肿瘤学-培训课件
肿瘤学-培训课件,肿瘤,培训,课件
BraintumorDongdongLuoMD.AssociateChiefNeurosurgeonNeurosurgicalDepartment.QQ:865656249Tel:13560163786Whatisbraintumor?IntracranialtumorCraniocerebraltumorBraintumorsarethe:leadingcauseofcancer-relateddeathsinmalesages20-39.fifthleadingcauseofcancer-relateddeathsinwomenages20-39.TeachingGoalContenttomaster:1.Commonclinicalcharateristicsofcerebraltumor;2.DiagnosisandtherapeuticprincipleContenttobefamiliarwith:1.Classificationofcerebraltumor;2.Mainclinicalmanifestationsofvariousbraintumors3.EtiologyandepidemiologyClassificationofcraniocerebraltumors1.Scalptumors(less,angioma,melanama,neurofibroma,basaloma)2.Skulltumors(less,osteoma,multiplemyeloma,fibrosarcoma,dermoidandepidermoid)braintissuemeningesprimarycranialnerve3.IntracranialtumorsintracranialvesselembryonictissueMetastaticfromotherorgansPrimarybraintumors1.Neuroepithelialtumors(gliomas)(神经上皮肿瘤、胶质瘤)Astrocytomas(星形细胞瘤)Oligodendroglioma(少突胶质细胞瘤)Medulloblastoma(髓母细胞瘤)Ependymoma(室管膜瘤)2.Meningioma(脑膜瘤)3.Neurofibroma(神经纤维瘤)3.Primarycerebrallymphoma(原发性脑淋巴瘤)4.Pituitaryadenoma(垂体腺瘤)5.TumorsofothertissuesBloodvessels:haemangioblastoma(血管母细胞瘤)Germcells:germinoma(生殖细胞瘤teratoma(畸胎瘤).Tumoursofmaldevelopmentalorigin:Craniopharyngioma(颅咽管瘤),epidermoid(表皮样囊肿)/dermoidcyst(皮样囊肿)Epidemiology1.Annualincidence:about8.2per1000002.Accountingforabout5%ofallneoplasmsinthebody3.Makeupapproximately50%ofallchildhoodmalignancies.4.DifferentprimarytumortypesandtheiranatomicallocationvarieswithageAdults:gliomas,meningiomas.80-85%supratentorialcompartment.15-20%infratentorialcompartment.Children:medulloblastomas,cerebellarastrocytomas40%supratentorialcompartment.60%infratentorialcompartment.5.Incidencedistributionofprimarybraintumors6.IncidenceofdistributionofallgliomasbyhistologysubtypeEtiologyWhatfactorscancausebraintumors?1.Geneticfactors2.Physicalfactors3.Chemicalfactors4.Biologicalfactorsclinicalmanifestationsdependonthesiteofthetumorsandthespeedofgrowth1.Featuresofincreasedintracranialpressure1)headache2)Vomiting3)Papilloedema2.Focalsymptomsandsignsdependsontheanatomicalsitewhetherthetumoreffectisirritativeordestructive.1)Benign:slowgrowing,mildedema2)Malignant:fastgrowing,aggressive,severveedema3.clinicalmanifestationsoflesionsinthecerebralhemisphereEpilepsyMentalsymptomsMotordisorderSensorydisturbanceAphasiaVisualfielddefectsEpilepsypartialseizuressimplepartialseizurecomplexpartialseizuregeneralizedseizureParalysisMusclestrengthgradingscale0/5Nocontraction1/5Visible/palpablemusclecontractionbutnomovement2/5Movementwithgravityeliminated3/5Movementagainstgravityonly4/5Movementagainstgravitywithsomeresistance5/5Movementagainstgravitywithfullresistance(normal)AphasiaagraphiamotoraphasiaBrocasareaWernickesareaalexiasensoryaphasia4.ClinicalmanifestationsoflesionsinthesellarregionDecreasedvisionVisualfielddefectsEndocrinologicalsymptomshypopituitarismHyperprolactinemiaAcromegaly/gigantismCushing,ssyndromeThyrotoxicosis5.ClinicalmanifestationsoflesionsinthepinealbodyObstructivehydrocephalusVerticalgazeparalysisParinaudsyndromepinealpinealbodybodyprecociouspuberty(性早熟性早熟)Dysfuncitonofmidbrain,cerebellumandhypothalamus6.ClinicalmanifestationsoflesionsintheposteriorcranialfossaCerebellarhemisphere:ataxiaintheipsilaterallimbCerebellarvermis:equilibriumdisorderCerebellopontineanglearea:damagetheipsilateralcranialnerveV-andcerebellarhemisphere.Clinicalcharacteristicsofdifferenttypesofintracranialtumors1.Astrocytomas(星形星形细细胞瘤胞瘤)thecommonestprimarybraintumors.occuratanyage,thecommonestintheagesof40-60years.Male/femaleincidenceis2:1.occurwithequalincidencethroughoutthefrontal,temporalandparietallobes,butareuncommonintheoccipitalFourpathologicalgrades(KernohanI-IV):gradesIandII:Low-monlyseeninchildren/youngadults.gradeIII:Anaplasticastrocytoma.gradeIV:GlioblastomamultiformisMalignantastrocytomasarefarmorecommonthanbenignones.pilocyticastrocytoma(gradeI)F,14-year-oldpreoperationpostoperationpreoperationpostoperationastrocytoma(gradeII)F,40-year-oldPreoperationPostoperationBrainstemastrocytoma(WHOIII)10-year-oldboypreoperationpostoperationGlioblastomamultiformis(gradeIV)M,50-year-old2.Oligodendrogliomaslow-growing/lowmalignancy.youngerage-group(30-50years).commoninfrontallobe.Imagingrevealsawell-demarcatedtumor,frequentlywithareasofcalcification.(少突胶质细胞瘤)(少突胶质细胞瘤)3.Medulloblastoma(髓母(髓母细细胞瘤)胞瘤)themostcommonmalignanttumorofchildhood(4-8years).arisesfromembryonictissueinthecerebellarvermis.mayseedthroughtheCSFpathwaystootherpartsofthecraniumorthespinalcord.4.Ependymoma(室管膜瘤)(室管膜瘤)thesecondmostcommontumorofchildhood.occursintheventricularsystemorthespinalcanal;commoninthefourthventricleandinthecaudalpartofthespinalcord.EpendymomaInlateralventricleInfourthventricleInmedullarycone5.Meningioma(脑脑膜瘤膜瘤)AbenigntumorarisingfromthearachnoidCompressesratherthaninvadestheneuraltissues.Maximumincidenceoccursin40-60yearsofageImagingrevealsawellcircumscribedlesionwithoccasionalcalcification.Commonin:sylvianregion,parasagittalsurfaceolfactorygrooves,lesserwingsofthesphenoid,tuberculumsellae,cerebellopontineangle,thoracicspinalcord6.Neurofibroma(神神经纤维经纤维瘤瘤)abenign,slow-growingtumor.developsonthevestibulardivisionofcranialnerveVIIIcommonly(misleadinglycalledanacousticneuroma).sensorineuraldeafnesstinnitusandvertigo.Itmayappearaspartoftheneurofibromatosissyndrome(type2),whenothertumours(particularlycontralateralacousticneuromas)shouldbesought.neurofibromatosissyndrome7.Primarycerebrallymphomaaggressivetumoursaccountforupto10%ofcentralnervoussystemcomplicationsinAIDSpatients.oftenperiventricular,andmaybemultiple.8.Pituitaryadenoma(垂体腺瘤)(垂体腺瘤)abenigntumorpresentswithneurologicalorendocrinologicalsymptomsSomesmallertumorspresentwithhyperprolactinemiaoracromegaly/gigantism,Cushing,ssyndromeorthyrotoxicosisLargepituitaryadenomausuallypresentswithheadache,bitemporalhemianopia(fromupwardpressureontheopticchiasm),andoccasionallyhypopituitarism.CongenitalbenigntumorStemfromcranialpharynxtuberesidualtissueinthepituitarystalkinembryonicperiodCommoninchildhoodMostlycysticManypostoperativecomplications9.Craniopharyngioma(颅颅咽管瘤)咽管瘤)10.Haemangioblastoma(血管母(血管母细细胞瘤)胞瘤)BenigntumorLocatedinthecerebellarhemisphereHaveageneticpredispositionMostlycysticwitharichbloodsupplyofnodules11.Germcelltumor(生殖(生殖细细胞胞肿肿瘤)瘤)Avarietyofpathologicaltype:germinoma,teratoma,endodermalsinustumor,embryonalcarnioma,chorionicepithelioma,mixedgermcelltumorCommonlyLocatedinpinealregionandsellarregion70%haveoccurredinages10-24SpreadeasilywithCSFSensitivetochemotherapyandradiotherapy12.Metastaticbraintumors(脑转脑转移瘤)移瘤)Metastaticbraintumoursarearound8timescommonerthanprimaryones.About20%ofpatientsdyingwithothertumorswillhaveintracranialmetastases.Theprimarytumorsare:44%bronchus10%breast7%genitourinary.6%bowel3%skin(melanoma)30%others.DiagnosisLocalizationdiagnosisQualitativediagnosis1.Clinicaldiagnosis:intracranialhypertension,seizure2.Imagediagnosis:CT,MRI,DSA,PET,SPECT3.Electrophysiologicalexamination:EEG,cerebralevokedpotential4.laboratoryexamination:anteriorpituitaryhormone,HCG,AFPnormalglioma1.magneticresonancespectroscopy(MRS)2.functionalmagneticresonanceimaging(fMRI)Showrelationshipbetweentumorandimportantareaofbrain3.magneticresonancediffusiontensorimaging(DTI)ShowstherelationshipbetweentumorsandthevitalnervefiberbundledirectlyTreatment1.Symptomatictherapydehydrationmedicine,steroids(toreducecerebraledema),anticonvulsants.2.Benigntumor:Surgery3.Malignanttumor:multimodaltreatment(surgery+radiotherapy+chemotherapy)Routinecraniotomy常规开颅术Routinecraniotomy常规开颅术externalventriculardrainageventriculo-peritonealshuntoperationAdvancedtechniqueMicroneurosurgeryEndoscopictechniqueEndoscopicresectionofpituitaryadenomaEndoscopicthirdventriculostomyNeuralnavigationneurosurgeryIntraoperative awaken and cortical electrical stimulation technologyThepatientremainsawakeduringoperationandacceptsthecortexstimulation,whichiseasilyforneurosurgontojudgethefunctionalregionofbrain.Thetechnologycanreducethedamageofbrainfunctionasmuchaspossible.Intra-operativeMRIIntraoperativeneurophysiologicalmonitoringRadiotherapy1.Highlysensitivetoradiotherapymedulloblastoma,germinoma,lymphoma2.Maglinantglioma1)Stronglyrecommendregularfractionatedirradiationasthestandardtherapyforpostoperativeglioma2)Xorrknifeisnotrecommendedthepreferredtreatmentforglioma3)Recommendstartingradiationtherapyassoonaspossiple2-4weeksaftersurgery.ChemotherapyAtpresentthemostcommonlyuseddrugis:temozolomide(TMZ)替莫替莫唑唑胺胺Moleculartargetingtreatment1)AntiangiogenesisinhibitorsVascularendothelialgrowthfactor(VEGF)monoclonalantibody(AVASTIN)阿瓦斯汀2)epidermalgrowthfactorreceptor(EGFR)inhibitors(GEFITINIB)吉非替尼Prognosisofgliomasin19732002KeyPointCommonclinicalcharateristicsanddiagnosisoftumorincerebralhemisphere,sellarregion,pinealregionandposteriorcrainalfossaCasereportFemale,39yHeadachefor10yearsandvomitingfor3days.CranialCT:LesionofrightfrontallobewithedemaPrimarydiagnosis:LesionofrightfrontallobePre-operativeMRIPre-operativeMRIPre-operativeMRITumorLateralLateralventricleventricleTumorPostoperativepathologicexmainationTumortissue4*6*8cmAnaplasticoligodendroglioma-astrocytomapostoperativeMRIPostoperativetherapy1.Secondweekaftersurgery:radiationtherapy(2.0Gypertime,5timesperweek,60Gyin6weeks)+TMZ2.Afterradiationtherapy:TMZchemotherapyforabout6monthes.Thankyou
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