Neuroepithelial Tumors: Astrocytoma

by Carlo Raj, MD

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    00:01 Let’s take a look at the pathology of fibrillary astrocytoma.

    00:05 You'll know this slide, you’ll know everything that you need to know about fibrillary astrocytoma or what you want to pay attention to prior was the gross and microscopic features of fibrillary.

    00:17 It’s a grade II in terms of grading or classification under WHO.

    00:22 Mean age here, look at this, a very young patient, less than 35.

    00:26 Initially management is often observation if symptoms are not serious.

    00:31 And oftentimes, you find that with brain tumors.

    00:33 Mean interval to progression, approximately four to five years.

    00:36 And management after progression is usually surgical resection, radiation or both.

    00:42 And mean survival after radiation treatment is six to eight years and this would be found in what’s know as your blue book.

    00:52 The pathology for anaplastic astrocytoma: This is referred to as being your grade III under WHO classification.

    00:59 The mean age here would be 40 still relatively young.

    01:02 Initial management, surgery and radiation.

    01:05 You get in there, you remove this sucker.

    01:07 Recurrence is almost certain.

    01:08 Anaplastic is absolutely chaos.

    01:10 Remember, mitotic rate is incredibly high.

    01:13 Progression to glioblastoma is frequent, unfortunately, and could occur within two years.

    01:18 Here, the management if it’s symptomatic, which is going to occur quite quickly, it’s called surgical debulking.

    01:25 Steroids for mass effect and maybe perhaps chemotherapy would be required.

    01:31 Anaplastic astrocytoma.

    01:34 Two down under neuroepithelial tumor and what are these? These are astrocytomas.

    01:43 Glioblastoma multiforme, you pay attention to this one.

    01:46 This is WHO grade IV.

    01:48 Mean age here would be 60.

    01:50 Necrosis or microvascular proliferation to diagnose this.

    01:54 Remember, we talked about angiogenesis taking place, proliferation of endothelial cells.

    02:00 Initial management: Maximum surgical resection, but even then, there’s no guarantee.

    02:05 Management after progression, symptomatic once again, if chemotherapy is required.

    02:10 However, take a look at the survival.

    02:12 Mean survival after initial treatment, one to two years.

    02:17 So then it comes into risk versus benefits and whether or not, well, that ends up becoming a behavioral science type of issue, in terms of communication with the family and whether or not they wish to opt for surgery and so on and so forth.

    02:30 Look for those types of scenarios.

    02:34 Here’s a histologic picture of glioblastoma multiforme.

    02:37 What I want you to pay attention to is right there in the middle there.

    02:41 And you’ll find a surrounding border of a palisading pattern of glioblastoma multiforme.

    02:47 So of all of the astrocytomas thus far in an adult, well, we looked at anaplastic, fibrillary and here’s glioblastoma multiforme, you’ll want to know its histologic picture in greater detail.

    03:00 Under astrocytomas, we have one that’s left.

    03:05 You’ll notice that we talked about grade II, III, and IV.

    03:10 Grade II was fibrillary, grade III was anaplastic, and grade IV was glioblastoma multiforme.

    03:15 It came under the category of astrocytomas.

    03:18 And astrocytomas are neuroepithelial tumors, which means that particular tumors then arising from your brain, brain, brain, the parenchyma.

    03:28 So we have one left.

    03:29 That’s grade I.

    03:31 And we leave this separate because pilocytic astrocytoma.

    03:36 The reason that I separated the pilo- and -cytic because I want you to pay attention to -cytic.

    03:40 And by -cytic, I want you to think of it as being cystic.

    03:45 So when I say cystic to you, what does that mean? It means that you have a fluid-filled compartment, don’t you? So where is this fluid-filled compartment located in this child? Do you realize that the reason that this is kept separate of all the astrocytomas is because this is the one that’s most commonly found in children.

    04:04 Now, be careful with this.

    04:06 This pilocytic astrocytoma is the most common astrocytoma to be found in a child.

    04:16 And the reason I’m being very technical here is because if there’s a question at any point in time that’s been imposed to you, what is the most common brain tumor overall, primary, in a child? Then, it will be medulloblastoma, which we haven’t discussed yet.

    04:33 Is that clear? Okay.

    04:35 Now, let’s move on.

    04:36 Typically occurs in children located in -- Aha! Where is this cystic type of lesion located? This -cytic or cystic type of lesion is located in the cerebellum.

    04:49 So how would your patient then present? Now, think about the cerebellum in a child.

    04:54 What is it going to do? Ah! It’s growing, it’s growing, and growing.

    04:58 What does it look like? It looks like a cystic-like structure.

    05:01 And whenever you think of a cyst and it’s fluid-filled, then if you have an imaging, you can only imagine that what you’re going to find in the middle of the cyst would be of what characteristic? Would it be opaque or would it be lucent? Fluid appears being lucent in this case.

    05:16 And so therefore, as it grows, it’s going to then impinge upon what in front of the cerebellum? Ah, there you go.

    05:24 So now, you’re talking about the fourth ventricle.

    05:26 This is not good.

    05:27 If you start then increasing obstruction of the fourth ventricle, then you’re creating obstructive non-communicating type of hydrocephalus.

    05:39 Keep those things in mind.

    05:40 Usually, cystic, so from henceforth, the clinical pearls here would be children, -cytic.

    05:48 By -cytic, you will refer to cystic.

    05:50 Located where? In the cerebellum.

    05:53 Therefore, what kind of presentation? Usually, there would be incoordination with walking.

    05:59 In other words, maybe ataxia.

    06:02 Quick little words about some of the remaining astrocytomas.

    06:06 Pleomorphic xanthoastrocytoma: Typically, once again here, seen in children.

    06:10 It could be found in young adults as well.

    06:12 Usually located in the temporal lobe.

    06:14 Pleomorphic, P.

    06:16 Pleomorphic, P, as in temporal lobe.

    06:19 Children, perhaps young adults.

    06:22 And we have something called SEGA.

    06:24 When I was growing up, back in the day, SEGA was actually a video game.

    06:28 Nowadays, I don’t even know if it exists.

    06:29 But anyhow, we have subependymal, we have giant cell astrocytoma.

    06:34 And here, you’re thinking about this being paraventricular type of tumor and with what’s known as tuberous sclerosis.

    06:42 And of course, tuberous sclerosis being a genetic issue with the particular gene known as TSC.

    06:49 At this juncture, we have now completed our neuroepithelial tumor, classification or subtype of astrocytomas.

    06:58 We began by looking at common adult type of astrocytomas and we have now looked at the most common child astrocytoma or astrocytoma to be found in a child, being your pilocytic, we looked at pleomorphic and SEGA.

    About the Lecture

    The lecture Neuroepithelial Tumors: Astrocytoma by Carlo Raj, MD is from the course Tumors of the CNS.

    Author of lecture Neuroepithelial Tumors: Astrocytoma

     Carlo Raj, MD

    Carlo Raj, MD

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