Difference between revisions of "Astrocytoma"

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


=Overview=
{| class="wikitable sortable"
! Name
! Type
! Variants / Patterns
! Image
|-
| Diffuse Astrocytoma, WHO II
| diffuse
| protoplasmatic, fibrillar, gemistocytic
| [[File:Astrocytoma whoII HE.jpg|thumb|center|150px]]
|-
| Anaplastic Astrocytoma, WHO III
| diffuse
| gliomatosis cerebri
| [[File:Anaplastic_astrocytoma_-_very_high_mag.jpg|thumb|center|150px]]
|-
| Glioblastoma, WHO IV
| diffuse
| small cell, epitheloid/rhabdoid, with PNET componet, with granular cell component, giant cell, gliosarcoma
| [[File:Glioblastoma_(1).jpg|thumb|center|150px]]
|-
| Pilocytic astrocytoma, WHO I
| circumscribed
| pilomyxoid astrocytoma, anaplastic pilocytic astrocytoma
| [[File:Rosenthal_HE_40x.jpg|thumb|center|150px]]
|-
| Pleomorphic xanthoastrocytoma, WHO II (PXA)
| circumscribed
| anaplastic PXA
| [[File:PXA_HE_x20.jpg|thumb|center|150px]]
|-
| Subependymal giant cell astrocytoma, WHO I (SEGA)
| circumscribed
| SEGA in tuberous sclerosis
| [[File:SEGA_HE.jpg|thumb|center|150px]]
|}
=Common=
=Common=
==Pilocytic astrocytoma==
==Pilocytic astrocytoma==
{{Main|Pilocytic astrocytoma}}
{{Main|Pilocytic astrocytoma}}
==Diffuse astrocytoma==
* Grade II and III diffuse astrocytic tumors
* Many of them carry IDH1/2 mutations


==Glioblastoma==
==Glioblastoma==
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=Uncommon=
=Uncommon=
==Subependymal giant cell astrocytoma==
{{Main|Subependymal giant cell astrocytoma}}
==Pleomorphic xanthroastrocytoma==
==Pleomorphic xanthroastrocytoma==
*Abbreviated ''PXA''.
*Abbreviated ''PXA''.
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*GFAP +ve -- required for Dx, may be patchy.
*GFAP +ve -- required for Dx, may be patchy.
*S-100 +ve -- cytoplasm, usu. diffuse.
*S-100 +ve -- cytoplasm, usu. diffuse.
==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 <ref>{{Cite journal  | last1 = Khuong-Quang | first1 = DA. | last2 = Buczkowicz | first2 = P. | last3 = Rakopoulos | first3 = P. | last4 = Liu | first4 = XY. | last5 = Fontebasso | first5 = AM. | last6 = Bouffet | first6 = E. | last7 = Bartels | first7 = U. | last8 = Albrecht | first8 = S. | last9 = Schwartzentruber | first9 = J. | title = K27M mutation in histone H3.3 defines clinically and biologically distinct subgroups of pediatric diffuse intrinsic pontine gliomas. | journal = Acta Neuropathol | volume = 124 | issue = 3 | pages = 439-47 | month = Sep | year = 2012 | doi = 10.1007/s00401-012-0998-0 | PMID = 22661320 }}</ref>


==Gliosarcoma==
==Gliosarcoma==

Revision as of 12:26, 2 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

Main article: Pilocytic astrocytoma

Diffuse astrocytoma

  • Grade II and III diffuse astrocytic tumors
  • Many of them carry IDH1/2 mutations

Glioblastoma

Main article: Glioblastoma

Uncommon

Subependymal giant cell astrocytoma

Main article: Subependymal giant cell astrocytoma

Pleomorphic xanthroastrocytoma

  • Abbreviated PXA.

General

  • Kids & young adults.
  • Prognosis usu. good.

Microscopic

Features:

  • Large cells with intracytoplasmic lipid accumulation, i.e. foamy cytoplasm - key features.[1]
    • 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:

IHC

Features:[2]

  • GFAP +ve -- required for Dx, may be patchy.
  • S-100 +ve -- cytoplasm, usu. diffuse.

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 [3]

Gliosarcoma

General

  • Considered to be a variant of glioblastoma by WHO.[4]
  • Rare ~ 200 cases reported in the literature.[4]
  • Definition: gliosarcoma = glioblastoma + sarcomatous component.[5]
  • Usual location (like glioblastoma): temporal lobe.

Microscopic

Features:

  • Glioblastoma.
  • Sarcomatous component (one of the following):[4][5]
    • Fibroblastic.
    • Cartilaginous.
    • Osseous.
    • Smooth muscle.
    • Striated muscle.
    • Adipocyte.

Images

  • Gliosarcoma - elastic von Giesson. (WC)

www:

IHC

  • GFAP +ve -- astrocytic component.[6]
    • Spindle cell component -ve.[7]

Gliosarcoma with smooth muscle component (gliomyosarcoma):[8]

  • SMA +ve.
  • Factor VIII +ve.

See also

References

  1. ↑ URL: http://moon.ouhsc.edu/kfung/jty1/neurotest/Q14-Ans.htm. Accessed on: 13 January 2011.
  2. ↑ URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970469-7. Accessed on: 13 January 2011.
  3. ↑ 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.
  4. ↑ 4.0 4.1 4.2 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/.
  5. ↑ 5.0 5.1 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.
  6. ↑ 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.
  7. ↑ URL: http://path.upmc.edu/cases/case361.html. Accessed on: 15 January 2012.
  8. ↑ 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.
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