Brain formation ICD 10. Tumors of the brain and other parts of the central nervous system. How do people die from glioblastoma?

Glioblastoma is a malignant neoplasm that develops in brain tissue. Despite the absence of metastases, the tumor poses a serious threat to human life. The prognosis of the disease is determined by a complex of factors, among which priority is given to the location of the tumor and the degree of its development at the time of diagnosis. The risk group includes older people. However, there are cases of glioblastoma developing in children.

Glioblastoma of the brain (ICD 10 code – C71) is a cancer. There are two ways of its development:

• primary – from glial cells (in most cases);
• secondary – from an existing astrocytoma (a type of brain cancer).

The second option is typical for middle-aged people and is characterized by slow growth.

Regardless of the path of development, the neoplasm is characterized by the following features:

1. predominant damage to the frontal and temporal lobes of the brain;
2. the presence of grade 4 (tumor cells are subject to rapid growth and reproduction);
3. diffuse nature of growth, the presence of its own network of blood vessels;
4. rare metastasis;
5. different consistency and different sizes;
6. the presence of cell infiltration beyond the visible tumor.

The etiology of the disease is unclear. Factors that provoke tumor development are presented:

1. genetic pathologies;
2. SV40, HHV-6 and cytomegalovirus viruses;
3. previous radiation therapy;
4. head injuries;
5. smoking.

Those at risk for developing glioblastoma include:

1. men over 40 years of age;
2. people with a history of astrocytoma;
3. patients suffering from neurofibromatosis, since the latter is accompanied by genetic disorders;
4. men and women who come into contact with polyvinyl chloride (this chemical has Negative influence on glial cells), with ionizing radiation (over a long period of time);
5. people suffering from frequent viral diseases;
6. patients with a family history.

Symptoms

The clinical picture of a brain tumor includes a wide range of symptoms. At an early stage, the presence of a neoplasm can be suspected by the occurrence of frequent fainting, speech or movement disorders. This occurs if the tumor is near the centers that control speech and movement.

Symptoms of glioblastoma include the following:

• regular headaches that cannot be relieved with analgesics;
• nausea after waking up;
• olfactory hallucinations;
• visual and speech impairment;
• weakening of memory;
• changes in sensitivity and mobility of arms and legs;
• drowsiness;
• dizziness;
• convulsions.

An increase in the growth rate of an aggressive tumor leads to increased clinical manifestations. In some cases, the size of the tumor is small, or the tumor is located far from the nerve centers. In this case, timely diagnosis of glioblastoma is difficult.

Classification

Depending on the type of cells, there are 3 types of tumors:

• giant cell glioblastoma, when the neoplasm includes large cells containing two or more nuclei;
• glioblastoma multiforme, the tissue of which includes overgrown blood vessels, foci of necrosis, etc.;
• gliosarcoma, consisting of glia (auxiliary cells of nervous tissue) and connective tissue cells.

The difference in the location of the tumor allows us to distinguish the following types:

• cerebral (the tumor is located in the temporal, frontal or other areas of the brain);
• stem, when the tumor is located in the brain stem (the tumor is inoperable because surgical intervention leads to disruption of the musculoskeletal system).

By histological classification There are 3 types of glioblastoma:

• isomorphic cellular, when the tumor consists of cells of the same type;
• multiform, in which the neoplasm consists of cells of different types;
• polymorphocellular (glioblastoma cells of different sizes and shapes).

Another basis for classification is the number of malignant cells of the neoplasm. In accordance with this, there are 4 stages of glioblastoma.

• The first stage is transitional. Diagnosis is not possible due to complete absence manifestations. Only a portion of benign cells develop into cancerous ones.
• The second stage is slow cell growth.
• The third stage is the development of a malignant tumor. Rapid growth of atypical cells occurs.
• The fourth stage is the manifestation of a vivid clinical picture. Stage 4 glioblastoma is most often diagnosed. The patient's life expectancy after diagnosis is several months.

Types of glioblastoma

There are 4 main types of glioblastoma depending on the cells predominant in the tumor tissue. Each type has a specific pathology and degree of malignancy.

• Multiform pathology

This type of glioblastoma is characterized by species diversity cancer cells. The basis for the development of neoplasms is glia, which is the connective tissue of a network of neurons. The trigger for degeneration is the impact of unfavorable factors.

Active growth of atypical cells contributes to the spread of cancer to other parts of the nervous system (for example, with the subsequent development of glioblastoma of the spinal cord). Treatment of multiform pathology has certain difficulties. They are due to the fact that each type of cancer cell is susceptible to different methods of therapy and has different rates of growth and development. Multifocal glioblastoma is considered the most dangerous.

• Giant cell form

During the study of the material, large pathological cells are revealed. They include multiple cores. The disease is considered less dangerous.

• Gliosarcoma

The neoplasm is characterized by bidermality. The tumor is a mixture of glial cells and connective tissue cells. Gliosarcoma is difficult to treat.

• Polymorphic cell form

Atypical cells are large, different shapes. The study reveals no a large number of cytoplasm. The kernels have different structures and sizes. Polymorphic cell glioblastoma is more common than other types.

Diagnostic methods

To make a diagnosis, there is a certain scheme for examining patients. Its main principle is complexity. Diagnostic measures include:

1. initial examination and history taking;
2. neurological examination;
3. ophthalmological examination;
4. MRI of the brain using contrast enhancement;
5. electroencephalography;
6. clinical blood test;
7. biochemical blood test (including liver and kidney function indicators).

The overall functional status is assessed using a special scale - the Karnofsky scale.

Tumor treatment methods

Glioblastoma is incurable, but the patient's suffering can be alleviated.

Therapy is aimed at:

• maximum reduction in the size of the formation without damaging normal cells;
• stopping further proliferation of pathological cells;
• creating conditions to improve the patient’s quality of life.

The initial stage of treatment for glioblastoma of the brain is surgery. The subsequent stages are chemotherapy and radiation therapy. The tumor is not completely removed in two cases:

1. The pathological formation is located in vital parts of the brain.
2. Around the tumor there are migrating cancer cells that invade the healthy area.

Partial removal of affected tissue can increase life expectancy. After consultation with your doctor, it is possible to use unconventional methods. Prescribing a modified diet for glioblastoma will slow down the growth of atypical cells and increase their sensitivity to therapy. Corticosteroid drugs may be used. So, Dexamethasone will help relieve brain swelling and reduce the feeling of pain. The drug has many side effects, so the decision to prescribe it is made by the doctor based on the patient’s health condition.

Neurosurgical intervention

The operation is performed on the brain. During surgery, they try to remove the tumor as much as possible. In some situations the method is not applicable or is risky. This is due to the close location of the tumor next to vital areas of the brain. If there is a relapse, repeat surgery may be prescribed.

Combined treatment

Application radiation therapy in combination with the drug Temodal

The essence of the treatment is the effect of ionizing radiation on atypical cells. This is necessary to reduce the activity of the tumor and inhibit its growth. The duration of radiation therapy for glioblastoma is on average 30 days. Treatment is carried out for 6 weeks (5 times a week).

At the same time, it is necessary to take Temodal, an antitumor drug. The treatment regimen for glioblastoma for each patient is determined individually depending on the age category and previous chemotherapy.

A type of radiation therapy is radiosurgery. The cyberknife method for glioblastoma is characterized by the least traumatic effect due to the targeted effect. Thanks to this, the number of sessions is less, and therapeutic effect higher.

Maintenance chemotherapy

Exposure to chemotherapy drugs is carried out to block the growth and development of pathological cells. The active substance used is temozolomide, contained in the drug Temodal. Chemotherapy for glioblastoma of the brain is carried out in combination with radiation therapy. Then maintenance courses are needed. Their duration is 5 days. The break is 23 days. On average, 6 courses are required.

Targeted therapy

The use of Avastin in treatment can disrupt the circulatory system in the tumor. As a result, tumor growth is reduced. The drug is used for relapses of glioblastoma. The initial diagnosis of a tumor is not an indication for prescribing this drug.

How do people die from glioblastoma?

Patients with stage 4 glioblastoma of the brain suffer from persistent severe headaches and seizures. The growth and reproduction of malignant cells leads to impaired mental functioning and mental disorders. The result of the disease is paralysis.

Consequences

Glioblastoma is particularly malignant. The prognosis is unfavorable. It depends on several factors:

• general condition of the patient;
• patient's age;
• location of the tumor;
• tumor size;
• the body's reaction to the therapy.

On average, life expectancy for glioblastoma ranges from 12 to 15 months. The inoperability of the tumor significantly shortens this period of time.

A small percentage of patients survive 2 years or more.

However, the presence of a neoplasm leads to a number of consequences:

• the occurrence of relapses even after effective treatment of the primary tumor;
• when the tumor is localized near vital centers of the brain, it grows and negatively affects the centers responsible for respiratory function and blood circulation;
• partial removal of glioblastoma leads to neurological disorders.

It is impossible to completely defeat glioblastoma. However, it is possible to slow down the growth of abnormal cells. Treatment of the tumor should begin immediately after diagnosis.

New treatments for this malignancy are being developed. In Germany they are testing new drug LY2109761. Israeli doctors are experimenting with exposing glioblastoma to a controlled electromagnetic field. It is possible that new techniques will increase the life expectancy of patients with glioblastoma.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Glioblastoma of the brain

Neuroglia are a special type of brain cells that retain the ability to divide even after birth. Morphologically, the cells are a type of neuron without an axon. By function, they distinguish astroglia, which participate in the formation of the blood-brain barrier (the barrier between blood and nervous tissue), oligodendroglia, which forms the myelin sheath, and ependymal glia, which lines the cerebrospinal fluid tract. Besides structural function they promote electrolyte metabolism, perform transport functions and much more.

Unfortunately, Neuroglia are the source of many types of brain tumors. Thus, immature astroglial cells are the source of brain glioblastomas. Glioblastomas primarily affect people of working age (35-60 years), there are no clear gradations by gender.

Information for doctors. Diagnosis coding according to ICD 10 is coded C71. In this case, it is necessary to digitally clarify the specific location of the tumor (0 - cerebrum, 1 - frontal lobe, 2 - temporal, 3 - parietal, 4 - occipital, 5 - ventricles, except the fourth, 6 - cerebellum, 7 - trunk and 4th ventricle , 8 – glioblastoma extending beyond one specified location). It is also possible to specify the code C71.9 - unspecified localization. It is necessary to indicate the cytological nature of the tumor (glioblastoma), syndromic manifestations (hypertensive-hydrocephalic syndrome, etc.).

Causes

The causes of glioblastoma have not been reliably established. Hereditary factors, the role of intoxication, radio radiation, and the action of mutagens have been suggested. Also at one time, the infectious nature of tumor development was considered. However, one theory of the disease has not been approved.

Symptoms

The morphological features of the tumor (infiltrative, “penetrating” growth, the rate of increase in the mass of glioblastoma) lead to the rapid development of symptoms.

The main symptoms can be divided into two parts: general cerebral and focal manifestations. General cerebral syndromes include hypertensive-hydrocephalic syndrome (expanding headaches, nausea, weakness), vestibular (uncertainty of gait, dizziness). Focal manifestations depend on the specific location of the tumor and include speech disorders, changes in the mental sphere, memory loss, inability to perform complex actions, etc.

Sometimes, against the background of a short period of general weakness and headache, a picture of a hemorrhagic stroke may develop due to extensive hemorrhage into the tumor tissue. If the brain stem is damaged, the patient's life and death are quickly threatened.

Based on the size of the tumor, its cytological nature (immaturity of the cells that make up the tumors and the rate of their growth) and some other parameters, four degrees of glioblastoma are distinguished.

Treatment

Glioblastoma is practically untreatable, especially at stages 3-4. Surgical treatment, chemotherapy, and radiological treatment methods usually serve only to prolong the life of patients. Surgical treatment for glioblastomas accidentally discovered in the early stages and the possibility of neurosurgical access, as a rule, does not lead to a cure. A relapse occurs soon tumor growth. In this case, most often the tumor is located deep in the hemispheres of the brain. Modern neurosurgical care is not able to provide access to such deeply located structures.

Life forecast

The prognosis for life with glioblastoma is unfavorable. In most cases, death occurs within several years after the first signs of the disease appear.

Brain astrocytoma: what is it and how to treat it?

There are various types of tumors in the central nervous system. Their source is various fabrics. It is known that the main tissue of the nervous system is neurons. Their bodies form the cerebral cortex, or substantia serine, and also lie in the middle of the spinal cord. Their processes – dendrites and axons – form pathways, or white matter.

But, in addition to nerve cells, there are helper cells that perform a connecting and trophic function. They are called glial tissue, or neuroglia, and they make up about half the mass of the entire nervous system. There may be more neuroglial cells per neuron. For example, oligodendrocytes are representatives of oligodendroglia, and astrocytes, which have star-shaped processes, are astroglia.

Astrocytes form the supporting skeleton of the neural network, regulate their nutrition, maintain glycogen reserves, and protect neurons. In general, these are “nanny” cells.

But sometimes it happens that it is from these cells that malignant tumors arise, such as brain astrocytoma. Since there are so many astrocytes, astrocytoma is the most common among all brain tumors.

ICD-10 does not provide separate histological labeling for tumors. There are localization options. Therefore, the general code C71 is provided for any tumor, and in the case of the presence of any tumor, for example, the cerebral hemispheres or cerebellum, including astrocytoma, the ICD -10 code is set accordingly

Types of tumor

The most important question that worries a patient with suspicion is the prospect of a cure and the prognosis of life with cerebral astrocytoma. Neurosurgeons cannot say this right away, since laboratory diagnostic results are needed to determine the type of tumor. It can be performed during surgery, if there are indications for removal, or during a stereotactic targeted biopsy.

The prognosis for the presence of cerebral astrocytoma depends on its location and cellular composition. The following types of neoplasms are distinguished:

• pilocytic form. It is practically benign. Therefore, it has slow growth and clear boundaries. As it increases, it does not germinate or destroy tissues, but only pushes them aside. Occurs more often in children. Often occurs in the brain stem, cerebellum and optic tract. Belongs to malignancy group 1;
• fibrillar variant. This is a more dangerous tumor, as evidenced by the lack of a clear border. Despite its slow growth, it can destroy surrounding tissue. Fibrillary astrocytoma of the brain is more common in older adults. Sometimes it can recur, so postoperative radiation therapy is required.
• anaplastic astrocytoma. A dangerous tumor of poorly differentiated cells that quickly grows and destroys brain structures. It belongs to the 3rd group of malignancy, and occurs at a more mature age - summer age, more often in men. Anaplastic astrocytoma of the brain is one of the leading causes of death from brain tumors.

The next and last degree of malignancy deserves special mention. This tumor, which has completely lost contact with its source - astrocytic glia - is called glioblastoma. These are the most undifferentiated cells that grow very quickly, destroying everything in their path. It most often occurs in adulthood, and more often in men.

It sometimes happens that the prognosis for anaplastic astrocytoma of the brain worsens significantly as it transforms into glioblastoma. It can be said that death within a few months of glioblastoma diagnosis is common.

Signs and treatment

The most dangerous and unfavorable, almost fatal option is an astrocytoma of the brain stem of the maximum degree of malignancy, that is, glioblastoma. Any tumor of the trunk, even benign, is very dangerous. Removing them is very difficult, and with low differentiation, even impossible.

In the trunk, in a tiny volume, there is a gigantic number of pathways and nuclei of cranial nerves, including vital ones. Therefore, germination by a tumor, for example, of the autonomic nuclei of the X pair of cranial nerves (vagus), causes disturbances in the functioning of the heart that are incompatible with life.

Signs of such an astrocytoma can be detected in the presence of a sudden alternating syndrome, with an increase in symptoms. On one side, central paralysis occurs, and on the opposite side there is damage to the cranial nerve (strabismus, tongue paralysis), or sensitivity disorders (pain, temperature, tactile).

In the case of a different tumor localization, the following may occur:

• headache;
• congestive signs in the fundus;
• nausea and vomiting;
• dizziness;
• epileptic seizures;
• bradycardia, or slow heart rate;
• violation higher functions: accounts, writing, intelligence.

These are the most common symptoms. In the future, everything depends on the localization, since astrocytoma can be located anywhere: in all lobes of the cerebral hemispheres, in the corpus callosum, in the trunk and subcortical nodes, in the region of the 3rd ventricle and the transparent septum, the quadrigeminal and other places.

Treatment of cerebral astrocytoma is only surgical, followed by courses of radiation and chemotherapy. If an inoperable tumor is diagnosed, for example, in the trunk, then only radiation and chemotherapy are used.

It is not possible to estimate the survival time after removal of an astrocytoma. general outline. You need to know the degree of malignancy. Thus, according to M.V. Bazunov, “after removal of astrocytomas, regardless of location, in almost 90% of cases the survival rate was more than 10 years.”

Astrocytoma ICD

Brain astrocytoma is a tumor of glial origin that is formed from astrocytes. Astrocytes are brain cells that have a star-shaped shape. This type of brain cell regulates the volume of intercellular fluid and also ensures the normal functioning of nerve cells in the brain. Astrocytes have the ability to divide. But in the case when the reproduction process becomes uncontrolled, the development of a malignant tumor is possible. Astrocytoma is often observed in men aged 28 to 60 years. Thanks to modern, improved diagnostic methods, doctors have found that almost the majority of brain tumors are astrocytomas. Astrocytoma is the most common form of glial tumor.

According to the ICD classification, astrocytoma belongs to malignant brain tumors. ICD is the international classification of diseases 10th reading. Astrocytoma according to ICD may have the following codes:

• C71 Malignant tumor localized in the brain;
• D43 formation of unknown etiology and nature in the central nervous system.

Localization of astrocytoma

This form of glial tumor can develop at any age and is localized in different zones brain. Often this type of tumor is diagnosed in the following parts of the brain:

• Large hemispheres of the brain - this localization is more often observed in adulthood;
• Brain stem (where the brain connects to the spinal cord). According to the ICD, such an astrocytoma is called spinal cord astrocytoma;
• Cerebellum (more common in childhood);
• Optic nerve in children.

Causes of astrocytoma

Currently, the exact reasons that lead to the development of astrocytoma have not been established. But scientists have identified some factors that provoke the development of this malignant formation:

• Hereditary predisposition to the development of cancer;
• Negative effects of the environment (radiation, chemicals);
• Viruses that have high risk oncogenicity.

Classification of astrocytoma

Doctors distinguish several types of astrocytoma. The most common types of astrocytoma are:

• Polycytic astrocytoma according to ICD is a benign formation that has clear boundaries. This type The tumor is localized in the cerebellum or in the brain stem and has the first degree of malignancy. This neoplasm is characterized by slow tumor growth. This form is most often diagnosed in childhood. Polycytic astrocytoma is treated only surgically;
• Protoplasmic astrocytoma can be localized on the surface of the gray matter of the brain or in its cortical structures. This form of tumor does not affect healthy tissue as it grows, which leads to a favorable prognosis for surgical treatment. In this case, the neoplasm grows very slowly and is characterized by the second degree of malignancy;
• Diffuse astrocytoma is one of the most severe forms of this tumor and has a second degree of malignancy. It has no clear boundaries and is characterized by very rapid growth, which is unfavorable for surgical treatment;
• Anaplastic astrocytoma is characterized by the third degree of malignancy, rapid growth and unclear boundaries. This form of astrocytoma grows into healthy brain tissue, which makes surgical treatment difficult;
• Glioblastoma is the most severe form of astrocytoma and is characterized by the fourth degree of malignancy. It is characterized by very intensive growth, which is manifested by a rapid increase in tumor size. This form of astrocytoma grows deeply into healthy tissue, making surgical treatment impossible.

Clinical symptoms of astrocytoma

This tumor is characterized by both general (develop due to the toxic effect of tumor metabolites or compression of adjacent brain structures) and local symptoms (when localized in a specific area of ​​the brain).

General symptoms of astrocytoma:

• Constant headaches;
• Dizziness, fainting;
• Nausea, vomiting;
• Unmotivated weakness;
• Speech disorders and memory impairment;
• Increased blood pressure, which is a consequence of increased intracranial pressure;
• Impaired coordination when moving;
• Disorders of vision, hearing, smell, taste;
• Seizures and epileptic seizures.

Diagnosis of astrocytomas

To establish the diagnosis of astrocytoma, the following diagnostic methods are used:

• Full collection of complaints;
• Full examination by a neurologist, ophthalmologist, otolaryngologist, neurosurgeon;
• Computed tomography of the brain (localization of the tumor is determined);
• Magnetic resonance imaging of the brain (assessing the anatomical structures of the brain and the presence of astrocytomas in the first stages of development);
• Histological examination by biopsy (precisely indicates the presence of cancer cells);
• Angiography (examines the vascular bed of the brain);
• Visual and vestibular function is assessed;
• Mental status is assessed;
• Ultrasound of the brain;
• Electroencephalography.

Treatment of astrocytes

The method and extent of treatment depends on the location of the tumor, its size and degree of malignancy.

The main therapeutic measures used to treat astrocytomas:

• Radical or partial removal of the tumor;
• Radiation therapy;
• Chemotherapy.

In cases where the tumor has grown into healthy brain tissue, partial surgical removal of the tumor is performed. When the tumor has clear boundaries and grows into healthy tissue, radical removal of the tumor is performed. The radiation treatment method involves the destruction or arrest of the development of the pathological process. Chemotherapy treatment is characterized by the use of special drugs that destroy tumor cells because they have a toxic effect on them.

Glioblastoma

Glioblastoma is considered the most dangerous malignant brain tumor that develops from glial cells. The main distinguishing criteria include the random arrangement of cells that have undergone a malignant process, changes in the configuration of blood vessels, widespread edema and the presence of necrotic areas in the brain. In addition, glioblastoma is characterized by rapid progression, involving surrounding tissues in the process, as a result of which the tumor does not have clear boundaries.

The only place of its localization is considered to be the nervous system. Most often, malignant neoplasms are located in the temporal and frontal regions. However, cases of detection of a lesion in other structures of the brain, such as the brainstem, cerebellum and even the spinal cord, cannot be excluded. Glioblastoma may include different kinds cells, such as astrocytes and oligodendrocytes. According to statistics, about 50% of all brain tumors are glial tumors, of which glioblastomas make up the majority.

ICD-10 code

Causes of glioblastoma

The causes of glioblastoma have not been sufficiently studied and have no evidence base. However, despite this, there are still some factors that stimulate its appearance. These include gender and age - most often glioblastoma occurs in males from 40 to 60 years old, the presence of other concomitant tumors, for example, astrocytoma, which can become the primary focus of the spread of altered cells. In addition to internal factors, it is worth paying attention to working conditions, since hazardous production using chemical substances or rubber has a negative impact on human health. Genetic predisposition and traumatic brain injuries can also be a trigger in the development of glioblastoma.

Symptoms of glioblastoma

The clinical manifestations of glioblastoma depend on its location and damage to certain brain structures. Glioblastoma has a large number of manifestations that are inherent not only to this tumor, but also to other diseases. Such symptoms of glioblastoma are called nonspecific. In addition, they can be focal and cerebral in nature. Focal symptoms are caused by damage to brain structures responsible for certain functions in the human body, resulting in a disruption in the functioning of the corresponding organ or system. The general cerebral clinic is characterized by signs of involvement of more of the brain in the process.

Glioblastoma can present with headaches. This symptom is considered quite common and one of the earliest symptoms that causes people to see a doctor. Painful sensations in the temporal and frontal regions bother more than half of people with a tumor. Of course, glioblastoma is not the only cause of headaches, but still, if there is this symptom over a long period and if other pathology is excluded, it is recommended to conduct additional examinations for the presence of a tumor in the brain. Headaches are constant, high intensity, can increase with physical activity, bending, sneezing, coughing and do not decrease after taking painkillers, antispasmodics or vascular drugs. A characteristic feature of headaches with brain tumors is their intensity increases in the morning, as fluid accumulates in the brain tissue. This occurs due to a violation of the outflow of blood from the head in a horizontal position. Glioblastoma is characterized by intensive growth, due to which a large number of toxic substances have a negative effect on the structures of the brain, including the veins. As a result, the affected vessels cannot cope with their function and ensure normal blood flow.

The next symptom is dizziness, which does not depend on changes in the position of the head or body. It refers to general cerebral manifestations and appears due to a sharp increase in intracranial pressure. If glioblastoma affects the cerebellum, pons, cerebellopontine ganglion or posterior cranial fossa, then the vestibular apparatus will suffer. In this case, dizziness will be considered a focal symptom.

In addition, there are symptoms of glioblastoma such as nausea and vomiting, which are of central origin, as a result of which they are not associated with food intake and vomiting does not bring relief. Most people note general weakness, increased fatigue and drowsiness. Impaired visual function and hearing may be a consequence of increased intracranial pressure or compression of the optic or auditory nerve by a tumor or swollen tissue. Impaired speech function, as well as loss of the ability to transform one’s thoughts into connected speech, are noted when the speech center is damaged. Thus, memory and mental abilities may deteriorate. In addition, a change in respiratory rate or even its inhibition is most often manifested as a one-sided process.

Mental disorders manifest themselves in the form of lethargy, general weakness and apathy. Sometimes there is confusion, during which a person does not clearly understand where he is and does not react to the events around him. Some symptoms of glioblastoma include paralysis of a certain part of the body or the entire side, as well as sensory disturbances. Horizontal nystagmus can manifest itself in the form of floating movements from side to side, which are not noticeable to the person himself. If there are cases of hallucinations, they are mainly not visual, but tactile or auditory. These may be barely audible sounds, single touches or smells. Approximately 10% of all people diagnosed with glioblastoma are likely to develop epileptic seizures.

Glioblastoma of the brain

Glioblastoma of the brain, depending on its specific characteristics, can be divided into several types. Among them, giant cell is distinguished, which consists of huge cells with several nuclei; multiform, isolated due to pronounced polymorphism of cells and tissue structures, as well as a high risk of hemorrhage and necrotic processes. The third type of neoplasm is called gliosarcoma, characterized by its aggressiveness and speed of development.

Depending on the affected area, glioblastoma of the brain can manifest itself with various symptoms, ranging from loss of appetite to coma.

Brain stem glioblastoma

This type of neoplasm is distinguished by its poor prognosis in terms of treatment, as it is considered an inoperable pathology. This is due to the presence of important structures in the brain stem that are responsible for the vital functions of the body. The brainstem is the connection between the brain and spinal cord. It has cores cranial nerves, as well as the respiratory and vasomotor centers. In this regard, if a glioblastoma of the brain stem is detected, then the symptoms will manifest themselves in the form of breathing problems and heartbeat. The disease can begin either in the brain stem itself or in another part of the brain. Glioblastoma has a high rate of development and spread, as well as significant cell atypicality.

Glioblastoma multiforme

Glioblastoma multiforme has its own distinctive features. Among them, one can distinguish a large number of different cells and tissues, as well as the emergence of new structures. The disease is one of the most aggressive forms of brain tumors and accounts for almost a third of all intracranial neoplasms. The source of tumor development is glial cells, which, under the influence of provoking factors, begin to degenerate into atypical cells. Most often, glioblastoma is localized in the cerebral hemispheres, but cases of malignant lesions of the spinal cord or brainstem have been reported.

Polymorphocellular glioblastoma

The polymorphocellular form of the disease is diagnosed quite often. During cytological examination, tumor cells have different sizes and shapes. Their cytoplasm takes up little space relative to other structures and is weakly stained during examination. Cell nuclei are also distinguished by their polymorphism; bean-shaped, oval, round and irregular in shape can be found. Polymorphic cell glioblastoma also has gigantic cells, in the middle of which there is one nucleus.

Isomorphic cell glioblastoma

Glioblastoma, which has an isomorphic cellular composition, is extremely rare. Tumor cells are characterized by uniformity, but there are still some minor differences in the size and shape of the nuclei in the cells. The most commonly observed are round and oval shapes. Isomorphic cell glioblastoma consists of cells, the cytoplasm and thin cellular processes of which are not clearly contoured, and the areas of division are quite widespread.

Glioblastoma grade 4

Depending on the presence of certain signs, brain tumors have four degrees of malignancy. The first degree is considered the boundary between benign and malignant processes. Such neoplasms have no signs of malignancy. The second degree already contains one of the signs, which is most often cellular atypia. Tumors of these grades grow slowly and are among the least malignant neoplasms. The third degree includes two signs, but without necrotic processes. Tumors grow faster than in previous stages and are classified as malignant. As for the fourth degree, it is characterized by all the signs of malignancy, including necrosis. Thus, grade 4 glioblastoma is characterized by a high growth rate, and itself is considered the most malignant of all primary brain tumors. The prognosis for life is unfavorable.

Glioblastoma recurrence

Despite significant progress in the field of medicine, in particular in neurosurgery, there still remains open question rapid development of glioblastoma and its frequent relapses. Glioblastoma refers to those tumors with an irregular shape that do not have clear boundaries. In this regard, it is impossible to completely remove the tumor, so relapse of glioblastoma is observed quite often. Neoplasm cells are highly resistant to radiation, as a result of which the possibilities of using radiation therapy are limited due to the sensitivity of surrounding healthy cells. In addition, chemotherapy courses also cannot guarantee tumor shrinkage, since not all drugs can penetrate the blood-brain barrier. A complex of treatment measures, including surgical removal of glioblastoma, radiation and chemotherapy, cannot guarantee complete recovery.

The main reason for the rapid progression and development of relapses is microRNA-138. Glioblastoma, namely stem cells, are capable of producing this miR-138. it can be used as a tumor biomarker. There is an assumption that by neutralizing this indicator, the likelihood of slowing the progression of the disease increases, as well as increasing the survival rate of people diagnosed with glioblastoma. Thanks to this discovery, recurrence of glioblastoma may be observed as the exception rather than the rule, as is the case today.

Classification of brain tumor according to ICD 10

ICD10 - International Classification of Diseases, 10th revision. If you decide to be treated in a foreign clinic, then most likely you will first of all be asked what ICD10 code your doctor diagnosed.

It is important to know that D43 are benign brain tumors, and C71 are malignant, that is, cancer.

Benign

Benign neoplasm of the brain and other parts of the central nervous system (D33).

A benign brain tumor is located in:

Astrocytomas - description.

Short description

Astrocytomas are the largest and most common group of primary tumors of the central nervous system, differing in location, gender and age distribution, growth pattern, grade of malignancy and clinical course. All astrocytomas are of “astroglial” origin. Incidence: 5–7: populations in developed countries.

For all astrocytomas, a universal grading system (WHO) is used according to the histological criterion of “degree of malignancy” Grade 1 (piloid astrocytoma): there should be no sign of anaplasia Grade 2 (diffuse astrocytoma): 1 sign of anaplasia, more often - nuclear atypia Grade 3 (anaplastic astrocytoma): 2 signs, more often nuclear atypia and mitoses. Grade 4 (glioblastoma): 3–4 signs: nuclear atypia, mitoses, proliferation of vascular endothelium and/or necrosis.

There are a number of clinicopathological groups of astrocytomas.

Diffuse-infiltrative astrocytoma. This concept combines several types of tumors varying degrees malignancy.

Diffuse astrocytoma (WHO-2) - 10–15% of all brain astrocytomas, peak incidence 30–40 years, men/women - 1.2:1; are more often located supratentorially in the cerebral hemispheres. Clinical picture. Most often, these tumors manifest as an episyndrome, focal neurological deficit, and signs of increased ICP appear at a late stage of disease development. Diagnostics. Tumors have characteristic CT and MRI semiotics. Treatment. Tactics: tumor removal or observation/symptomatic therapy (the decision can be made only after consultation with a neurosurgeon). The previously popular tactic - biopsy + radiation therapy - has no advantage over “observation”. Prognosis: The average life expectancy after surgery is 6–8 years with marked individual variations. The clinical course of the disease is mainly influenced by the tendency of these tumors to malignant transformation, which is usually observed 4–5 years after diagnosis. Clinically favorable prognostic factors are young age and “total resection” of the tumor. Among diffuse astrocytomas, a number of histological variants are distinguished. Fibrillar astrocytoma is the most common variant and consists mainly of fibrillar tumor astrocytes. Nuclear atypia is diagnostic criterion. Mitoses, necrosis, and endothelial proliferation are absent. The cell density in the specimen is low to moderate. Protoplasmic astrocytoma is a rare variant, consisting mainly of tumor astrocytes with a small body and thin processes. The cell density in the preparation is low. Characteristic features are mucoid degeneration and microcysts of gemistocytic astrocytoma. This variant is characterized by the presence of a significant fraction of gemistocytes in fibrillary astrocytoma (usually more than 20%). A gemistocyte is a variant of an astrocyte with a large, angular, misshapen eosinophilic body.

Anaplastic astrocytoma (WHO-3) accounts for% of all brain astrocytomas, peak incidence 40–45 years, men/women -1.8:1; are most often located supratentorially in the cerebral hemispheres. At the moment, the dominant point of view is that anaplastic astrocytoma is the result of malignant transformation of diffuse astrocytoma. Its pathomorphology is characterized by signs of diffuse infiltrative astrocytoma with severe anaplasia and high proliferative potential. The clinical picture is in many ways similar to diffuse astrocytoma, but signs of increased ICP are more common, and there is a more rapid progression of neurological symptoms. Diagnosis: tumors do not have characteristic CT and/or MRI semiotics and can often appear as diffuse astrocytoma or glioblastoma. Treatment: at the moment, the standard treatment algorithm is combination treatment (surgery, radiation therapy, polychemotherapy). Forecast. The average life expectancy after surgery and adjuvant treatment is about 3 years. The clinical course of the disease is mainly influenced by transformation into glioblastoma, which is usually observed 2 years after diagnosis. Clinically favorable prognostic factors are young age, “total resection” of the tumor, and good preoperative clinical status of the patient. The presence of an oligodendroglial component in the tumor may increase survival to >7 years.

Glioblastoma (GBM) and its variants (WHO-4). It is the most malignant of astrocytomas and accounts for about 50% of all astrocytomas of the brain, peak incidence 50–60 years, men/women - 1.5:1; most often located supratentorially in the cerebral hemispheres. There are primary (more often) and secondary GBM (as a result of malignancy of diffuse or anaplastic astrocytoma). Its pathomorphology is characterized by signs of diffuse infiltrative astrocytoma with severe anaplasia, high proliferative potential, signs of endothelial proliferation and/or necrosis. Clinical picture. Primary GBM is characterized by a short medical history, dominated by nonspecific neurological symptoms and rapidly progressive intracranial hypertension. In secondary GBM, the clinical picture is largely similar to anaplastic astrocytoma. Diagnostics. The tumor has characteristic CT and MRI semiotics; differential diagnosis is usually carried out with metastasis and abscess. Characteristic is the invasive growth of the tumor along long conductors (GBM in the form of a “butterfly” when growing through corpus callosum). Treatment. At the moment, the standard treatment algorithm is combination treatment (surgery and radiation therapy; the role of polychemotherapy in increasing survival in GBM has not yet been reliably proven, and the need for its implementation is considered only in cases where all other treatment methods have been carried out and turned out to be ineffective (“ therapy of despair." Prognosis: The average survival after surgery and adjuvant treatment is about 1 year. Clinical favorable prognostic factors are similar to those for anaplastic astrocytoma.

In addition to the typical glioblastoma multiforme, the following histological variants are distinguished: Giant cell glioblastoma is characterized by a large number of giant, ugly multinucleated cells. Gliosarcoma is a two-component malignant tumor with foci of both glial and mesenchymal differentiation.

Pilocytic (piloid) astrocytoma is a tumor of childhood, characterized by a relatively “demarcated” growth pattern (in contrast to diffuse astrocytomas) and has characteristic features of localization, morphology, genetic profile and clinical course. It belongs to the lowest (1st degree of malignancy according to the WHO classification for tumors of the central nervous system) and has the most favorable prognosis. More often occurs before the age of 20 years. The most common location is the cerebellum, visual pathways, brain stem. The clinical picture is characterized by a very slow increase in both focal (depending on the location of the tumor) and general cerebral symptoms with good adaptation of the body. Particularly characteristic is the slow increase in occlusive hydrocephalus with tumors of the cerebellum and brainstem. Diagnostics. The tumor has characteristic CT and MRI semiotics, which allows, together with the clinical picture, to make a diagnosis before surgery. The standard preoperative examination of such patients is contrast-enhanced MRI. Treatment is surgical; the goal of the operation is “total removal” of the tumor, which is often impossible due to its location (brain stem, hypothalamus). Forecast. Survival of patients is often more than 10–15 years, and therefore exact survival rates do not exist due to difficulties in analyzing such a long follow-up. Note. Among piloid astrocytomas (usually hypothalamic), there is a small subgroup of tumors with locally pronounced “invasive growth” and a tendency to metastasize in the subarachnoid spaces.

Pleomorphic xanthoastrocytoma is a rare tumor (less than 1% of all astrocytomas), occupies an intermediate position in the series of “malignancies” due to its dual behavior (WHO-2). In some cases, the tumor is well demarcated and slowly growing with a favorable prognosis. At the same time, cases of its malignant transformation with an unfavorable prognosis have been described. Clinical picture. Most often the tumor occurs in at a young age and manifests itself as an episyndrome. Characteristic is superficial subcortical localization and a tendency to involve the adjacent meninges in the pathological process (“meningo-cerebral” volumetric process). Diagnostics: CT/MRI. Treatment is surgical, the goal of the operation is “total removal” of the tumor, which is often achievable. Forecast. 5-year survival rate is 81%, 10 - 70%. An independent prognostic factor is increased (more than 5 mitoses in a high-power field) mitotic activity. Most tumors with an aggressive course are characterized by this indicator.

ICD-10 D43 Neoplasm of uncertain or unknown nature of the brain and central nervous system C71 Malignant neoplasm of the brain

Application. Genetic aspects In astrocytomas, 2 types of damaged genes have been registered: dominantly inherited oncogenes, protein products of the gene accelerate cell growth; typical damage is an increase in the gene dose due to amplification or activating mutation; tumor suppressors; protein products of the gene inhibit cell growth; typical damage is physical loss of a gene or an inactivating mutation Mutations: TP53 gene (*191170, 17p13.1, Â) MDM2 (164585, 12q14.3–12q15, Â) CDKN1A (*116899, 6p, Â) CDKN2A and CDKN2B (9p21) CDK4 and CDK6 (12q13–14) EGFR (*131550, 7, Â).

Treatment of brain astrocytoma

Why does the throat and ear hurt, and how to treat the symptom?

Causes and treatment of itching in the ears

Why do my ears and back of my head hurt?

Why does my ear hurt on one side?

Why there is shooting in the ear and how to treat ear pain

In the article we discuss cerebral astrocytoma. We talk about its types, symptoms and diagnosis. You will learn how treatment is carried out, what the prognosis is, what nutrition is needed for this disease.

What is cerebral astrocytoma

Astrocytoma is a brain tumor that develops from astrocytes - neuroglial cells. The density of astrocytoma is similar to the gray matter of the brain and has a pale pink tint. The boundaries of the tumor are quite clear, but in advanced cases they are difficult to determine. Cysts often form in the cavity of an astrocytoma; they grow slowly and can reach large sizes.

Cysts in the tumor more often occur in children; the astrocytoma itself in childhood is predominantly located in the cerebellum. Adult patients are characterized by localization of the tumor in the cerebral hemispheres.

ICD-10 code – C71 Malignant neoplasm of the brain.

The classification of astrocytomas is combined with the stages of malignancy of the disease.

The following types of astrocytoma are distinguished:

• pilocytic or piloid – stage 1 of malignancy, a relatively benign tumor, has clear boundaries and slow growth, located in the small brain, brain stem, optic nerves;
• fibrillar – stage 2 of malignancy, grows slowly, there are no clear boundaries, most often occurs in young people under 30 years of age, stage 2 also includes protoplasmic astrocytoma;
• anaplastic – stage 3, astrocytoma has no clear boundaries, it grows quickly and invades other brain tissues, it occurs in patients years old;
• glioblastoma – stage 4 malignancy, the tumor has no boundaries, it is characterized by rapid growth and invasion into the brain tissue, occurs in older patients, predominantly male.

In addition to the above types of tumor, microcystic cerebellar astrocytoma and diffuse cerebral astrocytoma are also distinguished. However, for prognosis, classification according to the degree of malignancy is most important.

Symptoms and diagnosis

Symptoms of brain astrocytoma depend on the size and location of the tumor. Small astrocytomas practically do not reveal themselves; they are characterized by a long asymptomatic course, which makes their detection difficult.

As the tumor grows, the patient experiences the following symptoms:

• headache;
• vertigo;
• attacks of nausea and vomiting, most pronounced in the morning after waking up;
• memory impairment;
• deterioration in concentration;
• decreased mental function;
• speech dysfunction;
• dulling or increased sensitivity;
• deterioration of motor function;
• decreased vision, hearing, and sense of smell;
• mood swings.

When the first signs of the disease develop, you should consult a doctor. A timely diagnosis and prescribed treatment significantly increase the chances of success.

Clinical examination is carried out by a neurologist, neurosurgeon, otolaryngologist and ophthalmologist. The examination includes a neurological examination, determination of visual acuity and ophthalmoscopy, threshold audiometry, diagnosis of the vestibular system and the patient’s mental state.

• ECHO EG of the brain;
• electroencephalography;
• computed tomography;
• magnetic resonance imaging;
• angiography.

To determine the degree of malignancy, a histological examination is carried out, and material is collected by performing a stereotactic biopsy or surgery.

Treatment

Removal of brain astrocytomas is carried out primarily surgically. The tumor must be removed if it is small in size and has clear boundaries, and is located in insignificant areas of the brain. Before the operation, a puncture of the organ is required; this allows doctors to determine the density of the tissue and detect cysts.

If the tumor does not have clear boundaries, it can be removed; to eliminate the remaining cells, the patient is prescribed radiation therapy or chemotherapy.

Large tumors are not removed, since if they grow extensively into the brain tissue, the main centers of the brain of the head will be affected. In these cases, it is possible to perform shunting to reduce hydrocephalus, as well as prescribe symptomatic therapy to improve general well-being.

Carrying out full-fledged stereotactic radiosurgery is possible only for small lesions not exceeding 3 centimeters. Radiosurgical removal of cerebral astrocytoma is carried out under the control of computer or magnetic resonance imaging; for this, a special stereotactic frame is placed on the patient’s head.

External radiation therapy is carried out repeatedly - the patient is prescribed from 10 to 30 sessions of irradiation of the affected area.

When choosing chemotherapy as the main or additional method of treatment, the patient is prescribed cytostatics, taken orally or through intravenous administration.

You will learn more about the treatment of brain astrocytoma in the following video:

Nutrition

A healthy lifestyle plays an important role in the treatment and prevention of brain astrocytoma. In addition to physical activity and giving up bad habits, changes also concern the patient’s diet.

Eliminate fatty and fried foods and other foods containing carcinogens from your menu. Do not drink coffee, carbonated water, or alcoholic beverages. Give preference to natural foods - fresh vegetables and fruits, cereals, products that improve brain function. Include in your diet salmon fish and fish oil, walnuts, avocados, broccoli, blueberries, pomegranates, red berries, green tea.

Forecast

The prognosis of life with cerebral astrocytoma is influenced by the following factors:

• degree of malignancy of the neoplasm;
• patient's age;
• localization of education;
• the rate of tumor transition to another stage;
• history of relapses.

First of all, the prognosis for life with astrocytoma depends on the stage of the disease. At the first stage, a life expectancy of 10 years is possible. Upon transition to stage 2, this value decreases to 7-5 years. In the last stages of the pathology, life expectancy is 3-4 years.

What to remember

1. Brain astrocytoma is a tumor growing from astrocytes and has 4 degrees of malignancy.
2. The clinical picture of astrocytoma includes headaches and neurological disorders of various types.
3. Tumor treatment is carried out surgically, using radiation therapy, radiosurgery and chemotherapy.

See you in the next article!

Please support the project - tell us about us

Tumors of the brain and other parts of the central nervous system

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)

Version: Archive - Clinical protocols Ministry of Health of the Republic of Kazakhstan (Orders No. 883, No. 165)

general information

Short description

Tumors of the central nervous system (CNS) include benign and malignant neoplasms that develop from cellular elements of the nervous system and other tissues (meninges, blood vessels, connective tissue) located in the cranial cavity and inside the spinal canal (A. G. Zemskaya et al. , 1985).

CNS tumors account for 1.8% to 2.3%. The incidence of brain tumors is 7-8 times higher than the incidence of spinal cord diseases. (B. M. Nikiforov et al., 2003). Of all brain tumors, gliomas make up 40-67%, and meningiomas 27%. There are 2 age peaks: in infancy – 4%,000, and in the teen age group – 27%,000. Spinal cord tumors account for 0.9-2.5% of the population, with the most common tumors being schwannomas and meningiomas. (Chapman & Hall Medical WHO, 2000).

According to the Kazakh Cancer Registry (indicators of the oncological service of the Republic of Kazakhstan. Almaty for 2009), the incidence of central nervous system tumors in 2009 was 600 or 3.8%000. The main causes of the development of tumors of the central nervous system should be considered to be the proven influence of two factors: dysembryogenetic and mutagenic.

Brain tumor ICD code 10

How is cerebral edema coded according to ICD 10?

The International Classification of Diseases, Tenth Revision, is the only document in which pathologies are encoded equally for all countries.

A condition such as cerebral edema according to ICD 10 can be encrypted in several ways. The etiological factor plays an important role in determining the pathology code. In case of edema it may be:

• trauma to the skull and brain;
• ischemic or hemorrhagic stroke;
• intracranial hematoma;
• inflammation of the meninges;
• birth trauma (or other pathologies of labor);
• severe childhood infections;
• intoxication damage to nervous tissue;
• infectious process.

Depending on the cause that caused the swelling, the coding of the pathological process may change. However, the class always remains the same.

Encryption options

Cerebral edema according to ICD 10 code belongs to the class where diseases of the nervous system are indicated. It is under G93, which is for other brain lesions. There are 9 categories in this paragraph, and the pathological accumulation of fluid is numbered 6. That is, the full code for this disease is as follows: G93.6. However, the encryption may be different.

The following conditions are excluded from this paragraph:

• Brain swelling caused by birth trauma. Pathology code: P11.0. It belongs to other birth injuries of the central nervous system. There are only 4 points in this section.
• Traumatic swelling. Pathological condition code: S06.1. It is in the section intracranial injuries. It is possible to additionally use a fifth character in the encoding (1 or 0), which will indicate the presence or absence of an open wound.

It is necessary to code cerebral edema according to ICD 10 to take into account statistical data. With the help of such encryption it is more convenient to store and process information. And since the pathology poses an immediate threat to life and often ends in death, the code is needed to correctly calculate mortality taking into account the etiological factor, which helps to develop effective methods for preventing mortality.

Causes and symptoms of cerebral edema, disease code according to ICD 10

All information on the site is provided for informational purposes. Before using any recommendations, be sure to consult your doctor. Self-medication can be dangerous to your health.

OGM - cerebral edema (ICD-10 code gives G93) - refers to diseases of the nervous system. Cerebral edema is another name for this serious illness. This is the body’s reaction to unfavorable factors, a serious complication of intracranial pathology. With this pathophysiological reactive state, certain changes occur in the brain tissue.

Reasons related to the autonomic nervous system are of great importance. Interstitial, vascular lesions are characteristic of AGM. About 0.07% of cases of pathology are registered among newborns. At the age of 4-12 years, there is a peak incidence in children. Cerebral edema associated with trauma can occur at any age.

2 Types of OGM

If you suppress a headache with pills, after a while it comes back again. Even stronger and, as always, at the wrong time. Without taking proper measures, the pain becomes chronic and interferes with life. Find out how site readers cope with headaches and migraines using a cheap remedy.

They differ in treatment methods, genesis, location of painful foci, and speed of development of the disease.

There are 4 types of pathology:

1. Exposure to bacteria, toxic substances, lack of brain nutrition during cerebral ischemia, disruption of cellular osmoregulation, swelling of brain cell membranes are the causes of cytotoxic OGM. The pathology develops as a result of oxygen starvation immediately after tissue damage.
2. With interstitial AGM, vascular permeability does not change. Intracranial pressure (ICP) increases in the ventricles of the brain. The pathology occurs due to cephalic dropsy - hydrocephalus.
3. Bacterial meningitis, epilepsy, tumors or brain metastases are the causes of vasogenic AGM. The permeability of the capillary wall increases. Blood plasma proteins exit the vascular bed into the intercellular space. Such high molecular weight nitrogen-containing compounds expand due to the accumulation of sodium ions and liquid in them. In the intercellular substance of the brain, the death of neurons occurs. This is the most common variant of the pathology.
4. Due to impaired salt excretion and water intoxication of the central nervous system, osmotic edema develops.

Depending on the affected area, OGM is distinguished:

3 Clinical picture of the disease

The liquid part of the blood sweats through the walls of the blood vessels. The brain swells and increases in volume. Cerebrovascular accident is associated with increased intracranial pressure. Displacement of brain structures into the foramen magnum occurs due to the progression of edema. Deterioration of cerebral circulation is the cause of cell death. Part of the brain is destroyed irrevocably. The patient experiences severe attacks of a bursting headache.

General somatic lethargy. Decreased mental activity and a constant desire to sleep are noted at the onset of the disease. Speech problems. Memory losses. Paroxysmal muscle contractions - cramps. Spontaneous dizziness, which is accompanied by panic fear, deterioration of balance, severe vomiting. Loss of normal concepts of space and time. Weakened reaction to irritation, complete immobility - stupor.

There are often pauses and interruptions in breathing. Tendon reflexes fade away. The tone of the neck muscles increases. The acts of swallowing are impaired. Visual impairment occurs. Paralysis of the oculomotor nerve develops. Diplopia occurs - double vision of the visible image. The pupils are dilated. Their reactions are significantly reduced. Vision disappears completely if the artery in the posterior parts of the brain is compressed.

Cerebral edema develops very quickly in children (ICD-10 code - G93.6). If OHM develops in a newborn, the patient constantly screams in a sharp, shrill voice. Later comes soporous state, which is characterized by loss of consciousness and loss of voluntary reflexes. Hyperthermia appears - an increase in body temperature.

If, due to a disorder of microcirculation, the capillaries are not sufficiently supplied with blood, this provokes the development of necrosis and ischemia worsens. If cerebral edema is not treated, the most disastrous consequences can occur; coma often develops. The risk of death increases.

4 Diagnostic tests

A neurologist makes a diagnosis and prescribes treatment. The nature of the disease can be identified using general analysis blood. The type, size and location of edema are determined using a brain tomogram. A neurological examination provides a complete picture of the pathology.

5 Therapy for cerebral edema

Depending on the cause and symptoms of the disease, the doctor determines treatment tactics. In most cases, it is necessary to treat the disease that caused the brain swelling.

ASTROCYTOMA is:

Astrocytoma is a class of glial tumors of the brain and spinal cord derived from astrocytes; grow infiltratively, not clearly demarcated from the brain tissue. Incidence: 5-6: population.

WHO classification in order of increasing malignancy (Stage)

Low-grade diffuse astrocytoma

Glioblastoma is the most malignant type of astrocytoma. Histological variants

Pilocytic astrocytoma (piloid, hair-like) is a highly differentiated (mature, benign) tumor containing parallel bundles of glial fibers that resemble hair in appearance; usually well demarcated from surrounding tissues.

Pleomorphic xanthoastrocytoma is a rare tumor, grows slowly and is well demarcated from surrounding tissue, but malignancy is possible

Low-grade diffuse astrocytomas (relatively benign)

Fibrillary astrocytoma is the most common variant; occurs predominantly from fibrous astrocytes, a small amount of fibrillar-protoplasmic astrocytes is acceptable. Cysts are often detected

Subependymal astrocytoma (subependymal glomerular astrocytoma, subependymoma) is a fibrillary astrocytoma originating from glia adjacent to the ependyma; it is characterized by small clusters of tumor cells

Fibrillar protoplasmic astrocytoma arises from fibrous and plasmatic astrocytes

Protoplasmic (plasma) astrocytoma is a rare type of tumor consisting of small neoplastic astrocytes with a small number of processes

Spindle cell astrocytoma is a benign glial tumor of the brain, characterized by the arrangement of elongated bipolar cells with spindle-shaped nuclei in the form of a bundle.

Anaplastic astrocytoma (atypical, heterotypic, de-differentiated, malignant, malignant) - diffuse astrocytoma with anaplasia (nuclear atypia, polymorphism) and rapid growth: can degenerate from low-stage astrocytoma; the clinical picture and treatment are similar to low-stage astrocytomas, but the duration of the course is shorter

Polymorphic cell astrocytoma is characterized by significant cell polymorphism

Large cell (mast cell) astrocytoma consists predominantly of hypertrophied astrocytes.

Glioblastoma (see Glioblastoma).

Genetic aspects

2 types of damaged genes:

Dominantly inherited oncogenes, protein gene products, accelerate cell growth; typical damage is an increase in gene dosage due to amplification or activating mutation

Tumor growth suppressors, protein gene products, inhibit cell growth; typical damage is physical loss of a gene or an inactivating mutation

Gene TP53 (, 17р13.1, 99

MDM2(, 12ql4.3-12ql5.99

CDKN1A (*116899, 6p, 90

CDKN2A and CDKN2B(fy1)

EGFR (*, 7, 99.

Characteristic

Pilocytic (piloid) astrocytoma

Benign histologically and relatively slowly growing glial tumor

Manifests in childhood or adolescence

Localization: optic nerve, optic chiasm, hypothalamus, thalamus and basal ganglia, cerebral hemispheres, cerebellum and brain stem; the spinal cord is affected much less frequently

The course of the disease is slow, with the possibility of stabilization or regression at any stage, rarely leading to death.

Diffuse astrocytomas are tumors located in any area of ​​the central nervous system, mainly in the cerebral hemispheres, usually clinically manifested in adults

Tumors diffusely infiltrate both adjacent and distant brain structures. Characterized by a pronounced tendency towards malignancy

Can degenerate from low-stage astrocytomas

The clinical picture and treatment are similar to low-stage astrocytomas, but the duration of the course is shorter

The clinical picture of anaplastic astrocytoma develops quickly (in 50% of cases within less than 3 months), sometimes resembling a stroke, except in cases of secondary glioblastomas.

Clinical picture

diagnosis and treatment - see Brain tumors. Spinal cord tumors.

The prognosis depends on the age of the patient (the younger the patient, the worse the prognosis), as well as on the degree of malignancy of the tumor (immature tumor - the prognosis is worse). Benign astrocytomas: with radical removal, the prognosis is relatively favorable. Patients can expect 3-5 years of life before relapse. For low-stage astrocytomas, the average survival is 2 years. Transition to a more malignant form and tumor spread are possible.

See also Glioblastoma. Oligodendroglioma. Brain tumors. Spinal cord tumors. Ependymoma

C71 Malignant neoplasm of the brain

D33 Benign neoplasm of the brain and other parts of the central nervous system

Goal of treatment: achieving complete or partial regression tumor process or its stabilization, elimination of severe accompanying symptoms.

Treatment tactics

Not drug treatment IA

Stationary regime, physical and emotional rest, limiting reading printed and artistic publications, watching television. Nutrition: diet No. 7 - salt-free. If the patient's condition is satisfactory, "general table No. 15".

Drug treatment IA

1. Dexamethasone, from 4 to 30 mg per day, depending on the severity general condition, intravenously, at the beginning of special treatment or throughout the entire hospitalization period. Also used when episodes of convulsive seizures occur.

2. Mannitol 400 ml, intravenously, used for dehydration. The maximum prescription is 1 time every 3-4 days, during the entire hospitalization period, together with potassium-containing drugs (asparkam, 1 tablet 2-3 times a day, panangin, 1 tablet 2-3 times a day).

3. Furosemide - a “loop diuretic” (Lasix 20-40 mg) is used after the administration of mannitol to prevent “rebound syndrome”. It is also used independently in case of episodes of convulsive seizures and increased blood pressure.

4. Diacarb - diuretic, carbonic anhydrase inhibitor. It is used for dehydration in a dose of 1 tablet 1 time a day, in the morning, together with potassium-containing drugs (asparkam 1 tablet 2-3 times a day, panangin 1 tablet 2-3 times a day).

5. Bruzepam solution 2.0 ml - a benzodiazepine derivative used when episodes of convulsive seizures occur or for their prevention in case of high convulsive readiness.

6. Carbamazepine is an anticonvulsant drug with mixed neurotransmitter action. Use 100-200 mg 2 times a day for life.

7. B vitamins - vitamins B1 (thiamine bromide), B6 ​​(pyridoxine), B12 (cyanocobalamin) are necessary for normal functioning central and peripheral nervous system.

List of therapeutic measures within the framework of VSMP

Other treatments

Radiation therapy: External beam radiation therapy for tumors of the brain and spinal cord, used in the postoperative period, independently, for radical, palliative or symptomatic purposes. It is also possible to carry out simultaneous chemotherapy and radiation therapy (see below).

In case of relapses and continued growth of the tumor after previously carried out combined or complex treatment where the radiation component was used, repeated irradiation is possible with mandatory consideration of the factors VDF, EDC, and linear-quadratic model.

In parallel, symptomatic dehydration therapy is carried out: mannitol, furosemide, dexamethasone, prednisolone, diacarb, asparkam.

Indications for the prescription of external beam radiation therapy are the presence of a morphologically established malignant tumor, as well as diagnosis based on clinical, laboratory and instrumental research methods, and, above all, CT, MRI, PET examination data.

Besides, radiation treatment carried out for benign tumors of the brain and spinal cord: pituitary adenomas, tumors from the remnants of the pituitary tract, germ cell tumors, tumors meninges, parenchymal tumors pineal gland, tumors growing into the cranial cavity and spinal canal.

Radiation therapy technique

Devices: External beam radiation therapy is carried out in a conventional static or rotational mode on gamma therapeutic devices or linear electron accelerators. It is necessary to produce individual fixing thermoplastic masks for patients with brain tumors.

In the presence of modern linear accelerators with a multi-lift (multiple-leaf) collimator, X-ray simulators with a computed tomography attachment and computed tomograph, modern planning dosimetric systems, it is possible to carry out new technological methods of irradiation: volumetric (conformal) irradiation in 3-D mode, intensively modulated radiation therapy, stereotactic radiosurgery for brain tumors, image-guided radiation therapy.

Dose fractionation modes over time:

1. Classic fractionation regimen: ROD 1.8-2.0-2.5 Gy, 5 fractions per week. Split or continuous course. Up to SOD 30.0-40.0-50.0-60.0-65.0-70.0 Gy in the conventional mode, and SOD 65.0-75.0 Gy in the conformal or intensively modulated mode.

2. Multifractionation mode: ROD 1.0-1.25 Gy 2 times a day, after 4-5 and 19-20 hours until ROD 40.0-50.0-60.0 Gy in the conventional mode.

3. Mode of average fractionation: ROD 3.0 Gy, 5 fractions per week, SOD - 51.0-54.0 Gy in the conventional mode.

4. “Spinal irradiation” in the classical fractionation mode ROD 1.8-2.0 Gy, 5 fractions per week, SOD from 18.0 Gy to 24.0-36.0 Gy.

Thus, the standard treatment after resection or biopsy is fractionated local radiotherapy (60 Gy, 2.0-2.5 Gy x 30; or equivalent dose/fractionation) IA.

Increasing the dose to more than 60 Gy did not affect the effect. In elderly patients, as well as in patients with poor performance status, it is usually suggested to use short hypofractionated regimens (eg 40 Gy in 15 fractions).

In a randomized phase III trial, radiotherapy (29 x 1.8 Gy, 50 Gy) showed superiority over the best symptomatic therapy in patients over 70 years of age.

Method of simultaneous chemotherapy and radiation therapy

Prescribed mainly for malignant brain gliomas G3-G4. The radiation therapy technique is carried out according to the above scheme in a conventional (standard) or conformal irradiation mode, continuous or split course against the background of monochemotherapy with Temodal 80 mg/m2 orally, for the entire course of radiation therapy (on the days of radiation therapy sessions and weekends but no. 42-45 times).

Chemotherapy: is prescribed only for malignant brain tumors in the adjuvant, neoadjuvant, independent regimen. It is also possible to carry out simultaneous chemotherapy and radiation therapy.

For malignant gliomas of the brain:

For medulloblastomas:

In conclusion, concomitant and adjuvant chemotherapy with temozolomide (temodal) and lomustine for glioblastoma demonstrated significant improvements in median and 2-year survival in the large randomized IA trial.

In a large randomized trial, adjuvant chemotherapy with procarbazine, lomustine, and vincristine (PCV regimen) did not improve survival in IA.

However, based on a large meta-analysis, nitrosourea chemotherapy may improve survival in selected patients.

Avastin (bevacizumab) is a targeted drug; the instructions for its use include indications for the treatment of malignant gliomas of grade III-IV (G3-G4) - anaplastic astrocytomas and glioblastoma multiforme. Currently, large-scale clinical randomized trials are being conducted on its use in combination with irinotecan or temozolomide in G3 and G4 malignant gliomas. The preliminary high effectiveness of these chemotherapy and targeted therapy regimens has been established.

Surgical method: performed in a neurosurgical hospital.

In the vast majority of cases, treatment of CNS tumors is surgical. A reliable diagnosis of a tumor in itself allows surgical intervention to be considered indicated. Factors limiting the possibilities of surgical treatment are the specific localization of the tumor and the nature of its infiltrative growth in the area of ​​such vital parts of the brain as the brainstem, hypothalamus, and subcortical nodes.

Wherein, general principle in neuro-oncology is the desire to maximize complete removal tumors. Palliative operations are a necessary measure and are usually aimed at reducing intracranial pressure when it is impossible to remove a brain tumor or to reduce compression of the spinal cord in a similar situation caused by an unremovable intramedullary tumor.

1. Total removal of the tumor.

2. Subtotal tumor removal.

3. Tumor resection.

4. Craniotomy with biopsy taking.

5. Ventriculocisternostomy (Torkildsen procedure).

6. Ventriculoperitoneal shunt.

Thus, surgery is a generally accepted primary treatment approach to reduce tumor volume and obtain material for verification. Tumor resection has prognostic value, and can provide benefits when trying to achieve maximum cytoreduction.

Preventive actions

Complex preventive measures in malignant neoplasms of the central nervous system coincides with those in other localizations. This is mainly about maintaining the ecology of the environment, improving working conditions in hazardous industries, improving the quality of agricultural products, improving the quality of drinking water, etc.

Further management:

1. Observation by an oncologist and neurosurgeon at the place of residence, examination once a quarter, for the first 2 years, then once every 6 months, for two years, then once a year, taking into account the results of MRI or CT images.

2. Observation consists of clinical assessment, especially nervous system functions, seizures or their equivalents, and the use of corticosteroids. Patients should reduce their steroid use as early as possible. Venous thrombosis is often observed in patients with inoperable or recurrent tumors.

3. Laboratory values ​​are not determined, except for patients receiving chemotherapy (clinical blood count), corticosteroids (glucose) or anticonvulsants (clinical blood count, liver function tests).

4. Instrumental observation: MRI or CT - 1-2 months after the end of treatment; 6 months after the last appearance for a follow-up examination; subsequently 1 time every 6-9 months.

List of basic and additional medications

Essential medications: see drug treatment and chemotherapy above (ibid.).

Additional medications: additionally prescribed medications by consultant doctors (ophthalmologist, neurologist, cardiologist, endocrinologist, urologist and others) necessary for the prevention and treatment of possible complications of concomitant diseases or syndromes.

Indicators of treatment effectiveness and safety of diagnostic and treatment methods

If the response to treatment can be assessed, then an MRI examination should be performed. An increase in contrast and the expected progression of the tumor, 4-8 weeks after the end of radiotherapy according to MRI data, may be an artifact (pseudo-progression), then a repeat MRI study should be performed after 4 weeks. Brain scintigraphy and PET scan if indicated.

Response to chemotherapy is assessed according to WHO criteria, but the state of nervous system function and the use of corticosteroids (McDonald criteria) should also be taken into account. Increasing overall survival and progression-free patients at 6 months is a valid goal of therapy and suggests that patients with stable disease also benefit from treatment.

1. Complete regression.

2. Partial regression.

3. Stabilization of the process.

4. Progression.

Brain tumors- a heterogeneous group of neoplasms for which common feature is the location or secondary penetration into the cranial cavity. Histogenesis varies and is reflected in the WHO histological classification (see below). There are 9 main types of CNS tumors. A: neuroepithelial tumors. B: tumors of the membranes. C: tumors from cranial and spinal nerves. D: hematopoietic tumors. E: germ cell tumors. F: cysts and tumor-like formations. G: tumors of the sella region. H: local spread of tumors from adjacent anatomical regions. I: Metastatic tumors.

Code according to the international classification of diseases ICD-10:

Epidemiology. Given the heterogeneity of the concept of “brain tumor,” precise generalized statistical data are not available. It is known that central nervous system tumors in children occupy the second place among all malignant neoplasms (after leukemia) and the first place in the group of solid tumors.

Classification. The main working classification used to develop treatment tactics and determine prognosis is the WHO Classification for CNS tumors. Tumors of neuroepithelial tissue.. Astrocytic tumors: astrocytoma (fibrillary, protoplasmic, gemistocytic [mast cell], or large cell), anaplastic (malignant) astrocytoma, glioblastoma (giant cell glioblastoma and gliosarcoma), pilocytic astrocytoma, pleomorphic xanthoastrocytoma, subependymal giant cell astrocytoma cytoma (tuberous sclerosis) .. Oligodendroglial tumors (oligodendroglioma, anaplastic [malignant] oligodendroglioma).. Ependymal tumors: ependymoma (cellular, papillary, clear cell), anaplastic (malignant) ependymoma, myxopapillary ependymoma, subependymoma.. Mixed gliomas: oligoastrocytoma, anaplastic (malignant) oligodendroglioma. goastrocytoma, etc. Tumors of the choroid plexus: papilloma and cancer of the choroid plexus. Neuroepithelial tumors of unknown origin: astroblastoma, polar spongioblastoma, cerebral gliomatosis. Neuronal and mixed neuronal glial tumors: gangliocytoma, dysplastic cerebellar gangliocytoma (Lhermitte Duclos), desmoplastic ganglioglioma in children ( infantile) , dysembryoplastic neuroepithelial tumor, ganglioglioma, anaplastic (malignant) ganglioglioma, central neurocytoma, filum terminale paraganglioma, olfactory neuroblastoma (esthesioneuroblastoma), variant: olfactory neuroepithelioma.. Parenchymal tumors of the pineal gland: pineocytoma, pineoblastoma, mixed/transitional pineal gland tumors.. Embryonic tumors: medulloepithelioma, neuroblastoma (option: ganglioneuroblastoma), ependymoblastoma, primitive neuroectodermal tumors (medulloblastoma [option: desmoplastic medulloblastoma], medullomyoblastoma, melanin-containing medulloblastoma). Tumors of the cranial and spinal nerves.. Schwannoma (neurilemoma, neuroma); options: cellular, plexiform, melanin-containing.. Neurofibroma (neurofibroma): limited (solitary), plexiform (mesh).. Malignant tumor of the peripheral nerve trunk (neurogenic sarcoma, anaplastic neurofibroma, “malignant schwannoma”); options: epithelioid, malignant tumor of the peripheral nerve trunk with divergence of mesenchymal and/or epithelial differentiation, melanin-containing. Tumors of the meninges.. Tumors of meningothelial cells: meningioma (meningothelial, fibrous [fibroblastic], transitional [mixed], psammomatous, angiomatous, microcystic, secretory, clear cell, chordoid, lymphoplasmacytic cell-rich, metaplastic), atypical meningioma, papillary meningioma, anaplas tic (malignant) meningioma.. Mesenchymal non-meningothelial tumors: benign (osteochondral tumors, lipoma, fibrous histiocytoma, etc.) and malignant (hemangiopericytoma, chondrosarcoma [option: mesenchymal chondrosarcoma], malignant fibrous histiocytoma, rhabdomyosarcoma, meningeal sarcomatosis and etc.) tumors.. Primary melanocytic lesions : diffuse melanosis, melanocytoma, malignant melanoma (option: meningeal melanomatosis).. Tumors of unknown histogenesis: hemangioblastoma (capillary hemangioblastoma). Lymphomas and tumors of hematopoietic tissue.. Malignant lymphomas.. Plasmacytoma.. Granulocellal sarcoma.. Others. Germ cell tumors(germ cell tumors) .. Germinoma .. Embryonic cancer .. Yolk sac tumor (endodermal sinus tumor) .. Chorionic carcinoma .. Teratoma: immature, mature, teratoma with malignancy .. Mixed germ cell tumors. Cysts and tumor-like lesions.. Rathke's pouch cyst.. Epidermoid cyst.. Dermoid cyst.. Colloid cyst of the third ventricle.. Enterogenous cyst.. Neuroglial cyst.. Granular cell tumor (choristoma, pituicytoma).. Neuronal hamartoma of the hypothalamus.. Nasal heterotopia. glia.. Plasmacytic granuloma. Tumors of the sella region.. Pituitary adenoma.. Pituitary cancer.. Craniopharyngioma: adamantinoma-like, papillary. Tumors growing into the cranial cavity.. Paraganglioma (chemodectoma).. Chordoma.. Chondroma.. Chondrosarcoma.. Cancer. Metastatic tumors. Unclassified tumors

Symptoms (signs)

Clinical picture. Most frequent symptoms brain tumors - progressive neurological deficit (68%), headaches (50%), seizures (26%). The clinical picture mainly depends on the location of the tumor and, to a lesser extent, on its histological characteristics. Supratentorial hemispheric tumors.. Signs of increased ICP due to mass effect and edema (headaches, congestive optic discs, impaired consciousness).. Epileptiform seizures.. Focal neurological deficit (depending on location).. Personality changes (most typical for frontal lobe tumors). Supratentorial tumors of mid-localization.. Hydrocephalic syndrome (headache, nausea/vomiting, disturbances of consciousness, Parinaud's syndrome, congestive optic discs)... Diencephalic disorders (obesity/wasting, thermoregulation disorders, diabetes insipidus)... Visual and endocrine disorders for tumors of the chiasmatic-sellar region. Subtentorial tumors.. Hydrocephalic syndrome (headache, nausea/vomiting, disturbances of consciousness, congestive optic discs).. Cerebellar disorders.. Diplopia, severe nystagmus, dizziness.. Isolated vomiting as a sign of an effect on the medulla oblongata. Tumors of the base of the skull. Often remain asymptomatic for a long time and only in the later stages cause neuropathy of the cranial nerves, conduction disorders (hemiparesis, hemihypesthesia) and hydrocephalus.

Diagnostics

Diagnostics. Using CT and/or MRI at the preoperative stage, it is possible to confirm the diagnosis of a brain tumor, its exact location and extent, as well as the presumptive histological structure. For tumors of the posterior cranial fossa and the base of the skull, MRI is more preferable due to the absence of artifacts from the bones of the base (the so-called beam - hardering artifacts). Angiography (both direct and MR and CT angiography) is performed in rare cases to clarify the characteristics of the blood supply to the tumor.

Treatment

Treatment. Therapeutic tactics depend on the exact histological diagnosis, the following options are possible: . observation. surgical resection. resection in combination with radiation and/or chemotherapy. biopsy (usually stereotactic) in combination with radiation and/or chemotherapy. biopsy and observation. radiation and/or chemotherapy without tissue verification based on CT/MRI results and studies of tumor markers.

Forecast depends mainly on the histological structure of the tumor. Without exception, all patients operated on for brain tumors require regular MRI/CT control studies due to the risk of relapse or continued tumor growth (even in cases of radically removed benign tumors).

ICD-10. C71 Malignant neoplasm of the brain. D33 Benign neoplasm of the brain and other parts of the central nervous system