Difference between revisions of "Pilocytic astrocytoma"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Pilocytic_astrocytoma_-_smear_-_very_high_mag.jpg | |||
| Width = | |||
| Caption = Pilocytic astrocytoma. Smear. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = | |||
| Subtypes = | |||
| LMDDx = piloid gliosis, [[oligodendroglioma]], [[glioblastoma]] | |||
| Stains = PAS-D +ve (eosinophilic granular bodies) | |||
| IHC = GFAP +ve | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = usually cerebellar +/-cystic | |||
| Grossing = | |||
| Site = | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = common - esp. in children | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = good (WHO Grade I) | |||
| Other = | |||
| ClinDDx = | |||
| Tx = | |||
}} | |||
'''Pilocytic astrocytoma''' is a low-grade [[astrocytoma]]. It the most common glioma in children. | '''Pilocytic astrocytoma''' is a low-grade [[astrocytoma]]. It the most common glioma in children. | ||
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DDx of pilocystic astrocytoma (brief): | DDx of pilocystic astrocytoma (brief): | ||
*Piloid gliosis. | *Piloid gliosis. | ||
*Oligodendroglioma. | *[[Oligodendroglioma]]. | ||
*Glioblastoma (uncommon - but important). | *[[Glioblastoma]] (uncommon - but important). | ||
===Images=== | ===Images=== | ||
Revision as of 02:18, 22 December 2013
| Pilocytic astrocytoma | |
|---|---|
| Diagnosis in short | |
 Pilocytic astrocytoma. Smear. H&E stain. | |
| LM DDx | piloid gliosis, oligodendroglioma, glioblastoma |
| Stains | PAS-D +ve (eosinophilic granular bodies) |
| IHC | GFAP +ve |
| Gross | usually cerebellar +/-cystic |
| Prevalence | common - esp. in children |
| Prognosis | good (WHO Grade I) |
Pilocytic astrocytoma is a low-grade astrocytoma. It the most common glioma in children.
General
- Low-grade astrocytoma - WHO Grade I by definition.
- Classically in the cerebellum in children; most common glioma in children.[1]
- The optic glioma associated with neurofibromatosis 1.
Gross
Features:[1]
- Usually well-circumscribed.
- Cystic or solid.
- Do not smear. (Ref. ?)
Microscopic
Features:[2]
- Classically biphasic (though either may be absent):
- Fibrillar.
- Microcystic/loose.
- Hair-like fibres ~ 1 micrometer; pilo- = hair.[3]
- Best seen on smear or with GFAP IHC.
- Rosenthal fibres - key feature.
- May be rare. Not pathognomonic (see below).
- Eosinophilic granular bodies.
- Low cellularity - when compared to medulloblastoma and ependymoma.
Notes:
- +/-Microvascular proliferation.
- +/-Focal necrosis.
- Necrosis with pseudopalisading more likely glioblastoma.
- +/-Mitoses - not significant in the context of the Dx.
DDx (of Rosenthal fibers):[4]
- Chronic reactive gliosis.
- Subependymoma.
- Ganglioma.
- Alexander's disease (rare leukodystrophy).
DDx of pilocystic astrocytoma (brief):
- Piloid gliosis.
- Oligodendroglioma.
- Glioblastoma (uncommon - but important).
Images
Smears
Bipolar cells with hair-like processes - smear - very high mag. (WC)
EGBs - smear. (WC/AFIP)
Rosenthal fibres - smear. (WC/AFIP)
Sections
Rosenthal fibres. (WC)
www:
- Rosenthal fibre (ouhsc.edu).
- Pilocytic astrocytoma (upmc.edu).
- Pilocytic astrocytoma - another case (upmc.edu).
- Pilocytic astrocytoma - pennies on a plate (upmc.edu).[5]
- Pilocytic astrocytoma (upmc.edu).
Stains
- PAS-D: eosinophilic granular bodies +ve.
IHC
Features:[6]
- GFAP +ve (fibres).
- CD68: may have a significant macrophage component.
- KI-67: may be "high" (~20% ???).
See also
References
- ↑ 1.0 1.1 Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 82. ISBN 978-0443069826.
- ↑ Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 82-4. ISBN 978-0443069826.
- ↑ URL: http://dictionary.reference.com/browse/pilo-. Accessed on: 24 November 2010.
- ↑ MUN. 9 Mar 2009.
- ↑ URL: http://path.upmc.edu/cases/case195.html. Accessed on: 8 January 2012.
- ↑ Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 84. ISBN 978-0443069826.