Glioma- Chinh Sua

8/17/2019 Glioma- Chinh Sua

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GLIOMAHV: Huỳnh Lê Hạnh ĐanLưu Mỹ

Nguyễn Thị Nam Phương


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“Gl!ma" # a g$n$%al &$%m u#$' &! '$#(%)$ any&um!% &ha& a%#$# *%!m &h$ #u++!%&,$ -“glu$y".&##u$ !* &h$ )%an/ Th# &##u$0 (all$' “gla0" h$l+#

&! 1$$+ &h$ n$u%!n# n +la($ an' *un(&!nng 2$ll/


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GLIOMAS

g%a'$

I II III IV

Astrocytic tumors

Pl!(y&( a#&%!(y&!ma 4

P&u(y&!ma -44. 4

Pl!my5!' a#&%!(y&!ma -44. 4

6u)$+$n'ymal gan& ($ll a#&%!(y&!ma 4Pl$!m!%+h( 5an&h!a#&%!(y&!ma 4

78u#$ a#&%!(y&!ma 4

9)%lla%y a#&%!(y&!ma 4

G$m#&!(y&( a#&%!(y&!ma 4

P%!&!+la#m( a#&%!(y&!ma 4

Ana+la#&( a#&%!(y&!ma 4Gl!)la#&!ma 4

Gan& ($ll gl!)la#&!ma 4

Gl!#a%(!ma 4

Gl!ma&!## ($%$)% n'


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Oligodendroglial tumors g%a'

$ I II III IV

Olg!'$n'%!gl!ma 4

Ana+la#&( !lg!'$n'%!gl!ma 4

Oligoastrocytic tumors

Olg!a#&%!(y&!ma 4

Ana+la#&( !lg!a#&%!(y&!ma 4Ependymal tumors

6u)$+$n'ym!m 4

My5!+a+lla%y $+$n'ym!ma 4

;+$n'ym!ma

4


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;&!l!gy

• ?@B !* all +%ma%y )%an &um!%#/• Th$ m!#& (!mm!n -CDB. an' m!#& malgnan&&y+$ # gl!)la#&!ma/

• E&h &h$ $5($+&!n !* +l!(y&( a#&%!(y&!ma#0 &h$+%!gn!## !* gl!ma +a&$n # #&ll +!!%/ L$##&han FB !* gl!)la#&!ma +a&$n a%$ #&ll al,$ a&D y$a%# a*&$% 'agn!##0 hgh$% ag$ )$ng &h$m!#& #gn>(an& +%$'(&!% !* +!!% !u&(!m$/

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P!+ula&!n)a#$' 'a&a !* n('$n($ %a&$#0 ag$ an' #$50 an' #u%,,al !* +a&$n 2&h gl!ma#/ 9%!m:Ohga1 H an' l$hu$# P/ ;+'$m!l!gy an' $&!l!gy !* gl!ma#/ A(&a N$u%!+a&h!l D0 J: JFK


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;+'$m!l!gy

• ;+'$m!l!g( *a(&!%# n(lu'ng #+$(>(!((u+a&!nal $5+!#u%$#0 $n,%!nm$n&al(a%(n!g$n#0 *!!'# (!n&anng Nn&%!#!

(!m+!un'#0 $l$(&%!magn$&( >$l'#0 $&(/ ha,$)$$n a##!(a&$' &! !nly a #mall +%!+!%&!n !*gl!ma#/

• Th$ !nly &2! >%mly $#&a)l#h$' *a(&!%# !*+%ma%y )%an &um!%# a%$ &h$ $5+!#u%$ &! hgh

'!#$# !* !nng %a'a&!n an' nh$%&$'mu&a&!n# !* hghly +$n$&%an& g$n$# a##!(a&$'2&h %a%$ #yn'%!m$#


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Inh$%&$' mu&a&!n# n m$m)$%# !* *aml$# a& n(%$a#$' %#1 !* gl!ma/ 9%!m ;+'$m!l!gy an'm!l$(ula% +a&h!l!gy !* gl!ma/ 6(h2a%&)aum A0 9#h$% L0 Al'a+$ 7 an' E%$n#(h M/ Na&


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A#&%!(y&( &um!u%


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Pl!(y&( a#&%!(y&!ma

• Pl!(y&( a#&%!(y&!ma# (!%%$#+!n' &! EHO g%a'$ I/

• A %$la&,$ly (%(um#(%)$'0 #l!2ly g%!2ng0 !*&$n (y#&(a#&%!(y&!ma !((u%%ng n (hl'%$n an' y!ung a'ul/

• A++%!5ma&$ly DCB !* all gl!ma# 2&h an !,$%all

n('$n($ !* /F@ +$% +$%#!n# +$% y$a%/• Th$ m!#& (!mm!n gl!ma n (hl'%$n0 n 2h!m &h$

ma!%&y a%#$ n &h$ ($%$)$llum/


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L!(ala&!n

• O+&( n$%,$

• O+&( (ha#mQhy+!&halamu#

• Thalamu# an' )a#al gangla

•


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6gn# an' #ym+&!m#

• Ma(%!($+haly

• H$a'a(h$

• ;n'!(%n!+a&hy

• In(%$a#$' n&%a(%anal +%$##u%$• 6$u%$#

• V#ual l!##

• Hy+!&halam(Q+&u&a%y 'y#*un(&!n


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Ma(%!#(!+y• 6!*&0 g%$y an' %a&h$% '#(%$&$

• -(h%!n( l$#!n#.•

• P%ma%y '8u#$

l$+&!m$nng$al +l!(y&(

a#&%!(y&!ma # a %a%&y


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)$%# an' l!!#$&$5&u%$'mul&+!la% ($ll# 2&h m(%!(y#

A )+ha#(0 (!m+a(& an' #+!ngy+a&&$%n

H#&!l!g(ally (ha%a(&$%$' )y a )+ha#( +a&&$%n 2&h,a%yng +%!+!%&!n# !* (!m+a(&$' )+!la% ($ll#a##!(a&$' 2&h S!#$n&hal >)$%# an' l!!#$&$5&u%$'mul&+!la% ($ll# a##!(a&$' 2&h m(%!(y# an'$!#n!+hl( g%anula% )!'$#Qhyaln$ '%!+l$/


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R+ha#( -(y#&( an' #!l'. +l!(y&(a#&%!(y&!ma 2&h num$%!u# S!#$n&hal>)$%#/

Pl!(y&( a#&%!(y&!ma/ H;#&an '$m!n#&%a&$# num$%!u#S!#$n&hal >)$%# -arrow./


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Pl!(y&( a#&%!(y&!ma/G%anula% $!#n!+hl( )!'$#/

Pl!(y&( a#&%!(y&!ma/ H;#&an %$,$al# $!#n!+hl(g%anula% )!'$# -arrow./


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Va#(ula% 2(1$%2!%1 +a&&$%n&y+(ally $n(!un&$%$' n($%$)$lla% l$#!n#

Tum!u% ,$##$l# 2&h $5&$n#,$hyalna&!n/


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Pl!my5!' a#&%!(y&!ma

•

• P%!mn$n& mu(!' ma&%5 an' ang!($n&%(a%%ang$m$n& !* m!n!m!%+h!u#0 )+!la% &um!u% ($ll#0&y+(ally 2&h!u& S!#$n&hal >)$%# !% $!#n!+hl(

g%anula% )!'$#Q hyaln$ '%!+l$/• P%$#$n n &h$ ,$%y y!ung -m$'an m!n&h#.0 )u&

(an !((u% n !l'$% (hl'%$n0 %a%$ n a'ul/

• Mal$ Q *$mal$ : %!ughly $Uual/


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L!(ala&!n

• Th$ hy+!&halam(Q(ha#ma&( %$g!n # &h$ m!#&(!mm!n l!(a&!n/

• Th$ &halamu#

•


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Ma(%!#(!+y

• 6!l'0 g$la&n!u# ma##

• In a& l$a#& #!m$ +a%&h$ &um!u%# mayn>l&%a&$ +a%$n(hyma0a (l$a% #u%g(al +lan$may n!& )$ '$n&>$'/


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• Ma%1$'ly mu(!' ma&%5• M!n!m!%+h!u# )+!la% ($ll#0

an' a +%$'!mnan&lyang!($n&%( ($lla%%ang$m$n&/

•

•


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Tum!u%# &y+(ally #h!2 am!n!m!%+h!u# +!+ula&!n !*($ll# n a h!m!g$n$!u#lymy5!')a(1g%!un'/

Pl!my5!' a#&%!(y&!ma# la(1 S!#$n&hal >)$%#0 an' &h$ &um!% (

$ll# u#ually (lu#&$% a%!un' )l!!'


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Th$ +%!mn$n& *$a&u%$ !* +l!my5!'a#&%!(y&!ma # &h$ ang!($n&%(a%%ang$m$n& !* &um!u% ($ll#

Th$ ,a#(ula%&y # !*&$n+%!mn$n& 2&h &h$ a)!,$m$n&!n$' ang!($n&%(a%%ang$m$n& !* &um!u% ($ll#0)u& !%' ,a#(ula% +%!l*$%a&!n #

%a%$


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Tum!u%# a%$ &y+(ally '8u#$ly an' #&%!ngly +!#&,$*!% G9AP/


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Pl$!m!%+h( 5an&h!a#&%!(y&!ma

•

• Ty+(ally $n(!un&$%$' n (hl'%$n an' y!ung a'ul2&h #u+$%>(al l!(a&!n n &h$ ($%$)%al h$m#+h$%$#an' n,!l,$m$n& !* &h$ m$nng$#/

• ;5+%$##ng G9AP an' !*&$n #u%%!un'$' )y a %$&(ulnn$&2!%1 a# 2$ll a# $!#n!+hl( g%anula% )!'$#/


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L!(ala&!n

• In,!l,ng &h$ m$nng$# an' ($%$)%um/

• Nn$&y$gh& +$%($n& !((u% #u+%a&$n&!%ally0 n +a%&(ula%&h$ &$m+!%al l!)$/

•


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Clinical features

• 9a%ly l!ng h#&!%y !* #$u%$#

• 6ym+&!m# %$$(& &h$ #&$# !* n,!l,$m$n&

•


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H#&!+a&h!l!gy

• E$ll $#&a)l#h$'

• WPl$!m!%+h(X %$*$%# &! &h$ ,a%a)l$ h#&!l!g(ala++$a%an($ !* &h$ &um!u%0 n 2h(h #+n'ly $l$m$na%$ n&$%mngl$' 2&h m!n! !% mul&nu(l$a&$' gan&

a#&%!(y&$#0 &h$ nu(l$ !* 2h(h #h!2 g%$a& ,a%a&!n n#$ an' #&anng/ In&%anu(l$a% n(lu#!n# a%$ *%$Uu$n&/


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A l$+&!m$nng$al PYA0 #ha%+ly'$ln$a&$'*%!m &h$ un'$%lyng ($%$)%al (!%&$5

G%anula% )!'$#0 n&$n#$ly$!#n!+hl( !% +al$0 a%$ alm!#& a(!n#&an& >n'ng


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PYA/


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Tum!u% ($ll# #h!2ng nu(l$a% an'(y&!+la#m( +l$!m!%+h#m an'5an&h!ma&!u# (hang$

Pl$!m!%+h(5an&h!a#&%!(y&!ma/Yan&h( ($ll#0 $5+%$##$' a#,a(u!la&!n !* &h$ n$!+la#&(

($ll#0 a%$ #h!2n


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Ma&u%$ gangl!n ($ll

an' lym+h!(y&( n>l&%a&$# n a PYA


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Immun!h#&!(h$m#&%y• G9AP an' 6 +%!&$n

• 6yna+&!+hy#n0 n$u%!>lam$n&0 (la## III Z&u)uln an'MAP

•


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78u#$ a#&%!(y&!ma

•

• 78u#$ a#&%!(y&!ma

9)%lla%y a#&%!(y&!ma

G$m#&!(y&( a#&%!(y&!ma P%!&!+la#m( a#&%!(y&!ma

• S$+%$#$n DB !* all a#&%!(y&( )%an &um!u%#0a++%!5ma&$ly / n$2 (a#$# Q mll!n +!+ula&!n ay$a%


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L!(ala&!n

• L!(a&$' n any %$g!n !* &h$


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Ma(%!#(!+y

• L!(al ma## l$#!n#/

• In'#&n(& )!un'a%$#/

• 6mall$% !% la%g$% (y# g%anula% a%$a# an' !n$# !*>%mn$## !% #!*&$nng/

• 6ngl$0 la%g$ (y#& >ll$'

2&h (l$a% u'/• 6ngl$0 la%g$

#m!!&h2all$' (y#/

• 9!(al (al(>(a&!n/

'8u#$ a#&%!(y&!ma] $nla%g$m$n& !*&halamu#] n>l&%a&!n !* a'a($n& 2h&$

ma&&$%] '!$#n^& '$#&%!y )%an &##u$0 u#&


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H#&!+a&h!l!gy

• E$ll '8$%$n&a&$' >)%lla%y !% g$m#&!(y&( n$!+la#&(a#&%!(y&$# !n &h$ )a(1g%!un' !* a l!!#$ly #&%u(&u%$'0!*&$n m(%!(y#&( &um!u% ma&%5/

•


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9)%lla%y a#&%!(y&!ma

• Th# m!#& *%$Uu$n& h#&!l!g(al ,a%an& !* a#&%!(y&!ma/

• Nu(l$a% a&y+a # a 'agn!#&( (%&$%!n )u& m&!&(a(&,&y0 n$(%!## an' m(%!,a#(ula% +%!l*$%a&!n a%$a)#$n&/

• Nu(l$a% a&y+a # a h#&!l!g(al hallma%1 '#&ngu#hng&um!u% ($ll# *%!m n!%mal an' %$a(&,$ a#&%!(y&$#/


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A >)%lla%y a#&%!(y&!ma n>l&%a&ngg%ay ma&&$%/N!&$ &h$ n$u%!n# 2&h la%g$ nu(l$an' +%!mn$n& nu(l$!l n &h$ l$*&u++$% an' ($n&$% >$l'# !* &h$ >gu%$

A m!'$%a&$ly ($llula% &um!u%(!m+!#$' !* un*!%m >)%lla%y a#&%!(y&( ($ll# 2&hm(%!(y#&( #&%!ma


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)%lla%y a++$a%an($ &! many!* &h$ ($ll#/ N!&$ ,a%a&!n n nu(l$a% #ha+$ an' #$/ Th$)a(1g%!un' ha# a #!m$2ha& ,a(u!la&$' a++$a%an($0l!!1ng l1$ n$u%!+l/


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;5&$n#,$ m(%!(y#& *!%ma&!n


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L!2 MIR la)$llng n'$5/


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G$m#&!(y&( a#&%!(y&!ma

•

n$!+la#&( a#&%!(y&$#/• M!%$ &han a++%!5ma&$ly B !* all &um!u% ($ll#/

• Plum+0 gla##y0 $!#n!+hl( ($ll )!'$# !* angula% #ha+$/

• 6&!u&0 %an'!mly !%$n&$' +%!($##$#0

*!%mng a (!a%#$ >)%lla%y n$&2!%1/

G$m#&!(y&( a#&%!(y&!ma/ Th$&um!% ($ll# a%$ #mla% &! ($%&an

%$a(&,$ a#&%!(y&$#


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Tum!u% ($ll# ha,$ a la%g$$!#n!+hl( (y&!+la#m 2&h nu(l$'#+la($' &! &h$ +$%+h$%y/

l&%a&$


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6&%!ng0 (!n##&$n& G9AP $5+%$##!n/


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+DF a((umula&!n # ma%1$' n nu(l$ !* #mall an'

g$m#&!(y&( &um!u% ($ll#/


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P%!&!+la#m( a#&%!(y&!ma•

2&h a *$2 a((' +%!($##$# 2&h a l!2 (!n&$n& !* glal>lam$n an' #(an& G9AP $5+%$##!n/

•


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Ana+la#&( a#&%!(y&!ma

•

• 78u#$ly n>l&%a&ng0 malgnan& a#&%!(y&!ma

• P%ma%ly a8$( a'ul/

• May a%#$ *%!m '8u#$ a#&%!(y&!ma EHO g%a'$ II !% '$n!,!/

• Inh$%$n& &$n'$n(y &! un'$%g! +%!g%$##!n &!gl!)la#&!ma/


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L!(ala&!n

• l&%a&nga#&%!(y&!ma#0 2&h a +%$*$%$n($ *!% &h$ ($%$)%alh$m#+h$%$#/


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Ma(%!#(!+y

• Ma(%!#(!+( (y# a%$ un(!mm!n/

• A%$a# !* g%anula%&y0 !+a(&y an' #!*& (!n##&$n(y/

• 7#($%n)l$ &um!u% ma## 2&h a m!%$ (l$a% '#&n(&!n*%!m #u%%!un'ng #&%u(&u%$# &han # &h$ (a#$ n '8u#$

a#&%!(y&!ma# EHO g%a'$ II


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H#&!+a&h!l!gy• 78u#$ly n>l&%a&ng a#&%!(y&!ma 2&h n(%$a#$' ($llula%&y

a# (!m+a%$' &! &h$ g%a'$ II $Uu,al$n&/

• 7#&n(& nu(l$a% a&y+a an' m&!&( a(&,&y/

• M(%!,a#(ula% +%!l*$%a&!n -mul&lay$%$' ,$##$l#. an'n$(%!## a%$ a)#$n&/


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Hy+$%($llula%&y an' hy+$%(h%!ma&(0 %%$gula% _na1$' nu(l$_a++$a%ng 2&hn a >)%lla%y )a(1g%!un'/6$,$%al m&!&( >gu%$# a%$ $,'$n&


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G9AP mmun!%$a(&,&y/


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6$,$%al &um!u% ($ll# #h!2 mmun!%$a(&,&y *!% &h$+%!l*$%a&!n ma%1$% MIR0 n(lu'ng a ($ll n

m&!##


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Glioblastoma

• Va%an (!%%$#+!n' &! EHO g%a'$ IV/

• Th$ m!#& *%$Uu$n& +%ma%y )%an &um!u%/

• Th$ m!#& malgnan& n$!+la#m 2&h +%$'!mnan&a#&%!(y&( '8$%$n&a&!n/

• Man*$#& %a+'ly '$ n!,!/

• In,a#,$ na&u%$0 (ann!& )$ (!m+l$&$ly %$#$(&$'/

• Ol'$% ag$ a# &h$ m!#& #gn>(an& a',$%#$ +%!gn!#&(*a(&!%/


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L!(ala&!n

• 6u)(!%&(al 2h&$ ma&&$% !* &h$ ($%$)%al h$m#+h$%$#/

• 9%!n&!&$m+!%al/

• In>l&%a&!n !*&$n $5&$n'# n&! &h$ a'a($n& (!%&$5 an'&h%!ugh &h$ (!%+u# (all!#um n&! &h$ (!n&%ala&$%al

h$m#+h$%$/• R%an #&$m -n*%$Uu$n& an' !*&$n a8$( (hl'%$n.


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( n$u%!l!g(al #ym+&!m# : h$a'a(h$0+$%#!nal&y (hang$#/


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Ma(%!#(!+y

• Th$ &um!u%# a%$ !*&$n #u%+%#ngly la%g$ an' may!((u+y mu(h !* a l!)$/

• Th$ l$#!n # u#ually unla&$%al0 )u& (an )$ )la&$%ally#ymm$&%(al n &h$ )%an #&$m an' (!%+u# (all!#um/

• Va%a)l$ (!l!u% 2&h +$%+h$%al g%$y#h &um!u% ma##$#an' ($n&%al a%$a# !* y$ll!2#h n$(%!## *%!m my$ln)%$a1'!2n/


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Gl!)la#&!ma an' ,a%an

(!%%$#+!n' &! EHO g%a'$ IV/

• 6+%$a' an' m$&a#&a##

• M$(han#m# !* n,a#!n• Mul&*!(al gl!)la#&!ma#

• P%ma%y an' #$(!n'a%y gl!)la#&!ma


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H#&!+a&h!l!gy

• T##u$ +a&&$%n#

• 6$(!n'a%y #&%u(&u%$#

• ;+&h$lal #&%u(&u%$#

•


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Gl!)la#&!ma 2&h hgh '$g%$$ !*ana+la#a


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A'$n!' GRM 2&h *!%ma&!n !*glan'ula% #&%u(&u%$#

;5&%$m$ ana+la#a n gan& ($llgl!)la#&!ma/


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Olg!'$n'%!glal (!m+!n$n& na GRM M(%!,a#(ula% +%!l*$%a&!n n a

gl!)la#&!ma 2&h *!%ma&!n !* amul&lay$%$' ^gl!m$%ul!' &u*&^


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9!(al #Uuam!u# ($ll m$&a+la#a n a gl!)la#&!ma

(ha%a(&$%$' )y


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Gan& ($ll gl!)la#&!ma (!n## !*($ll# 2&h ,a%a)l$ #$ an' #ha+$

An a&y+(al m&!&( >gu%$ n agan& ($ll/


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A ,$%y la%g$ mul&nu(l$a&$' gan& ($ll/


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6mall ($ll gl!)la#&!ma 2&h,$%y hgh MIR la)$llng n'$5/

Th$ ($ll# #$$n n)$a% #!m$%$#$m)lan($ &!

n$u%!n#0 )u&mmun!%$a(&,&y*!% G9AP (!n>%m#&h$% a#&%!(y&(na&u%$


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Gl!)la#&!ma 2&h -A. !,$%$5+%$##!n !* ;G9S n &h$ +la#mam$m)%an$ !* &um!u% ($ll# an' -R. nu(l$a% a((umula&!n !*+DF +%!&$n n &um!u% ($ll# )u& n!& $n'!&h$lal ($ll#/


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S$&(uln #&an #h!2ng a ^ga%lan'^ !* +%!l*$%a&$'

gl!ma ,$##$l#


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Ma%1$' (y&!1$%a&n $5+%$##!n/


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Ma%1$' #&%!mal %$a(&!n -R!'an #l,$% #&an.


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Tum!u% #h!2# a hgh la)$llng n'$5 2&h MIR

an&)!'y/


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Gl!#a%(!ma

•

• (ha%a(&$%$' )y a )+ha#( &##u$ +a&&$%n 2&hal&$%na&ng a%$a# '#+layng glal an' m$#$n(hymal'8$%$n&a&!n/

• Gl!#a%(!ma (!n#&&u&$# a++%!5ma&$ly B !* allgl!)la#&!ma/

• P%$*$%$n&al man*$#&a&!n )$&2$$n ag$# an' C0%a%$ (a#$# n (hl'%$n/

• Mal$# a%$ m!%$ *%$Uu$n&ly a8$(&$'/


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L!(ala&!n

• [#ually l!(a&$' n &h$ ($%$)%al h$m#+h$%$#/

• T$m+!%al/

• 9%!n&al/

• Pa%$&al/

• O((+&al l!)$#/

• P!#&$%!% *!##a an' &h$ #+nal (!%' -%a%$ly./


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H#&!+a&h!l!gy

• R+ha#( &##u$ +a&&$%n

• Malgnan& &%an#*!%ma&!n : nu(l$a% a&y+a0 m&!&(a(&,&y0 n$(%!## ///

• Malgnan& >)%!u# h#&!(y&!ma

• M$#$n(hymal '8$%$n&a&!n : &h$ *!%ma&!n !*(a%&lag$0 )!n$0 !#&$!'(h!n'%al &##u$0 #m!!&h an'#&%a&$' mu#(l$#0 l+!ma&!u# *$a&u%$#/


91/176

Gl!#a%(!ma/-a. ;l!nga&$' ($ll# a%$a%%ang$' n *a#((l$#]

m&!&( >gu%$# a%$ %$a'ly*!un' n &h$#$#a%(!ma&!' n$!+la#m#2h(h al#! (!n&an *!( !*a#&%!(y&( ($ll#/

-).


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Gl!#a%(!ma/ Th$ gl!ma&!u# (!m+!n$n& #h!2##&%!ng G9AP $5+%$##!n an' may )$ g$!g%a+h(ally

#$+a%a&$' *%!m


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Gl!#a%(!ma/ In&$%mngl$' 2&h &h$#a%(!ma&!u# &um!u%($ll#


94/176

A )+ha#( &##u$ +a&&$%n '$n!&ng %$&(uln%(h#a%(!ma&!u# an' %$&(uln*%$$ gl!ma&!u#

$l$m$n/


95/176

Gl!ma&!## ($%$)%

•

• M!#& (!mm!nly '#+lay# an a#&%!(y&( +h$n!&y+$/-!lg!'$n'%!gl!ma an' m5$' !lg!a#&%!(y&!ma (anal#! +%$#$n&.

•


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L!(ala&!n

• N! ana&!m( #&$ !* &h$ )%an ha# )$$n $5(lu'$'/ Th$m!#& (!mm!nly n,!l,$' a%$a#0

• Th$ ($%$)%al h$m#+h$%$# [email protected] &h$ m$#$n($+hal!n-DB.0 &h$ +!n# -DB.0 &h$ &halamu# -FB.0 &h$ )a#al

gangla -FB.0 &h$ ($%$)$llum -JB.0 &h$ m$'ulla!)l!nga&a -FB.0 &h$ hy+!&halamu#0 &h$ !+&( n$%,$#an' (ha#m0 an' &h$ #+nal (!%' -$a(h a& JB.


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( +a%a$#&h$#a0,#ual '#&u%)an($#/


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Ma(%!#(!+y

• 62!ll$n an' >%m

• Rlu%%$' '#&n(&!n )$&2$$n g%$y an' 2h&$


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H#&!+a&h!l!gy

• A +%!l*$%a&!n !* #mall glal ($ll# 2&h $l!nga&$'0*u#*!%m nu(l$/

• O),!u#ly a#&%!(y&(0 an' g$m#&!(y&( *!%m0 (la##(alm!%+h!l!g( *$a&u%$# !* !lg!'$n'%!gl!ma ha,$ al#!

)$$n '$#(%)$'/• 6gn# !* '$my$lna&!n0 )u& n$u%!n# an' a5!n# a%$n&a(& /


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H#&!l!g(al *$a&u%$# !* gl!ma&!##($%$)%/ A 78u#$ n>l&%a&!n !* &h$(!%+u# (all!#um 2&h $l!nga&$'&um!u% ($ll#/

Gl!ma&!## ($%$)%/ P!!%ly'8$%$n&a&$' glal ($ll# n>l&%a&$ &h$)%an an' (%!2' a%!un' )l!!' ,$##$l#an' n$u%!n#/


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H#&!l!g(ally0 & #h!2# atypical glialcells (usually Grade II or III)diusely in!ltrating &h%!ugh!u& &h$n,!l,$' l!)$#

Hgh$% magn>(a&!n *%!m &h$+%$,!u# (a#$ #h!2ng!((a#!nal atypical glial cells 2&hml'ly $nla%g$' hy+$%(h%!ma&(

nu(l$ diusely in!ltrating

Immun!h#&!(h$m#&%y


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• G9AP an' 6 +%!&$n mmun!#&anng %$#ul a%$ ,a%a)l$]n many (a#$#0 &um!u% ($ll# $5h)& #&%!ng +!#&,&y *!% )!&h

ma%1$%#0 2h$%$a# n !&h$%# a ma!%&y !* &um!u% ($ll# a%$n!n%$a(&,$/

#igure $% Immuno"istoc"emistry of tumour cells s"o&ing

G#A' positiity *i +, labelling inde-./01

li d d li l


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Oligodendroglial tumours

• Olg!'$n'%!gl!ma

• Ana+la#&( !lg!'$n'%!gl!ma


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Oligodendroglioma

• Occur most often in the frontal lo"e

• #ost often present with epilepsy

• Are pro"a"yly more chemossensiti$e and radiosensiti$e and

more prone to hemorrhage

• A"normal genetic chromosomes 1p and 1q

O


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Oligodendroglioma

• &a$e a $ariety of macroscopic appearance

• 'ifficult to locate in resection specimens

• 'istortion of the normal cortical gray and white matter interface

• 'iscoloration of tissue pro$ide clues to their location.

Oli d d li


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Oligodendroglioma

- (hite matter in

the frontal lo"e- )*pands the gyri

- 'istorting the

lateral $entricles


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Oligodendroglioma

- Composed of uniform cells

-+he round nuclei and ill-defined cytoplasm

Oligodendroglioma


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Oligodendroglioma

A relati$ely circumscri"ed "order to what is generally an

infiltrating neoplasm may "e o"ser$ed in white matter

Oligodendroglioma


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'ystrophic calcification is a common feature

Oligodendroglioma


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A networ, of delicate "ifurcating capillaries is typical

Oligodendroglioma


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Oligodendroglioma

#ay show rhythmic nuclear palisading

7I99;S;NTIAL 7IAGNO6I6 O9


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7I99;S;NTIAL 7IAGNO6I6 O9OLIGO7;N7SOGLIOMA

N!n n$!+la#m (!n'&!n: '$my$lna&!n -#mall %!un'nu(l$ an' (l$a% (y&!+la#m.

78u#$ a#&%!(y&!ma

- Nu(l$ m!%$ +l$!m!%+h#m

- 7! n!& ha,$ &h$ n$&2!%1 !* )%an(hng (a+lla%$# an'($ll# 2&h +$%nu(l$a% hal!#

Oligodendroglioma


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Oligodendroglioma

mmunohistochemistry

- /ositi$e A/2 31002 #A/4 5strong6

- egati$e )#A

Anaplastic oligodendroglioma


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Anaplastic oligodendroglioma

• )ndothelial hypertrophy

• Comple* micro$ascular proliferation

• Conspicuous mitotic acti$ity 8 9oined

• n some cases2 "y necrosis and often accompanied "y dense

cellularity and o"$ious nuclear atypism.

Ana+la#&( !lg!'$n'%!gl!ma


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Ana+la#&( !lg!'$n'%!gl!ma

Oligoastrocytic tumours


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Oligoastrocytic tumours

Th$ !nly Wm5$'X gl!ma# )%!a'ly %$(!gn$' )y )!&hn$u%!+a&h!l!g# an' &h$ EHO a%$ &h!#$ man*$#&nga#&%!(y&( an' !lg!'$n'%!glal *$a&u%$#/

• Olg!a#&%!(y&!ma

• Ana+la#&( !lg!a#&%!(y&!ma

)pidemiology : Clinical presentation


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)pidemiology : Clinical presentation

•

•

• OA# m!#& (!mm!nly +%$#$n& 2&h $&h$% +a%&al !%g$n$%al#$' #$u%$#0 h$a'a(h$#0 an' +$%#!nal&y(hang$#/


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• Th$#$ &um!%# (an )$*!un' any2h$%$ 2&hn&h$ ($%$)%alh$m#+h$%$# !* &h$)%an

• Olg!a#&%!(y&!ma# a%#$+%ma%ly n &h$ ($%$)%alh$m#+h$%$#0 2&h &h$*%!n&al l!)$# )$ng m!#&*%$Uu$n&ly a8$(&$'0*!ll!2$' )y &h$&$m+!%al l!)$#/

Olg!a#&%!(y&!ma


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g y

Anaplastic Oligoastrocytoma


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Anaplastic Oligoastrocytoma

• In(%$a#$' ($llula%&y0 nu(l$a% a&y+a0 an' hgh m&!&(a(&,&y0 m(%!,a#(ula% +%!l*$%a&!n

mmunohistochemistry


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A/

M5$' !lg!a#&%!(y&!ma -G9AP 5./


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E d l t


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Ependymal tumours

• 6u)$+$n'ym!ma

• My5!+a+lla%y $+$n'ym!ma

• ;+$n'ym!ma


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Ependymomas

• ` DJB !* +%ma%y


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• P%n(+al (ln(al man*$#&a&!n# n(lu'$• Pan l!(al$' &! &h$ n$(1 !% )a(1• Num)n$##• Pa%$#&h$#a# !* &h$ '#&al $5&%$m&$#

• A&%!+hy !* han' mu#(ula&u%$• Ga& '#&u%)an($#/

• In &h$ *!u%&h ,$n&%(l$0 $+$n'ym!ma# a%$ &y+(ally #!l' !%


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+a+lla%y ma##$# a%#ng *%!m &h$ !!% !* &h$ ,$n&%(l$/

• In &h$ n&%a#+nal &um!%# &h$ #ha%+ '$ma%(a&!n


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• In &h$ n&%a#+nal &um!%#0 &h$ #ha%+ '$ma%(a&!n#!m$&m$# ma1$# &!&al %$m!,al *$a#)l$/

;+$n'ym!ma


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Ty+>$' )y a '$n#$ m$#h2!%1 !* >)%lla%y

(y&!+la#m(0 #&%!mal )l!!' ,$##$l# n *!%ma&!n#1n!2n a# +$%,a#(ula% +#$u'!%!#$&&$#


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132/176

Pa+lla%y ;+$n'ym!ma

M(%!+h!&!g%a+h #h!2#+a+lla%y #&%u(&u%$# ln$' )y#ngl$ an' mul&+l$ lay$%# !*

m!n!m!%+h( (u)!'al &um!%

Tum!%# n 2h(h n$!+la#&($+$n'ymal ($ll# a##um$ a (!lumna%(!n>gu%a&!n an' a%$ #u++!%&$' )y

>)%!,a#(ula% (!%$#


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Clear cell ependymomas a%$ *%$Uu$n&ly supratentorial and

cystic an' a%$ (ha%a(&$%$' )y la%g$ nu(l$ an' (l$a%(y&!+la#m/ Th$ (y&!+la#m( *$a&u%$# (%$a&$ #!m$ resemblanceto oligodendrogliomas/H!2$,$%0 unl1$ !lg!'$n'%!gl!ma#0 &h$y a%$ #ha%+ly'$ma%(a&$'/

Tany(y&( ;+$n'ym!ma


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Tany(y&( $+$n'ym!ma/ N!&$ &h$#+n'l$' m!%+h!l!gy an' ,agu$+$%,a#(ula% +#$u'!%!#$&&$#/ Th#$5am+l$ (!n&an# #(a&&$%$' ($ll# 2&h#&%1ng nu(l$a% a&y+a/

Th$ &any(y&( $+$n'ym!ma *%$Uu$n&ly&a1$# !n an a#&%!(y&( a++$a%an($ 2&h>)%lla% (y&!+la#m &ha& #&%$am# )y ,$##$l#%a&h$% &han !%$n&ng &!2a%'# &h$m/

My5!+a+lla%y ;+$n'ym!ma


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$+$n'ym!mal1$ ($ll#/


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Th$ 'agn!## !* anaplastic ependymoma (23O Grade

III) %$Uu%$# "ypercellularity cytologic atypia increasedmitotic actiity0 an' microascular proliferation/ Th$ mag$#h!2# hghly ana+la#&( &um!% ($ll# a%%ang$' a%!un' a ,$##$l(%$a&ng a +#$u'!%!#$&&$/

3u"ependymoma


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3u"ependymoma

• A((!un& *!% `B !* $+$n'ym!ma#/

• A%$ g$n$%ally *!un' n &h$ *!u%&h an' la&$%al ,$n&%(l$#/

• Manly !((u% n a'ul& +a&$n/

• P%$#$n& 2&h hy'%!($+halu# !% may )$ a#ym+&!ma&(0)$ng *!un' a& au&!+#y/

3u"ependymoma


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p y

Th$ )!'y !* &h$ %gh& la&$%al,$n&%(l$ # >ll$' )y a n!'ula%ma## !* >%m0 2h&$ &##u$/

Rla&$%al 6u)$+$n'ym!ma


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a++$a%ng nu(l$ #(a&&$%$' n a '$n#$0 >n$0 glal >)%lla% )a(1g%!un'


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Immun!h#&!(h$m#&%y

;+$n'ym!ma


141/176

+ y

Glal *)%lla%y a('( +%!&$n -G9AP.mmun!%$a(&,&y # u#ually m!#&n&$n#$ n &h$ +$%,a#(ula% #&%u(&u%$# !*$+$n'ym!ma#

I& # m+!%&an& &! n!&$ &ha& $+$n'ym!ma# #h!2 ,a%a)l$ mmun!%$a(&,&y *!%;MA an' (y&!1$%a&n#/H!2$,$%0 &h$ $+$n'ymal na&u%$ !* &h$ &um!%# # %$a'ly (!n>%m$' )y &h$


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Tany(y&( $+$n'ym!ma/ Glal >)%lla%ya('( +%!&$n -G9AP. mmun!%$a(&,&yhghlgh &h$ n&$n#$ >)%lla%y na&u%$ !*&h$ &um!%X# ($ll#

+ y y ynu(l$a% (h%!ma&n +a&&$%n an' &h$ >)%lla%y (ha%a(&$% !* (y&!+la#m( +%!($##$#0hghlgh&$' )y G9AP an' ,m$n&n mmun!%$a(&,&y/

Pa+lla%y $+$n'ym!ma:M(%!+h!&!g%a+h #h!2# G9APmmun!%$a(&,&y +%$'!mnan&ly n &h$+#$u'!%!#$&&$# -G9AP b./

Ana+la#&( ;+$n'ym!ma


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6c #&anng #h!2ng '8u#$nu(l$a% an' (y&!+la#m( +!#&,&y

Immun!h#&!(h$m#&%y 2&h a C@ an&)!'y&y+(ally #h!2# a hgh la)$lng n'$5 n a%$a#2&h a hgh nu(l$a%:(y&!+la#m( %a&!/

7I99;S;NTIAL 7IAGNO6I6 O9;P;N7dMOMA


144/176

• A#&%!(y&!ma0 !lg!'$n'%!gl!ma0 m$'ull!)la#&!ma0

($n&%al n$u%!(y&!ma0 m(%!(y#&(Q+a+lla%y m$nng!ma Th$ +%$#$n($ !* +$%,a#(ula% anu(l$a% !n$# -+#$u'!%!#$&&$#. 2&h >n$>)%lla%y G9AP+!#&,$ +%!($##$# # &h$ 1$y &! '8$%$n&a&ng$+$n'ym!ma# *%!m &h$#$ n$!+la#m#

• A#&%!)la#&!ma

• Pa+lla%y &um!% !* &h$ +n$al %$g!n Th# &um!% !*&$n $5+%$##$# (y&!1$%a&n# -unl1$ $+$n'ym!ma.0 )u&!nly #+a%#$ G9AP/

• Pa%agangl!ma !* &h$ >lum &$%mnal$0 #(h2ann!ma• Pa%agangl!ma# (an )$ '#&ngu#h$' )y &h$% mmun!%$a(&,&y *!%

(h%!m!g%ann an' #yna+&!+hy#n0 an' an a%%ang$m$n& !* ($ll# nn$# !% (!%'# #u%%!un'$' )y %$&(uln/

• 6(h2ann!ma# (an )$ '#&ngu#h$' )y &h$% '$n#$ +$%($llula%%$a(&!n *!% %$&(uln/


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lial tumors of uncertain origin


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g

• Astro"lastoma

• Angiocentric glioma

• Chordoid glioma of the third $entricle

Astro"lastoma


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• ;are neoplasm 5


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• >sually a solid uniform mass of firm

• 3lightly mucoid tissue

• Cyst formation can occur

Astro"lastoma


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Characteri?ed microscopically "y two particular features

Astro"lastomatous rosettes

A focal hyalini?ation of its $ascular networ,

Astro"lastomatous rosettes


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- Characteri?ed "y a corona of short fi"rillaryprocesses from peri$ascular tumor cells

- +umor cells in astro"lastomas tend to ha$e a high

nuclear cytoplasm ratio and monomorphic nuclei



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Astro"lastoma


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• 'ifferential diagnosis

- )pendymoma more fi"rillar2 nuclei smaller

• mmunohistochemistry @ 5A/2 $imentin2 310062 -5C2

synatophysin6

Angiocentric glioma


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• (ho grade 1 tumor of children and young adults 54 to 70 years2

mean 17 years6

• &istory of intracta"le epilepsy

• Occurs in the superficical cere"ral corte*

• (ith features of infiltrating astrocytoma and ependymoma.

• ;elationship to ependymoma is unclear

Angiocentric glioma


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Angiocentric glioma

• #acroscopically2 e*pand and distort in$ol$ed "rain

• #icroscopicallyConsist of uniform cells with o$al or spindle-shape nuclei.

Cytoplasmic are poorly defined2 though some cells appear epithelioid

ecrosis and angiogenesis are a"sent'ystrophic calcification is rare

#itotic figures are $ery rare

Angiocentric glioma


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At low power peri$ascular and infilltrati$e

tumor cell patterns can discerned2 as can

aggregates of su"pial cells

Angiocentric glioma


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3pindled profile sheath and colar cere"rocortical

"lood $essels in this typical e*ample

Angiocentric glioma


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'ifferential diagnosis

- Astro"lastoma discrete "orders2 epithelioid cells2

$ascular sclerosis

- Astrocytoma infiltrating no pseudorosettes orsu"pial palisading

- )pendymoma enhancing2 discrete "orders

mmunohistochemistry @ )#A2 @ A/

Chordoid glioma of the third $entricle


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• +his rare neoplasm occurs in third $entricle of adult patients

• /resents with o"structi$e hydrocephalus

• >sually middle age women 5B%2 median age years6


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Cords of tumor2 focal micro$asculation and

lymphoplasmacytic infiltrate



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A $ague tra"ecular arrangement of moderately uniform cells is

e$ident2 along with micro$acuolation and a my*oid "ac,ground



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A mi*ture of epithelioid cells and cells with fi"rillary

cytoplasmic processes is present.

ote the plasma cells and the russell "odies



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Cytoplasmic "orders are apparent in this population

of epithelioid cells



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mmunohistochemistry

- /ositi$e A/2 $imentin2 C'2 )#A@C 5focal6

- egati$e 3)2 desmin2 p!



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'ifferential diagnosis

- Chordoid meningioma whorls2 psammoma "odies2 nuclear

pseudoinclusions2 - A/

- Chordoma infitrates "one2 physaliphorous cells2 -A/


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Pl!(y&( A#&%!(y&!ma

• R+!la% ($ll#• S!#$n&hal >)$%#• ;!#n!+hl( g%anula%

)!'$#Q• hyaln$ '%!+l$


167/176

PYA

• Pl$!m!%+h#m#gn>(an& ($llula% an'nu(l$a% +l$!m!%+h#m

• Yan&h! ($ll#,a(u!la&$' &um!% ($ll#(!n&anng l+' '%!+l$


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Ana+la#&(A#&%!(y&!ma

• 'ensely cellular moderate• uclear pleomorphism• ncreased mitotic acti$ity


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Gl!)la#&!ma

&igh cellularity2 admi*tures of• emistocytes2

• i"rillary astrocytes2• 3mall cells2• #ultinucleated giant cells.


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Olg!'$n'%!gl!ma

[n*!%m0 %!un' ($n&%al nu(l$


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Olg!a#&%!(y&!ma

+h$n!&y+$#• Olg!'$n'%!glal ($ll#• A#&%!(y&$#

Ana+la#&(

Olg!a#&%!(y&!ma• Nu(l$a%

a&y+aQ+l$!m!%+h#m• Hgh ($llula%&y• Hgh m&!&( a(&,&y


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A#&%!)la#&!ma

• A#&%!)la#&!ma&!u# %!#$&&$#• Va#(ula% hyalna&!n


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E/H/O GSA7ING


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AM;NA&y+a

M&!## ;n'!&h$lal

+%!l*$%a&!n

N$(%!##

Grade 6 &um!%# do not meet any !* &h$ (%&$%a/Grade 7 &um!%# m$$& one (%&$%!n0 u#ually nu(l$a%

a&y+a/Grade $ &um!%# m$$& t&o (%&$%a0 u#ually nu(l$a%a&y+a an' m&!##/Grade / &um!%# m$$& t"ree or four !* &h$ (%&$%a/


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Documents

Glioma- Chinh Sua