminal filament lumbar enlargement conus medullaris cervical enlargement A spinal cord segment = a portion of spinal cord that spinal ganglion gives rise to a pair (right & left) of spinal nerves. Each spinal dorsal nerve is attached to the spinal cord by means of dorsal and spinal ventral roots composed of rootlets. Spinal segments, spinal root (rootlets) nerve roots, and spinal nerves are all identified numerically by th region, e.g., 6 cervical (C6) spinal segment. ventral Sacral and caudal spinal roots (surrounding the conus root medullaris and terminal filament and streaming caudally to (rootlets) reach corresponding intervertebral foramina) collectively constitute the cauda equina. Both the spinal cord (CNS) and spinal roots (PNS) are enveloped by meninges within the vertebral canal. Spinal nerves (which are formed in intervertebral foramina) are covered by connective tissue (epineurium, perineurium, & endoneurium) rather than meninges. -
Gliomatosis Cerebri with Neurofibromatosis: an Autopsy-Proven Case
Child's Nerv Syst (1999) 15:219-221 © Springer-Verlag 1999 BRILF Önal Gliomatosis cerebri with neurofibromatosis: Çiçek an autopsy-proven case Gliomatosis cerebri Received: 15 July 1998 Abstract is a stereotactic ante-mortem diagnosis glial neoplastic process that is dif- and the other after autopsy. in this fusely distributed through neural paper. the autopsy-proven case Ç. Önal (BI) 1 • Ç. structures, whose anatomical config- of this rare disease with coexistent Department of Neurosurgery, uration remains Among the neurofibromatosis - the sixth lstanbul School of Medicine, more than 19,000 cases hospitalized case reported in the literature - Universitv of Istanbul, Çapa. Turkey in Istanbul University Istanbul is presented. School of Medicine Department of address: 1 Cad. Özenç Sok .. 4/9. Neurosurgery throughout the past Key words Gliomatosis cerebri · TR-81080 Erenköy-lstanbul. Turkey 45 years, only 2 cases were diag- Neurofibromatosis · Autopsy · Fax: +90-422-34 !O 726 nosed as gliomatosis cerebri. 1 by GFAP tened gyri showing diffuse oedema and no enhancement lntroduction (Fig. 1 Antibiotic and therapy was begun when the initial diagnosis of meningitis was made. No change was noted on Gliomatosis cerebri is a rare tumour of neuroepithelial or- follow-up CT performed 5 days later. MRI studie~ showed diffuse igin with vague presentation [l. 3. 5-8). Even hypo-isointense lesions in T1 and extensive lesions in with the aid T2-weighted and proton density tPDJ images (Figs. 2. 3). The me- of the most sophisticated techniques, ante-mortem diagno- dulla spinalis was in spite of an therapy. her condi- sis is difficult [2, 8). -
Risk-Adapted Therapy for Young Children with Embryonal Brain Tumors, High-Grade Glioma, Choroid Plexus Carcinoma Or Ependymoma (Sjyc07)
SJCRH SJYC07 CTG# - NCT00602667 Initial version, dated: 7/25/2007, Resubmitted to CPSRMC 9/24/2007 and 10/6/2007 (IRB Approved: 11/09/2007) Activation Date: 11/27/2007 Amendment 1.0 dated January 23, 2008, submitted to CPSRMC: January 23, 2008, IRB Approval: March 10, 2008 Amendment 2.0 dated April 16, 2008, submitted to CPSRMC: April 16, 2008, (IRB Approval: May 13, 2008) Revision 2.1 dated April 29, 2009 (IRB Approved: April 30, 2009 ) Amendment 3.0 dated June 22, 2009, submitted to CPSRMC: June 22, 2009 (IRB Approved: July 14, 2009) Activated: August 11, 2009 Amendment 4.0 dated March 01, 2010 (IRB Approved: April 20, 2010) Activated: May 3, 2010 Amendment 5.0 dated July 19, 2010 (IRB Approved: Sept 17, 2010) Activated: September 24, 2010 Amendment 6.0 dated August 27, 2012 (IRB approved: September 24, 2012) Activated: October 18, 2012 Amendment 7.0 dated February 22, 2013 (IRB approved: March 13, 2013) Activated: April 4, 2013 Amendment 8.0 dated March 20, 2014. Resubmitted to IRB May 20, 2014 (IRB approved: May 22, 2014) Activated: May 30, 2014 Amendment 9.0 dated August 26, 2014. (IRB approved: October 14, 2014) Activated: November 4, 2014 Un-numbered revision dated March 22, 2018. (IRB approved: March 27, 2018) Un-numbered revision dated October 22, 2018 (IRB approved: 10-24-2018) RISK-ADAPTED THERAPY FOR YOUNG CHILDREN WITH EMBRYONAL BRAIN TUMORS, HIGH-GRADE GLIOMA, CHOROID PLEXUS CARCINOMA OR EPENDYMOMA (SJYC07) Principal Investigator Amar Gajjar, M.D. Division of Neuro-Oncology Department of Oncology Section Coordinators David Ellison, M.D., Ph.D. -
Epidemiology and Survival of Patients with Brainstem Gliomas: a Population-Based Study Using the SEER Database
ORIGINAL RESEARCH published: 11 June 2021 doi: 10.3389/fonc.2021.692097 Epidemiology and Survival of Patients With Brainstem Gliomas: A Population-Based Study Using the SEER Database † † Huanbing Liu 1 , Xiaowei Qin 1 , Liyan Zhao 2, Gang Zhao 1* and Yubo Wang 1* 1 Department of Neurosurgery, First Hospital of Jilin University, Changchun, China, 2 Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China Background: Brainstem glioma is a primary glial tumor that arises from the midbrain, Edited by: pons, and medulla. The objective of this study was to determine the population-based Yaohua Liu, epidemiology, incidence, and outcomes of brainstem gliomas. Shanghai First People’s Hospital, China Methods: The data pertaining to patients with brainstem gliomas diagnosed between Reviewed by: 2004 and 2016 were extracted from the SEER database. Descriptive analyses were Kristin Schroeder, conducted to evaluate the distribution and tumor-related characteristics of patients with Duke Cancer Institute, United States Gerardo Caruso, brainstem gliomas. The possible prognostic indicators were analyzed by Kaplan-Meier University Hospital of Policlinico G. curves and a Cox proportional hazards model. Martino, Italy *Correspondence: Results: The age-adjusted incidence rate was 0.311 cases per 100,000 person-years Gang Zhao between 2004 and 2016. A total of 3387 cases of brainstem gliomas were included in our [email protected] study. Most of the patients were white and diagnosed at 5-9 years of age. The most Yubo Wang [email protected] common diagnosis confirmed by histological review was ependymoma/anaplastic †These authors have contributed ependymoma. The median survival time was 24 months.