Brain Tumor

A brain tumor is an abnormal growth of cells within the brain, which can be cancerous(malignant) or non-cancerous (benign). It is defined as any intracranial tumor created by abnormal and uncontrolled cell division, normally either in the brain itself (neurons, glial cells (astrocytes,oligodendrocytes, ependymal cells, myelin-producing Schwann cells), lymphatic tissue, blood vessels), in the cranial nerves, in the brain envelopes (meninges), skull, pituitary and pineal gland, or spread from cancers primarily located in other organs (metastatic tumors).

Primary (true) brain tumors are commonly located in the posterior cranial fossa in children and in the anterior two-thirds of the cerebral hemispheres in adult, although they can affect any part of the brain.

In the United States in the year 2005, it was estimated there were 43,800 new cases of brain tumors (Central Brain Tumor Registry of the United States, Primary Brain Tumors in the United States, Statistical Report, 2005–2006),^[1] which accounted for 1.4 percent of all cancers, 2.4 percent of all cancer deaths,^[2] and 20–25 percent of pediatric cancers.^[2][3] Ultimately, it is estimated there are 13,000 deaths per year in the United States alone as a result of brain tumors.^[1]

Contents [hide] 1 Causes 2 Signs and symptoms 3 Types of brain tumors 4 Diagnosis 5 Treatment and prognosis 5.1 Research to treatment with the vesicular stomatitis virus 6 Brain tumors in infants and children 7 See also 8 References 9 External links

[edit]Causes

Metastatic cancers are far more common than primary tumors of the brain and spinal cord.

Apart from exposure to vinyl chloride or ionizing radiation, there are no known environmental factors associated with brain tumors. Mutations and deletions of so-called tumor suppressor genes are thought to be the cause of some forms of brain tumors. Patients with various inherited diseases, such as Von Hippel-Lindau syndrome, multiple endocrine neoplasia, neurofibromatosis type 2 are at high risk of developing brain tumors. It is alleged that mobile phones/cell phones might be a cause of brain tumors, according to one report.^[4] (see Mobile phone radiation and health) There is an association of brain tumor incidence and malaria, suggesting that the anopheles mosquito, the carrier of malaria, might transmit a virus or other agent that could cause a brain tumor.^[5] Malignant brain tumor incidence and Alzheimer's disease prevalence are associated in 19 US states. The two diseases may share a common cause, possibly inflammation.^[6]

[edit]Signs and symptoms

Symptoms of brain tumors may depend on two factors: tumor size (volume) and tumor location. The time point of symptom onset in the course of disease correlates in many cases with the nature of the tumor ("benign", i.e. slow-growing/late symptom onset, or malignant, fast growing/early symptom onset) is a frequent reason for seeking medical attention in brain tumor cases..

Large tumors or tumors with extensive perifocal swelling edema inevitably lead to elevated intracranial pressure (intracranial hypertension), which translates clinically into headaches, vomiting (sometimes without nausea), altered state of consciousness (somnolence, coma), dilatation of the pupil on the side of the lesion (anisocoria), papilledema (prominent optic disc at the funduscopic eye examination). However, even small tumors obstructing the passage of cerebrospinal fluid (CSF) may cause early signs of increased intracranial pressure. Increasedintracranial pressure may result in herniation (i.e. displacement) of certain parts of the brain, such as the cerebellar tonsils or the temporaluncus, resulting in lethal brainstem compression. In young children, elevated intracranial pressure may cause an increase in the diameter of theskull and bulging of the fontanelles.

Depending on the tumor location and the damage it may have caused to surrounding brain structures, either through compression or infiltration, any type of focal neurologic symptoms may occur, such as cognitive and behavioral impairment, personality changes, hemiparesis,hypoesthesia, aphasia, ataxia, visual field impairment, facial paralysis, double vision, tremor etc. These symptoms are not specific for brain tumors—they may be caused by a large variety of neurologic conditions (e.g. stroke, traumatic brain injury). What counts, however, is the location of the lesion and the functional systems (e.g. motor, sensory, visual, etc.) it affects.

A bilateral temporal visual field defect (bitemporal hemianopia—due to compression of the optic chiasm), often associated with endocrine disfunction—either hypopituitarism or hyperproduction of pituitary hormones and hyperprolactinemia is suggestive of a pituitary tumor.

[edit]Types of brain tumors

• Glioblastoma multiforme
• Medulloblastoma
• Astrocytoma
• CNS lymphoma
• Brainstem glioma
• Germinoma
• Meningioma
• Oligodendroglioma
• Schwannoma
• Craniopharyngioma
• Ependymoma
• Mixed gliomas
• Brain metastasis^[7]

[edit]Diagnosis

Micrograph of an oligodendroglioma, a type ofbrain cancer. Brain biopsy. H&E stain.

Although there is no specific clinical symptom or sign for brain tumors, slowly progressive focal neurologic signs and signs of elevated intracranial pressure, as well as epilepsy in a patient with a negative history for epilepsy should raise red flags. However, a sudden onset of symptoms, such as an epileptic seizure in a patient with no prior history of epilepsy, suddenintracranial hypertension (this may be due to bleeding within the tumor, brain swelling or obstruction of cerebrospinal fluid's passage) is also possible.

Glioblastoma multiforme and anaplastic astrocytoma have been associated in case reports onPubMed^[who?] with the genetic acute hepatic porphyrias (PCT, AIP, HCP and VP), including positive testing associated with drug refractory seizures. Unexplained complications associated with drug treatments with these tumors should alert physicians to an undiagnosed neurological porphyria.

Imaging plays a central role in the diagnosis of brain tumors. Early imaging methods—invasive and sometimes dangerous—such as pneumoencephalography and cerebral angiography, have been abandoned in recent times in favor of non-invasive, high-resolution modalities, such as computed tomography (CT) and especially magnetic resonance imaging (MRI). Benign brain tumors often show up as hypodense (darker than brain tissue) mass lesions on cranial CT-scans. On MRI, they appear either hypo- (darker than brain tissue) or isointense (same intensity as brain tissue) on T1-weighted scans, or hyperintense (brighter than brain tissue) on T2-weighted MRI, although the appearance is variable. Perifocal edema also appears hyperintense on T2-weighted MRI. Contrast agent uptake, sometimes in characteristic patterns, can be demonstrated on either CT or MRI-scans in most malignant primary and metastatic brain tumors. This is because these tumors disrupt the normal functioning of the blood-brain barrier and lead to an increase in its permeability. However it is not possible to diagnose high versus low grame gliomas based on enhancement pattern alone.

Electrophysiological exams, such as electroencephalography (EEG) play a marginal role in the diagnosis of brain tumors.

The definitive diagnosis of brain tumor can only be confirmed by histological examination of tumor tissue samples obtained either by means of brain biopsy or open surgery. The histological examination is essential for determining the appropriate treatment and the correct prognosis. This examination, performed by a pathologist, typically has three stages: interoperative examination of fresh tissue, preliminary microscopic examination of prepared tissues, and followup examination of prepared tissues after immunohistochemical staining or genetic analysis.

Another possible diagnosis would be neurofibromatosis which can be in type one or type two.

ganglion cyst (Tendon Cyst)

A ganglion cyst (also known as a bible cyst) is a swelling that often appears on or around jointsand tendons in the hand or foot. The size of the cyst can vary over time. It is most frequently located around the dorsum of wrist and on the fingers. The term "Bible Bump" comes from a common urban legend that treatment in the past consisted of pounding on the cyst with a Bible or another large book.^[1]

Contents [hide] 1 Cause 2 Treatment 3 Epidemiology 4 Image gallery 5 See also 6 References 7 External links

[edit]Cause

Ganglion cysts are idiopathic, but presumably reflect a variation in normal joint or tendon sheathfunction. Cysts near joints are connected to the joint and the leading theory is that a type of check valve forms that allows fluid out of the joint, but not back in. The cyst contains clear fluid similar to, but thicker than, normal synovial fluid. They are most often found around the wrist joint, especially at the scapho-lunate joint, which accounts for 80% of all ganglion cysts.

[edit]Treatment

If a ganglion cyst is symptomatic, it can be managed by aspiration or excision. Aspiration and injection of hylase into the cyst is the simpler of the two procedures, but cysts recur in more than 50% of cases. With surgery, the recurrence rate is reduced to only 5 to 10% if the check valve at the joint capsule is removed.

Arthroscopy of the wrist is becoming available as an alternative to open excision of ganglion cysts. During arthroscopy, the origin of the cyst can be seen within the joint.

The traditional method of treating a ganglion cyst was to strike the lump with a large heavy book, causing the cyst to rupture and drain into the surrounding tissues. An urban legend states that since even the poorest households often possessed a Bible (referring to the large family Bibles), this was commonly used, which led to the nicknaming of ganglion cysts as "Jillian's lump" "Bible Bumps" or "Gideon's Disease."^[1]This type of treatment is not recommended by some doctors as it can damage the area around the cyst and the cyst may come back anyway.

[edit]Epidemiology

The epidemiology is not well studied, but some have stated that they occur most often in the 20–40 age group and are three times more common in women.^[2]

[edit]Image gallery

Gallstone

Gallstones Overview

Gallstones (commonly misspelled gall stones) are solid particles that form frombile in the gallbladder.

• The gallbladder is a small saclike organ in the upper right part of the abdomen. It is located under the liver, just below the front rib cage on the right side.
  
  
• The gallbladder is part of the biliary system, which includes the liver and thepancreas.
  
  
• The biliary system, among other functions, produces bile and digestive enzymes.

Bile is a fluid made by the liver to help in the digestion of fats.

• It contains several different substances, including cholesterol and bilirubin, a waste product of normal breakdown of blood cells in the liver.
  
  
• Bile is stored in the gallbladder until needed.
  
  
• When we eat a high-fat, high-cholesterol meal, the gallbladder contracts and injects bile into the small intestine via a small tube called the common bile duct. The bile then assists in the digestive process.

There are two types of gallstones: 1) cholesterol stones and 2) pigment stones.

1. Patients with cholesterol stones are more common in the United States, making up approximately 80% of all gallstones. They form when there is too much cholesterol in the bile.
   
   
2. Pigment stones form when there is excess bilirubin in the bile.

Gallstones can be any size, from tiny as a grain of sand to large as a golf ball.

• Although it is common to have many smaller stones, a single larger stone or any combination of sizes is possible.
  
  
• If stones are very small, they may form a sludge.
  
  
• Whether gallstones cause symptoms depends partly on their size and their number, although no combination of number and size can predict whether symptoms will occur or the severity of the symptoms.

Gallstones within the gallbladder often cause no problems. If there are many or they are large, they may cause pain when the gallbladder responds to a fatty meal. They also may cause problems if they move out of the gallbladder.

• If their movement leads to blockage of any of the ducts connecting the gallbladder, liver, or pancreas with the intestine, serious complications may result.
  
  
• Blockage of a duct can cause bile or digestive enzymes to be trapped in the duct.
  
  
• This can cause inflammation and ultimately severe pain, infection, and organ damage.
  
  
• If these conditions go untreated, they can even cause death.

Up to 20% of adults in the United States may have gallstones, yet only 1%-3% develop symptoms.

• Hispanics, Native Americans, and Caucasians of Northern European descent are most likely to be at risk for gallstones. African Americans are at lower risk.
  
  
• Gallstones are most common among overweight, middle-aged women, but the elderly and men are more likely to experience more serious complications from gallstones.
  
  
• Women who have been pregnant are more likely to develop gallstones. The same is true for women taking birth control pills or on hormone/estrogen therapy as this can mimic pregnancy in terms of hormone levels.

http://www.emedicinehealth.com/gallstones/article_em.htm