Division of Neuropathology

Clinical FAQs

The meaning of the word tumor is a "lump" or a "swelling", and in medical language it is used to indicate an abnormal, uncontrolled growth in any part of the body. You may think of it as a group of cells which rapidly divide and do not recognize any rule or limit. The brain tumors are similar to the tumors of other organs. However, since the brain is the center of many critical functions, tumors arising in this organ have serious outcomes.

How is a brain tumor recognized?

Many brain tumors may create complaints which force the patient to seek medical help. However, today more and more tumors are being recognized before they create complaints with the help of advanced radiological studies. These studies sometimes are performed for other reasons, and coincidentally lead to discovery of tumors. Even though the physician may find the effects of a brain tumor in the body, he/she can not feel or see them during a routine physical examination. Radiological studies like CT Scan or MRI generates images that suggest a tumor. In addition, there are some rare genetic diseases in which there is a higher possibility of developing a brain tumor. In such cases, radiological studies can be performed even in the absence of complaints. After the evaluation of the radiologist, a suspicion of a tumor is raised, and a definitive diagnosis is planned. Brain tumors are often difficult to diagnose because their symptoms, which serve as clues for the medical specialist, can be hard to pin down. As a tumor grows, it can affect other parts of the brain, producing new symptoms. The tumor may compress the normal tissues, hence causing a "mass effect". Complaints may appear gradually, and because they are often not clear-cut, there may be delays between the beginning of symptoms and the actual diagnosis.

How is a definitive diagnosis of a brain tumor made?

The most accurate, and sometimes the only way to accurately diagnose a brain tumor requires a biopsy. The surgeon performs the biopsy and the pathologist makes the final diagnosis, and can tell whether the tumor appears benign or malignant.

What is a biopsy?

The word biopsy is derived from the Greek words bio (life) and opsis (vision), and literally means seeing the live tissue. It is the process of removing a tissue from living patients for diagnostic examination. Biopsy can be done by a physician either in surgery or in an office setting. Brain biopsies are invariably performed in operating rooms

What is a benign brain tumor?

Benign probably is derived from the Latin word benigenus which means "a good kind" (bene= well, genus= born of, kind). In theory all benign tumors behave well and do not pose serious danger to the patient. Benign tumors are usually easily separated from normal tissues and therefore they can be removed surgically. However, tumors do not read books, so they are not aware of this sharp definition. Because of the critical functions of the brain, even a benign tumor located in a very dangerous area can cause death.

What is a malignant brain tumor?

This word is derived from the Latin malignus which meant evil disposed, and is used as the opposite of benign. A malignant brain tumor is life-threatening. Malignant brain tumors possess certain chemicals which enable them to infiltrate into other tissues and spread into other parts of the body. Malignant tumors are almost impossible to remove totally by surgery, unless they are caught early in their course. Interestingly, malignant tumors that originate in the brain very rarely spread to organs other than the brain and spinal cord. However, malignant tumors of other organs such as lung cancer, breast cancer, and skin cancer (melanoma) often find their way to the brain in later stages.

Who decides what is benign and what is malignant?

The most definitive and diagnosis of brain tumors are done by analyzing a fragment of the tumor under the microscope by the pathologist. The surgeon removes a piece of the tumor and sends it to the pathologist. Using special tissue staining methods, the pathologist can tell whether the tumor is classified under a benign or malignant category. However, this is only the first step in a patient's management. Even if the pathologist may give a benign diagnosis, the tumor may still be deadly because of its location. The simplistic approach divides tumors into benign and malignant. However, in reality this distinction is not always clear. Like the divisions in a metric ruler, there are many intermediate forms between purely benign and purely malignant tumors. An appropriate pathology report reflects the nature of a brain tumor to the best of our current knowledge.

Who is a Pathologist?

Pathology is derived from the Greek words pathos, meaning suffering and logos meaning discourse or study. It is the science or study of disease. A pathologist studies the cause or nature of the diseases and identifies the changes diseases create in our body. In a hospital practically all the diagnostic tests performed with material removed from the body are evaluated or performed by pathologist. There are various branches of pathology, and the branch that specializes on brain and its diseases is neuropathology.

Who is a Neuropathologist?

Neuropathologist specializes in the diseases of the brain and spinal cord (together, brain and spinal cord are known as the central nervous system = CNS), and usually is the person who makes the definitive diagnosis of brain tumors.

How many types of brain tumors are there?

Even though it seems as if there are two types of brain tumors, benign and malignant, there are close to one hundred tumor types. Furthermore one can divide brain tumors into primary and metastatic types. The primary brain tumors arise from the cells that make up the brain and spinal cord or the tissues covering the brain. The metastatic tumors spread from another body site to the brain, and by definition, are always malignant. In general, there are just as many primary brain tumors as metastatic brain tumors. The World Health Organization classification of brain tumors gives the major categories of brain tumors.

What are the most common brain tumors?

The most common childhood tumors are:

  • Astrocytoma (often low grade or Pilocytic Astrocytoma)
  • Medulloblastoma
  • Ependymoma

The most common adult tumors are:
  • Metastatic brain tumors from lung, breast, melanoma, and other cancers
  • Glioblastoma Multiforme and Anaplastic Astrocytoma
  • Meningioma