Difference between revisions of "Anaplastic pilocytic astrocytoma"

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{{ Infobox diagnosis
'''Anaplastic pilocytic astrocytoma''', abbreviated '''APA''', is an outdated tumor terminology. Most of these tumors are now classified either as [[High-grade astrocytoma with piloid features]], [[Pleomorphic xanthoastrocytoma]] or as [[Glioblastoma]], IDH-wildtype.
| Name      = {{PAGENAME}}
| Image      = Pilocytic astrocytoma with anaplastic features.jpg
| Width      =
| Caption    = Anaplastic pilocytic astrocytoma. [[H&E stain]].
| Synonyms  =
| Micro      =
| Subtypes  =
| LMDDx      = [[astrocytoma]], [[oligodendroglioma]], [[glioblastoma]]
| Stains    = PAS-D +ve (eosinophilic granular bodies)
| IHC        = GFAP +ve
| EM        =
| Molecular  =
| IF        =
| Gross      = usually cerebellar
| Grossing  =
| Site      = brain - usu. [[cerebellum]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = very rare - esp. in children
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = poor (analog to WHO Grade III)
| Other      =
| ClinDDx    =
| Tx        =
}}
'''Anaplastic pilocytic astrocytoma''', abbreviated '''APA''', is a rare high-grade [[astrocytoma]]. It can develop from a [[pilocytic astrocytoma]].


==General==
==General==
*High-grade [[astrocytoma]] - behaviour corresponds to ''WHO Grade III''.
*High-grade [[astrocytoma]] - behaviour corresponded in older classifications to ''WHO Grade III''.
*Some authors prefer the designation '''pilocytic astrocytoma with anaplastic features'''.
*Some authors prefered the designation '''pilocytic astrocytoma with anaplastic features'''.
*Less than 2% of all pilocytic astrocytomas.<ref>{{Cite journal  | last1 = Rodriguez | first1 = FJ. | last2 = Scheithauer | first2 = BW. | last3 = Burger | first3 = PC. | last4 = Jenkins | first4 = S. | last5 = Giannini | first5 = C. | title = Anaplasia in pilocytic astrocytoma predicts aggressive behavior. | journal = Am J Surg Pathol | volume = 34 | issue = 2 | pages = 147-60 | month = Feb | year = 2010 | doi = 10.1097/PAS.0b013e3181c75238 | PMID = 20061938 }}</ref>
*Less than 2% of all pilocytic astrocytomas.<ref>{{Cite journal  | last1 = Rodriguez | first1 = FJ. | last2 = Scheithauer | first2 = BW. | last3 = Burger | first3 = PC. | last4 = Jenkins | first4 = S. | last5 = Giannini | first5 = C. | title = Anaplasia in pilocytic astrocytoma predicts aggressive behavior. | journal = Am J Surg Pathol | volume = 34 | issue = 2 | pages = 147-60 | month = Feb | year = 2010 | doi = 10.1097/PAS.0b013e3181c75238 | PMID = 20061938 }}</ref>
*De novo cases in the setting of neurofibromatosis 1 reported.
*De novo cases in the setting of neurofibromatosis 1 reported.
*Many tumors have history of previous radiation.
*Many tumors have history of previous radiation.


==Microscopic==
==Old microscopic criteria==
Features:<ref>{{Cite journal  | last1 = Rodriguez | first1 = FJ. | last2 = Scheithauer | first2 = BW. | last3 = Burger | first3 = PC. | last4 = Jenkins | first4 = S. | last5 = Giannini | first5 = C. | title = Anaplasia in pilocytic astrocytoma predicts aggressive behavior. | journal = Am J Surg Pathol | volume = 34 | issue = 2 | pages = 147-60 | month = Feb | year = 2010 | doi = 10.1097/PAS.0b013e3181c75238 | PMID = 20061938 }}</ref>
Features:<ref>{{Cite journal  | last1 = Rodriguez | first1 = FJ. | last2 = Scheithauer | first2 = BW. | last3 = Burger | first3 = PC. | last4 = Jenkins | first4 = S. | last5 = Giannini | first5 = C. | title = Anaplasia in pilocytic astrocytoma predicts aggressive behavior. | journal = Am J Surg Pathol | volume = 34 | issue = 2 | pages = 147-60 | month = Feb | year = 2010 | doi = 10.1097/PAS.0b013e3181c75238 | PMID = 20061938 }}</ref>
*At least 4 mitoses/10 high power fields - see [[HPFitis]].
*At least 4 mitoses/10 high power fields - see [[HPFitis]].
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*Epithelioid cells (15%)
*Epithelioid cells (15%)
*Fibrillary areas resembling [[diffuse astrocytoma]].
*Fibrillary areas resembling [[diffuse astrocytoma]].
DDx of APA (brief):
*[[Ependymoma]]
*[[Oligodendroglioma]].
*[[Glioblastoma]] including small-cell GBM (important).
===Images===
<gallery>
Image:Pilocytic astrocytoma with anaplastic features.jpg | APA, [[FFPE]] specimen, HE (WC).
Image:Pilocytic astrocytoma with anaplastic features mimicking focally a GBM.jpg | Vacular proliferations and necrosis in APA mimicking [[GBM]] (WC).
</gallery>


==IHC==
==IHC==
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*[[IDH1]] (R132H) -ve.
*[[IDH1]] (R132H) -ve.
*[[H3F3A]] (K27M) -ve.
*[[H3F3A]] (K27M) -ve.
==Molecular==
*Molecular data is still limited.
*KIAA1549-BRAF fusion transcripts and [[NF1]] cases reported<ref>{{Cite journal  | last1 = Jones | first1 = DT. | last2 = Hutter | first2 = B. | last3 = Jäger | first3 = N. | last4 = Korshunov | first4 = A. | last5 = Kool | first5 = M. | last6 = Warnatz | first6 = HJ. | last7 = Zichner | first7 = T. | last8 = Lambert | first8 = SR. | last9 = Ryzhova | first9 = M. | title = Recurrent somatic alterations of FGFR1 and NTRK2 in pilocytic astrocytoma. | journal = Nat Genet | volume = 45 | issue = 8 | pages = 927-32 | month = Aug | year = 2013 | doi = 10.1038/ng.2682 | PMID = 23817572 }}</ref>
==Prognosis==
*Poor, but better than conventional glioblastoma.<ref>{{Cite journal  | last1 = Rodriguez | first1 = FJ. | last2 = Scheithauer | first2 = BW. | last3 = Burger | first3 = PC. | last4 = Jenkins | first4 = S. | last5 = Giannini | first5 = C. | title = Anaplasia in pilocytic astrocytoma predicts aggressive behavior. | journal = Am J Surg Pathol | volume = 34 | issue = 2 | pages = 147-60 | month = Feb | year = 2010 | doi = 10.1097/PAS.0b013e3181c75238 | PMID = 20061938 }}</ref>
*Prognostic unfavourable paramters include: Necrosis, Mitoses and previous radiation.


==See also==
==See also==

Latest revision as of 13:52, 17 October 2022

Anaplastic pilocytic astrocytoma, abbreviated APA, is an outdated tumor terminology. Most of these tumors are now classified either as High-grade astrocytoma with piloid features, Pleomorphic xanthoastrocytoma or as Glioblastoma, IDH-wildtype.

General

  • High-grade astrocytoma - behaviour corresponded in older classifications to WHO Grade III.
  • Some authors prefered the designation pilocytic astrocytoma with anaplastic features.
  • Less than 2% of all pilocytic astrocytomas.[1]
  • De novo cases in the setting of neurofibromatosis 1 reported.
  • Many tumors have history of previous radiation.

Old microscopic criteria

Features:[2]

  • At least 4 mitoses/10 high power fields - see HPFitis.
  • Hypercellularity.
  • Necrosis +/-.
  • Pilocytic like (biphasic) - most common.
    1. Eosinophilic granular bodies +/-.
  • Small cell (32%)
  • Epithelioid cells (15%)
  • Fibrillary areas resembling diffuse astrocytoma.

IHC

Features:[3]

  • GFAP +ve (fibres).
  • p53: +ve.
  • KI-67: high 25%.
  • ATRX loss may be present.[4]
  • IDH1 (R132H) -ve.
  • H3F3A (K27M) -ve.

See also

References

  1. ↑ Rodriguez, FJ.; Scheithauer, BW.; Burger, PC.; Jenkins, S.; Giannini, C. (Feb 2010). "Anaplasia in pilocytic astrocytoma predicts aggressive behavior.". Am J Surg Pathol 34 (2): 147-60. doi:10.1097/PAS.0b013e3181c75238. PMID 20061938.
  2. ↑ Rodriguez, FJ.; Scheithauer, BW.; Burger, PC.; Jenkins, S.; Giannini, C. (Feb 2010). "Anaplasia in pilocytic astrocytoma predicts aggressive behavior.". Am J Surg Pathol 34 (2): 147-60. doi:10.1097/PAS.0b013e3181c75238. PMID 20061938.
  3. ↑ Rodriguez, FJ.; Scheithauer, BW.; Burger, PC.; Jenkins, S.; Giannini, C. (Feb 2010). "Anaplasia in pilocytic astrocytoma predicts aggressive behavior.". Am J Surg Pathol 34 (2): 147-60. doi:10.1097/PAS.0b013e3181c75238. PMID 20061938.
  4. ↑ Ebrahimi, A.; Skardelly, M.; Bonzheim, I.; Ott, I.; Mühleisen, H.; Eckert, F.; Tabatabai, G.; Schittenhelm, J. (Jun 2016). "ATRX immunostaining predicts IDH and H3F3A status in gliomas.". Acta Neuropathol Commun 4 (1): 60. doi:10.1186/s40478-016-0331-6. PMID 27311324.
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