A pilocytic astrocytoma (and its variant juvenile pilomyxoid astrocytoma) is a brain tumor that occurs more often in children and young adults (in the first 20 years of life). They usually arise in the cerebellum, near the brainstem, in the hypothalamic region, or the optic chiasm, but they may occur in any area where astrocytes are present, including the cerebral hemispheres and the spinal cord. These tumors are usually slow growing and benign.[1] The neoplasms are associated with the formation of one or more cysts, and can become very large.
In this multi-institutional study we compiled a retrospective cohort of 86 posterior fossa tumors having received the diagnosis of cerebellar glioblastoma (cGBM). All tumors were. Patients with GBM (mean age, 54 years) are generally older than patients with AA (mean age, 45 years), with less than 10% of cases occurring in children. Median overall survival in GBM patients is approximately 10 to 12 months, whereas median survival for AA patients is 3 to 4 years.
Pilocytic astrocytomas are often cystic, and, if solid, tend to be well-circumscribed. They are characteristically easily seen on computed tomography (CT scans) and magnetic resonance imaging (MRI).
Juvenile pilocytic astrocytoma is associated with neurofibromatosis type 1 (NF1), and optic gliomas are among the most frequently encountered tumors in patients with this disorder. The majority of pilocytic astrocytomas have a unique KIAA1549L-BRAF fusion gene.[2][3]
Symptoms[edit]
Stereotactic MRI brain showed recurrent postoperative brain stem cystic pilocytic astrocytoma.
Children affected by pilocytic astrocytoma can present with different symptoms that might include failure to thrive (lack of appropriate weight gain/ weight loss), headache, nausea, vomiting, irritability, torticollis (tilt neck or wry neck), difficulty to coordinate movements, and visual complaints (including nystagmus). The complaints may vary depending on the location and size of the neoplasm. The most common symptoms are associated with increased intracranial pressure due to the size of the neoplasm.[citation needed]
Diagnosis[edit]
Pilocytic astrocytoma in the hypothalamic region.
Axial non contrast CT in a nine-year-old girl showing a slightly hypodense mass in the tectum of the brainstem, compressing the aqueduct of Sylvius and causing obstructive hydrocephalus
Sagittal T1-weighted MRI showing a well circumscribed hypointense mass in the tectum presumably a tectal plate glioma. These lesions are a distinct subset of pilocytic astrocytomas which present with hydrocephalus in 6 to 10 year olds and are rarely progressive lesions, when imaging is characteristic, biopsy is usually not performed because of the risks to adjacent structures, often shunting is the only treatment required.
T1-weighted coronal MRI image post contrast showing heterogeneous contrast enhancement within the presumed tectal plate glioma
Usually – depending on the interview of the patient and after a clinical exam which includes a neurological exam and an ophthalmological exam – a CT scan and/or an MRI scan will be performed. A special dye may be injected into a vein before these scans to provide contrast and make tumors easier to identify. The neoplasm will be clearly visible.
If a tumor is found, it will be necessary for a neurosurgeon to perform a biopsy of it. This simply involves the removal of a small amount of tumorous tissue, which is then sent to a (neuro)pathologist for examination and staging.[4] The biopsy may take place before surgical removal of the tumor, or the sample may be taken during surgery.
Visual aspect[edit]
Microscopically, an astrocytoma is a mass that looks well-circumscribed and has a large cyst. The neoplasm may also be solid.
Under the microscope, the tumor is seen to be composed of bipolar cells with long 'hairlike' GFAP-positive processes, giving the designation 'pilocytic' (that is, made up of cells that look like fibers when viewed under a microscope[5]). Some pilocytic astrocytomas may be more fibrillary and dense in composition. There is often presence of Rosenthal fibers,[6]eosinophilic granular bodies, and microcysts. Myxoid foci and oligodendroglioma-like cells may also be present, though non-specific. Long-standing lesions may show hemosiderin-laden macrophages and calcifications.
Treatment[edit]
The most common form of treatment is having the tumor surgically removed. However, total resection is often not possible. The location could prohibit access to the neoplasm and lead to incomplete or no resection at all. Removal of the tumor will generally allow functional survival for many years. In particular for pilocytic astrocytomas (commonly indolent bodies that may permit normal neurologic function), surgeons may decide to monitor the neoplasm's evolution and postpone surgical intervention for some time. However, left unattended these tumors may eventually undergo neoplastic transformation.
If surgery is not possible, recommendations such as chemotherapy or radiation may be suggested. However, side effects from these treatments can be extensive and long term.[7]
Side effects[edit]![]()
Children with cerebellar pilocytic astrocytoma may experience side effects related to the tumor itself depending on the location and related to the treatment.
Expected outcome after treatment[edit]
Grade I pilocytic astrocytoma and cerebellar gliomas are not associated with recurrence after complete resection. Grade II astrocytomas and cerebellar gliomas are more likely to recur after surgical removal. Pilomyxoid astrocytomas may behave more aggressively than classic pilocytic astrocytoma.
After complete surgical removal, in cases of progressive/recurrent disease or when maximal surgical removal has been achieved, chemotherapy and/or radiation therapy will be considered by the medical team.[citation needed]
Occurrence[edit]
According to a Dutch source, juvenile pilocytic astrocytoma occurs at a rate of 2 in 100,000 people. Most affected are children ages 5–14 years.[8] According to the National Cancer Institute, more than 80% of astrocytomas located in the cerebellum are low grade (pilocytic grade I) and often cystic; most of the remainder are diffuse grade II astrocytomas.[9] https://cllwqg.weebly.com/blog/dmg-for-windows.
Tumors of the optic pathway account for 3.6-6% of pediatric brain tumors, 60% of which are juvenile pilocytic astrocytomas. Astrocytomas account for 50% of pediatric primary central nervous system tumors. About 80-85% of cerebellar astrocytomas are juvenile pilocytic astrocytomas.[10]
Recent genetic studies of pilocytic astrocytomas show that some sporadic cases have gain in chromosome 7q34 involving the BRAF locus.[11]
Additional images[edit]
References[edit]
External links[edit]
Retrieved from 'https://en.wikipedia.org/w/index.php?title=Pilocytic_astrocytoma&oldid=901937285'
Anaplastic astrocytoma is a rare WHO grade III type of astrocytoma, which is a type of cancer of the brain. In the United States, the annual incidence rate for Anaplastic astrocytoma is 0.44 per 100,000 people [1]
Signs and symptoms[edit]Anaplastic Astrocytoma Stage 3
Initial presenting symptoms most commonly are headache, depressed mental status, focal neurological deficits, and/or seizures.[2] The growth rate and mean interval between onset of symptoms and diagnosis is approximately 1.5–2 years but is highly variable,[2] being intermediate between that of low-grade astrocytomas and glioblastomas.[2] Seizures are less common among patients with anaplastic astrocytomas compared to low-grade lesions.[2] World of warcraft dmg hack.
Causes[edit]
Most high-grade gliomas occur sporadically or without identifiable cause.[3] However, a small proportion (less than 5%) of persons with malignant astrocytoma has a definite or suspected hereditary predisposition.[4] The main hereditary predispositions are mainly neurofibromatosis type I, Li-Fraumeni syndrome, hereditary nonpolyposis colorectal cancer and tuberous sclerosis.[3] Anaplastic astrocytomas have also been associated with previous exposure to vinyl chloride and to high doses of radiation therapy to the brain.[3]
Pathology[edit]
Anaplastic astrocytomas fall under the category of high grade gliomas (WHO grade III-IV), which are pathologically undifferentiated gliomas that carry a poor clinical prognosis. Unlike glioblastomas (WHO grade IV), anaplastic astrocytomas lack vascular proliferation and necrosis on pathologic evaluation.[5] Compared to grade II tumors, anaplastic astrocytomas are more cellular, demonstrate more atypia, and mitoses are seen.
Treatment[edit]
The standard initial treatment is to remove as much of the tumor as possible without worsening neurologic deficits. Radiation therapy has been shown to prolong survival and is a standard component of treatment. There is no proven benefit to adjuvant chemotherapy or supplementing other treatments for this kind of tumor. Although temozolomide is effective for treating recurrent anaplastic astrocytoma, its role as an adjuvant to radiation therapy has not been fully tested.
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Quality of life after treatment depends heavily on the area of the brain that housed the tumor. In many cases, patients with anaplastic astrocytoma may experience various types of paralysis, speech impediments, difficulties planning and skewed sensory perception. Most cases of paralysis and speech difficulties can be rehabilitated with speech, occupational, physical, and vision therapy.
Prognosis[edit]
The age-standardized 5-year relative survival rate is 23.6%.[6] Patients with this tumor are 46 times more likely to die than matched members of the general population.[6] It is important to note that prognosis across age groups is different especially during the first three years post-diagnosis. When the elderly population is compared with young adults, the excess hazard ratio (a hazard ratio that is corrected for differences in mortality across age groups) decreases from 10.15 to 1.85 at 1 to 3 years, meaning that the elderly population are much more likely to die in the first year post-diagnosis when compared to young adults (aged 15 to 40), but after three years, this difference is reduced markedly.[6] Typical median survival for anaplastic astrocytoma is 2–3 years. Secondary progression to glioblastoma multiforme is common. Radiation, younger age, female sex, treatment after 2000, and surgery were associated with improved survival in AA patients.[7]
References[edit]Anaplastic Astrocytoma Vs Glioblastoma
External links[edit]Anaplastic Astrocytoma Versus Dmg C
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