Brain Tumors - Adults / Locations

Intra-axial: Supratentorial: Cortical

Oligodendroglioma

Oligodendroglioma is a primary central nervous system (CNS) tumor that begins in the brain or spinal cord. It is considered the third most common glioma accounting for 2%–5% of primary brain tumors and 5%–18% of all glial neoplasms. Oligodendrogliomas are usually tumors of middle-aged adults, occurring most commonly in the 4th and 5th decades of life. They can be WHO CNS grade 2 or 3. Radiation therapy can be used to destroy what remains of the tumor after surgery¹.

(1) Oligodendroglioma Diagnosis and Treatment - NCI - National Cancer Institute. https://www.cancer.gov/rare-brain-spine-tumor/tumors/oligodendroglioma.

(2) Oligodendroglioma | Radiology Reference Article | Radiopaedia.org. https://radiopaedia.org/articles/oligodendroglioma.

(3) Oligodendroglioma, Brain Tumor: Causes, Symptoms & Treatments. https://my.clevelandclinic.org/health/diseases/21191-oligodendroglioma.

Intra-axial: Supratentorial: Cortical

Ganglioglioma

Gangliogliomas are rare tumors that start from groups of nerve cells (ganglion and glial cells) and grow in the brain or spinal cord. They are usually small and noncancerous, and they do not spread to other parts of the body. They are most common in children and young adults.

Gangliogliomas are composed of both mature nerve cells (ganglion cells) and immature nerve cells (glial cells). They are classified into two grades based on how fast they grow and how likely they are to become malignant. 

• Grade 1 gangliogliomas are low-grade tumors that grow slowly and tend to stay in one place. 

• Grade 2 gangliogliomas are high-grade tumors that grow faster and can become malignant or spread to other parts of the central nervous system.

(1) Ganglioglioma - Wikipedia. https://en.wikipedia.org/wiki/Ganglioglioma Accessed 4/10/2023.

Intra-axial: Supratentorial: Cortical

Pleomorphic xanthoastrocytoma

Pleomorphic xanthoastrocytoma (PXA) is a rare type of brain tumor that arises from astrocytes, which are cells that support the nerve cells in the brain. PXA can be classified as either grade 2 or grade 3 according to the World Health Organization (WHO) criteria, depending on the degree of abnormality and aggressiveness of the tumor cells. 

• Grade 2 PXAs are low-grade tumors that grow slowly.

• Grade 3 PXAs (also known as anaplastic PXAs) are malignant tumors that grow faster and have a worse prognosis.

Intra-axial: Supratentorial: Subcortical

Astrocytoma

Astrocytomas are tumors that form in the brain or spinal cord from star-shaped cells called astrocytes. Astrocytes are a type of glial cell, which are cells that support and protect the nerve cells in the central nervous system (CNS).

Astrocytomas are classified into four grades: 

• Grade 1 astrocytomas are low-grade tumors that grow slowly and do not spread. They are also called pilocytic astrocytomas. 

• Grade 2 astrocytomas are also low-grade tumors that grow slowly, but they can spread to nearby tissues. They are also called diffuse astrocytomas.

• Grade 3 astrocytomas are high-grade tumors that grow faster and can spread to other parts of the CNS. They are also called anaplastic astrocytomas. 

• Grade 4 astrocytomas are the most aggressive and malignant tumors that grow very fast and can spread to other parts of the body. They are also called glioblastomas.

Intra-axial: Supratentorial: Subcortical

Oligodendroglioma 

Oligodendrogliomas are a type of brain tumor that originates from the cells that support and insulate the nerve fibers in the brain and spinal cord. These cells are called oligodendrocytes, and they are a type of glial cell. Glial cells are cells that surround and protect the nerve cells in the central nervous system.

Oligodendrogliomas are classified into two grades based on how fast they grow and how likely they are to spread. 

• Grade 2 oligodendrogliomas are low-grade tumors that grow slowly and tend to stay in one place. 

• Grade 3 oligodendrogliomas are high-grade tumors that grow faster and can spread to other parts of the CNS or beyond.

(1) Oligodendroglioma - Overview - Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/oligodendroglioma/cdc-20350152 Accessed 4/10/2023. (2) Oligodendroglioma, Brain Tumor: Causes, Symptoms & Treatments. https://my.clevelandclinic.org/health/diseases/21191-oligodendroglioma Accessed 4/10/2023. (3) Oligodendroglioma - Wikipedia. https://en.wikipedia.org/wiki/Oligodendroglioma Accessed 4/10/2023. (4) Oligodendroglioma Diagnosis and Treatment - NCI - National Cancer Institute. https://www.cancer.gov/rare-brain-spine-tumor/tumors/oligodendroglioma Accessed 4/10/2023.

Intra-axial: Supratentorial: Subcortical

Gliomatosis cerebri

Gliomatosis cerebri is a rare and aggressive brain cancer that originates from a type of brain cell called an astrocyte¹. It is not a specific type of tumor, but a pattern of tumor growth that invades multiple lobes of the brain, especially the cerebrum, which controls many functions and emotions²³⁴. It can affect anyone at any age, but is more common in adults².

Gliomatosis cerebri is no longer recognized as a formal diagnosis, rather it refers to a diffuse pattern of glioma cells with extensive growth that invade multiple lobes of the brain². Gliomas of different grade and cell of origin (astrocytes, oligodendrocytes) can grow with this pattern, and very little is understood about the molecular basis of the disease. More research is needed to discover the origin of these tumors and to improve their treatment.

Gliomatosis cerebri can be divided into two types³:

- Type 1: no discrete mass, usually with no change in the genes called isocitrate dehydrogenase (IDH).

- Type 2: discrete mass with further diffuse CNS involvement, IDH mutation is more common in this subtype.

Intra-axial: Supratentorial: Subcortical

CNS lymphoma

FIX primary lymphomas of the CNS

secondary CNS lymphoma

Extra-axial: Intraventricular: Ventricular wall/ septum pellucidum

Subependymoma

FIX

Subependymomas are uncommon, benign (WHO grade 1) tumors which are slow-growing and non-invasive. They tend to occur in middle-aged and older individuals and usually identified as an incidental finding. 

Extra-axial: Intraventricular: Ventricular wall/ septum pellucidum

Central neurocytoma

FIX - Central neurocytomas are WHO grade 2 neuroepithelial intraventricular tumors with fairly characteristic imaging features, appearing as heterogeneous masses of variable size and enhancement within the lateral ventricle, typically attached to the septum pellucidum. They are typically seen in young patients and generally have a good prognosis provided a complete resection can be achieved. 

Extra-axial: Intraventricular: Choroid plexus

Pleomorphic Xanthroastrocytoma

FIX Pleomorphic xanthoastrocytomas (PXA) are an uncommon circumscribed astrocytic tumor found in young patients and can be WHO grade 2 or 3. 

Extra-axial: Intraventricular: Choroid plexus

Xanthogranuloma

FIX

Choroid plexus xanthogranulomata are common, incidental and almost invariably asymptomatic lesions.

Extra-axial: Intraventricular: Other

Meningioma

Meningiomas are typically slow-growing tumors that arise from the meninges, the membranes that cover the brain and spinal cord. They are the most common primary brain tumors, accounting for approximately one-third of all cases. Treatment options for meningiomas depend on several factors, including the tumor size, location, and histology, and may involve surgery, radiation therapy, or a combination of both. 

Extra-axial: Intraventricular: Other

Colloid cyst

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Extra-axial: Intraventricular: CP Angle

Schwannoma

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Extra-axial: CP Angle

Meningioma

Meningiomas are typically slow-growing tumors that arise from the meninges, the membranes that cover the brain and spinal cord. They are the most common primary brain tumors, accounting for approximately one-third of all cases. Treatment options for meningiomas depend on several factors, including the tumor size, location, and histology, and may involve surgery, radiation therapy, or a combination of both. 

Extra-axial: CP Angle

Epidermoid

Intracranial epidermoid cysts are rare benign tumors that arise from ectodermal cells that are misplaced during embryonic development. They are usually located in the cerebellopontine angle and parasellar region. Epidermoid cysts are typically seen as well-circumscribed, low-density lesions on CT scans and as hyperintense lesions on T1-weighted MRI scans.

Extra-axial: CP Angle

Dermoid

FIX TEXT

Intracranial dermoid cysts are uncommon lesions with characteristic imaging appearances. Dermoid cysts can be thought of as along the spectrum: from epidermoid cysts at one end (containing only desquamated squamous epithelium) and teratomas at the other (containing essentially any kind of tissue from all three embryonic tissue layers). 

On imaging, they are usually well-defined lobulated midline masses that have low attenuation (fat density) on CT and high signal intensity on T1-weighted MR images. Typically they do not enhance after contrast administration.

Extra-axial: CP Angle

IAC lipoma

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https://radiopaedia.org/articles/cerebellopontine-angle-lipoma?lang=us

Extra-axial: CP Angle

Arachnoid cyst

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https://radiopaedia.org/articles/arachnoid-cyst?lang=us

Arachnoid cysts are relatively common benign and asymptomatic lesions occurring in association with the central nervous system, both within the intracranial compartment (most common) as well as within the spinal canal. They are usually located within the subarachnoid space and contain CSF. 

Extra-axial: Dura

Meningioma

ABOVE

Extra-axial: Skull Base

Chordoma

Intracranial chordomas are rare malignant tumors that arise from remnants of the notochord within the skull base. They are usually slow-growing and can cause symptoms due to their mass effect on surrounding structures.

Extra-axial: Skull Base

Chondrosarcoma

Intracranial chondrosarcomas are rare malignant tumors that arise from cartilage cells within the skull base. They are usually slow-growing and can cause symptoms due to their mass effect on surrounding structures. 

Extra-axial: Sella/parasellar

MacroAdenoma

Intracranial macroadenomas are large benign tumors that arise from the pituitary gland. They are usually greater than 10 mm in size and can cause symptoms due to their mass effect on surrounding structures. 

Extra-axial: Sella/parasellar

MICROAdenoma

Intracranial microadenomas are small benign tumors that arise from the pituitary gland. They are less than 10 mm in size and are often asymptomatic. Microadenomas are typically seen as well-circumscribed, low-density lesions on CT scans and as hyperintense lesions on T1-weighted MRI scans.

Extra-axial: Sella/parasellar

Pituitary apoplexy

Pituitary apoplexy is a rare but potentially life-threatening condition that occurs when the blood supply to the pituitary gland is suddenly interrupted, leading to infarction or hemorrhage of the gland. It is usually caused by the rupture of a pre-existing pituitary adenoma or by the sudden enlargement of a non-functioning adenoma. Pituitary apoplexy is typically seen as a hyperdense lesion on CT scans and as a hypointense lesion on T1-weighted MRI scans. The diagnosis of pituitary apoplexy is usually established by MRI with defined radiological criteria to distinguish benign pituitary apoplexy from tumors of this area. The pineal region is best imaged with MRI although CT, angiography and ultrasound (in infants) also play a role. 

Extra-axial: Sella/parasellar

Rathke cleft cyst

Rathke cleft cysts are benign cystic lesions that arise from remnants of Rathke’s pouch, which is an embryonic precursor to the anterior pituitary gland. They are usually located in the sellar and suprasellar regions of the brain. Rathke cleft cysts are typically seen as well-circumscribed, low-density lesions on CT scans and as hyperintense  or hypointense lesions on T1-weighted MRI scans.

Extra-axial: Sella/parasellar

Epidermoid

SEE ABOVE

Intracranial epidermoid cysts are rare benign tumors that arise from ectodermal cells that are misplaced during embryonic development. They are usually located in the cerebellopontine angle and parasellar region. Epidermoid cysts are typically seen as well-circumscribed, low-density lesions on CT scans and as hyperintense lesions on T1-weighted MRI scans.

Extra-axial: Sella/parasellar

Craniopharyngioma - adamantinomatous

Craniopharyngiomas are rare tumors that develop in the brain near the pituitary gland. They are usually benign but can be locally aggressive and cause significant morbidity. Craniopharyngiomas are classified into two types: adamantinomatous and papillary. Adamantinomatous craniopharyngiomas are more common in children and adolescents, while papillary craniopharyngiomas are more common in adults. The diagnosis of craniopharyngioma is usually established by MRI with defined radiological criteria to distinguish benign craniopharyngioma from tumors of this area. The pineal region is best imaged with MRI although CT, angiography and ultrasound (in infants) also play a role. 

Extra-axial: Sella/parasellar

Craniopharyngioma

papillary craniopharyngiomas

Craniopharyngiomas are rare tumors that develop in the brain near the pituitary gland. They are usually benign but can be locally aggressive and cause significant morbidity. Craniopharyngiomas are classified into two types: adamantinomatous and papillary. Adamantinomatous craniopharyngiomas are more common in children and adolescents, while papillary craniopharyngiomas are more common in adults. The diagnosis of craniopharyngioma is usually established by MRI with defined radiological criteria to distinguish benign craniopharyngioma from tumors of this area. The pineal region is best imaged with MRI although CT, angiography and ultrasound (in infants) also play a role. 

Extra-axial: Sella/parasellar

Hypothalamic Hamartoma

Hypothalamic hamartomas are benign non-neoplastic heterotopias in the brain that typically occur in the region of the hypothalamus, arising from the tuber cinereum, a part of the hypothalamus located between the mammillary bodies and the optic chiasm¹. A hypothalamic hamartoma is a tumor-like formation on the hypothalamus, the area at the base of the brain that controls the production and release of hormones by the pituitary gland³. Hypothalamic hamartomas are benign lesions². Parents must be informed to avoid concerns for any potential malignant transformation or metastasis². Puberty will typically occur even after the use of GnRH agonists, and children will develop normally after surgical or ablative procedures².

(1) Hypothalamic hamartoma | Radiology Reference Article | Radiopaedia.org. https://radiopaedia.org/articles/hypothalamic-hamartoma.

(2) Hypothalamic Hamartoma | Children's Hospital of Philadelphia. https://www.chop.edu/conditions-diseases/hypothalamic-hamartoma.

(3) Hypothalamic Hamartoma - StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK560663/.

Extra-axial: Pineal

Pineocytoma

Pineocytoma is a rare type of brain tumor that arises from pinealocytes, which are specialized cells in the pineal gland. Pineocytomas are typically slow-growing and may not cause symptoms for many years. However, as the tumor grows, it can compress surrounding structures and cause neurological symptoms such as headaches, nausea, and vision changes. On imaging studies, pineocytomas typically appear as well-defined, homogeneous masses with minimal surrounding edema. They may enhance with contrast and can be hyperintense on T2-weighted MRI sequences. Treatment options for pineocytomas typically involve surgical resection, followed by radiation therapy and/or chemotherapy depending on the extent and grade of the tumor.

Extra-axial: Pineal

Pineal Cyst

A Pineal cyst is a relatively common finding on neuroimaging studies, particularly on MRI. It is a fluid-filled sac located within the pineal gland, which is situated in the central part of the brain. Pineal cysts are usually small and asymptomatic, but in rare cases, they may cause neurological symptoms such as headache, visual disturbances, and balance problems. Radiologists should carefully evaluate the size, location, and morphology of pineal cysts, as well as their relationship to adjacent structures, to help determine their clinical significance. While most pineal cysts are benign and do not require intervention, larger cysts or those associated with symptoms may require further investigation or treatment.