Difference between revisions of "Astrocytoma"

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(Table with overview)
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=Common=
=Common=
==Pilocytic astrocytoma==
==Pilocytic astrocytoma==
* Benign, cystic, infratentorial.
* Classic childhood tumor, surgically resectable.
* Variant: [[Pilomyxoid astrocytoma]]
{{Main|Pilocytic astrocytoma}}
{{Main|Pilocytic astrocytoma}}


==Diffuse astrocytoma==
==Diffuse astrocytoma==
* Grade II and III diffuse astrocytic tumors
* Grade II astrocytic tumors typically seen in adults.
* Many of them carry IDH1/2 mutations
* Usually show progression to glioblastoma.
{{Main|Diffuse astrocytoma}}
 
==Anaplastic astrocytoma==
* Grade III astrocytic tumors typically seen in adults.
* Lacks endothelial proliferations and necrosis of glioblastoma.
{{Main|Anaplastic astrocytoma}}


==Glioblastoma==
==Glioblastoma==
* Most common malignant brain tumor peaking around 65 years.
* Prognosis very poor.
* Variant: [[Giant cell glioblastoma]]
* Variant: [[Gliosarcoma]]
{{Main|Glioblastoma}}
{{Main|Glioblastoma}}


=Uncommon=
=Uncommon=
==Subependymal giant cell astrocytoma==
==Subependymal giant cell astrocytoma==
* Intraventricular benign tumor of adolescents.
* Assoicated with [[Tuberous sclerosis]].
{{Main|Subependymal giant cell astrocytoma}}
{{Main|Subependymal giant cell astrocytoma}}


==Pleomorphic xanthroastrocytoma==
==Pleomorphic xanthroastrocytoma (PXA)==
*Abbreviated ''PXA''.
* Kids & young adults usually with good prognosis.
===General===
* Large lipidized cells mimicking a malignant tumor
*Kids & young adults.
{{Main|Pleomorphic xanthoastrocytoma}}
*Prognosis usu. good.
 
===Microscopic===
Features:
*Large cells with intracytoplasmic lipid accumulation, i.e. foamy cytoplasm - '''key features'''.<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/neurotest/Q14-Ans.htm http://moon.ouhsc.edu/kfung/jty1/neurotest/Q14-Ans.htm]. Accessed on: 13 January 2011.</ref>
**May not be obvious/one may have to search for this.
*Focal marked nuclear atypia - including hyperchromasia, marked nuclear enlargement, irregular chromatin.
*Multinucleation - common.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Pleo_xantho.jpg PXA (WC/AFIP)].
*[http://moon.ouhsc.edu/kfung/jty1/neurotest/Q14-Ans.htm PXA (ouhsc.edu)].
 
===IHC===
Features:<Ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970469-7 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970469-7]. Accessed on: 13 January 2011.</ref>
*GFAP +ve -- required for Dx, may be patchy.
*S-100 +ve -- cytoplasm, usu. diffuse.


==Gliomatosis cerebri==
==Gliomatosis cerebri==
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* More than 3 lobes have to be involved, us. bilateral (radiology).
* More than 3 lobes have to be involved, us. bilateral (radiology).
* biologic behaviour corresponds to WHO III (ICD-O: 9381/3)
* biologic behaviour corresponds to WHO III (ICD-O: 9381/3)


==H3.3 K27M mutated glioma of the midline==
==H3.3 K27M mutated glioma of the midline==
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====Images====  
====Images====  
<gallery>
<gallery>
Image:Gliosarcoma_Histopathology_200x_EVG.jpg | Gliosarcoma - elastic von Giesson. (WC)
Image:Gliosarcoma_Histopathology_200x_EVG.jpg | Gliosarcoma - elastica van Giesson. (WC)
</gallery>
</gallery>
www:
www:
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*SMA +ve.
*SMA +ve.
*Factor VIII +ve.
*Factor VIII +ve.
==Gliofibroma==
* Very rare indolent tumor in children <ref>{{Cite journal  | last1 = Deb | first1 = P. | last2 = Sarkar | first2 = C. | last3 = Garg | first3 = A. | last4 = Singh | first4 = VP. | last5 = Kale | first5 = SS. | last6 = Sharma | first6 = MC. | title = Intracranial gliofibroma mimicking a meningioma: a case report and review of literature. | journal = Clin Neurol Neurosurg | volume = 108 | issue = 2 | pages = 178-86 | month = Feb | year = 2006 | doi = 10.1016/j.clineuro.2004.11.021 | PMID = 16412839 }}</ref>
* Usually not dura-based (DD: Desmoplastic infantile astrocytoma)
* Glial tumor with non-neoplastic fibromatous component.


=See also=
=See also=

Revision as of 12:35, 20 July 2015

An astrocytoma is a neoplasm derived from an astrocyte. Astrocytomas are common. This article is a brief introduction them. An overview of CNS tumours is found in the CNS tumours article.

Overview

Name Type Variants / Patterns Image
Diffuse Astrocytoma, WHO II diffuse protoplasmatic, fibrillar, gemistocytic
Astrocytoma whoII HE.jpg
Anaplastic Astrocytoma, WHO III diffuse gliomatosis cerebri
Anaplastic astrocytoma - very high mag.jpg
Glioblastoma, WHO IV diffuse small cell, epitheloid/rhabdoid, with PNET componet, with granular cell component, giant cell, gliosarcoma
Glioblastoma (1).jpg
Pilocytic astrocytoma, WHO I circumscribed pilomyxoid astrocytoma, anaplastic pilocytic astrocytoma
Rosenthal HE 40x.jpg
Pleomorphic xanthoastrocytoma, WHO II (PXA) circumscribed anaplastic PXA
PXA HE x20.jpg
Subependymal giant cell astrocytoma, WHO I (SEGA) circumscribed SEGA in tuberous sclerosis
SEGA HE.jpg

Common

Pilocytic astrocytoma

  • Benign, cystic, infratentorial.
  • Classic childhood tumor, surgically resectable.
  • Variant: Pilomyxoid astrocytoma
Main article: Pilocytic astrocytoma

Diffuse astrocytoma

  • Grade II astrocytic tumors typically seen in adults.
  • Usually show progression to glioblastoma.
Main article: Diffuse astrocytoma

Anaplastic astrocytoma

  • Grade III astrocytic tumors typically seen in adults.
  • Lacks endothelial proliferations and necrosis of glioblastoma.
Main article: Anaplastic astrocytoma

Glioblastoma

Main article: Glioblastoma

Uncommon

Subependymal giant cell astrocytoma

Main article: Subependymal giant cell astrocytoma

Pleomorphic xanthroastrocytoma (PXA)

  • Kids & young adults usually with good prognosis.
  • Large lipidized cells mimicking a malignant tumor
Main article: Pleomorphic xanthoastrocytoma

Gliomatosis cerebri

  • Extensively diffusely growing astrocytic neoplasm.
    • Currently considered a pattern of diffuse glioma infiltration.
  • More than 3 lobes have to be involved, us. bilateral (radiology).
  • biologic behaviour corresponds to WHO III (ICD-O: 9381/3)

H3.3 K27M mutated glioma of the midline

  • High-grade astrocytic neoplasm associated with midline structures
  • Mostly in children and adolescents
  • Includes diffuse intrinsic pontine gliomas (DPIG)
  • Will become provisonal variant in upcoming WHO 2016 classification
  • Distinct biological and clinical group with poor prognosis [1]

Gliosarcoma

General

  • Considered to be a variant of glioblastoma by WHO.[2]
  • Rare ~ 200 cases reported in the literature.[2]
  • Definition: gliosarcoma = glioblastoma + sarcomatous component.[3]
  • Usual location (like glioblastoma): temporal lobe.

Microscopic

Features:

  • Glioblastoma.
  • Sarcomatous component (one of the following):[2][3]
    • Fibroblastic.
    • Cartilaginous.
    • Osseous.
    • Smooth muscle.
    • Striated muscle.
    • Adipocyte.

Images

  • Gliosarcoma - elastica van Giesson. (WC)

www:

IHC

  • GFAP +ve -- astrocytic component.[4]
    • Spindle cell component -ve.[5]

Gliosarcoma with smooth muscle component (gliomyosarcoma):[6]

  • SMA +ve.
  • Factor VIII +ve.

Gliofibroma

  • Very rare indolent tumor in children [7]
  • Usually not dura-based (DD: Desmoplastic infantile astrocytoma)
  • Glial tumor with non-neoplastic fibromatous component.


See also

References

  1. ↑ Khuong-Quang, DA.; Buczkowicz, P.; Rakopoulos, P.; Liu, XY.; Fontebasso, AM.; Bouffet, E.; Bartels, U.; Albrecht, S. et al. (Sep 2012). "K27M mutation in histone H3.3 defines clinically and biologically distinct subgroups of pediatric diffuse intrinsic pontine gliomas.". Acta Neuropathol 124 (3): 439-47. doi:10.1007/s00401-012-0998-0. PMID 22661320.
  2. ↑ 2.0 2.1 2.2 Han SJ, Yang I, Tihan T, Prados MD, Parsa AT (February 2010). "Primary gliosarcoma: key clinical and pathologic distinctions from glioblastoma with implications as a unique oncologic entity". J. Neurooncol. 96 (3): 313–20. doi:10.1007/s11060-009-9973-6. PMC 2808523. PMID 19618114. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2808523/.
  3. ↑ 3.0 3.1 Ayadi L, Charfi S, Khabir A, et al. (March 2010). "[Cerebral gliosarcoma: clinico-pathologic study of 8 cases]" (in French). Tunis Med 88 (3): 142–6. PMID 20415184.
  4. ↑ Horiguchi, H.; Hirose, T.; Kannuki, S.; Nagahiro, S.; Sano, T. (Aug 1998). "Gliosarcoma: an immunohistochemical, ultrastructural and fluorescence in situ hybridization study.". Pathol Int 48 (8): 595-602. PMID 9736406.
  5. ↑ URL: http://path.upmc.edu/cases/case361.html. Accessed on: 15 January 2012.
  6. ↑ Khanna, M.; Siraj, F.; Chopra, P.; Bhalla, S.; Roy, S.. "Gliosarcoma with prominent smooth muscle component (gliomyosarcoma): a report of 10 cases.". Indian J Pathol Microbiol 54 (1): 51-4. doi:10.4103/0377-4929.77324. PMID 21393877.
  7. ↑ Deb, P.; Sarkar, C.; Garg, A.; Singh, VP.; Kale, SS.; Sharma, MC. (Feb 2006). "Intracranial gliofibroma mimicking a meningioma: a case report and review of literature.". Clin Neurol Neurosurg 108 (2): 178-86. doi:10.1016/j.clineuro.2004.11.021. PMID 16412839.
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