Protoplasmic astrocytoma: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 32: | Line 32: | ||
*Protoplasmic astrocytoma is demonstrated by positivity to tumor marker such as [[GFAP]]. | *Protoplasmic astrocytoma is demonstrated by positivity to tumor marker such as [[GFAP]]. | ||
== Causes == | |||
<br /> | |||
==Differentiating Protoplasmic Astrocytoma from other Diseases== | ==Differentiating Protoplasmic Astrocytoma from other Diseases== | ||
*Protoplasmic astrocytoma must be differentiated from: | *Protoplasmic astrocytoma must be differentiated from: | ||
| Line 50: | Line 52: | ||
===Gender=== | ===Gender=== | ||
*Males are more commonly affected with protoplasmic astrocytoma than females. The male to female ratio is approximately 1.67 to 1.<ref name="pmid7785654">{{cite journal| author=Prayson RA, Estes ML| title=Protoplasmic astrocytoma. A clinicopathologic study of 16 tumors. | journal=Am J Clin Pathol | year= 1995 | volume= 103 | issue= 6 | pages= 705-9 | pmid=7785654 | doi=10.1093/ajcp/103.6.705 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7785654 }} </ref> | *Males are more commonly affected with protoplasmic astrocytoma than females. The male to female ratio is approximately 1.67 to 1.<ref name="pmid7785654">{{cite journal| author=Prayson RA, Estes ML| title=Protoplasmic astrocytoma. A clinicopathologic study of 16 tumors. | journal=Am J Clin Pathol | year= 1995 | volume= 103 | issue= 6 | pages= 705-9 | pmid=7785654 | doi=10.1093/ajcp/103.6.705 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7785654 }} </ref> | ||
== Risk Factors == | |||
There are no established risk factors for protoplasmic astrocytoma. | |||
== Screening == | |||
There is insufficient evidence to recommend routine screening for protoplasmic astrocytoma. | |||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
| Line 60: | Line 68: | ||
:*[[Hydrocephalus]] | :*[[Hydrocephalus]] | ||
== | == Diagnosis == | ||
===History=== | |||
=== Diagnostic Study of Choice === | |||
The diagnosis of protoplasmic astrocytoma is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3]. | |||
===History and Symptoms=== | |||
*When evaluating a patient for protoplasmic astrocytoma, you should take a detailed history of the presenting symptom (onset, duration, and progression), other associated symptoms, and a thorough family and past medical history review. | *When evaluating a patient for protoplasmic astrocytoma, you should take a detailed history of the presenting symptom (onset, duration, and progression), other associated symptoms, and a thorough family and past medical history review. | ||
*Symptoms of protoplasmic astrocytoma include:<ref name="symptomspa1">Clinical presentation of protoplasmic astrocytoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/protoplasmic-astrocytoma. Accessed on January 8, 2016</ref> | *Symptoms of protoplasmic astrocytoma include:<ref name="symptomspa1">Clinical presentation of protoplasmic astrocytoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/protoplasmic-astrocytoma. Accessed on January 8, 2016</ref> | ||
:*[[Headaches]] | :*[[Headaches]] | ||
| Line 73: | Line 85: | ||
:*[[vision loss|Changes in vision]] | :*[[vision loss|Changes in vision]] | ||
:*[[Speech difficulties]] | :*[[Speech difficulties]] | ||
Physical Examination | |||
==CT== | ==CT== | ||
Revision as of 16:02, 17 July 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Synonyms and keywords: Protoplasmic astrocytomas; Diffuse astrocytoma; Low grade astrocytoma
Overview
Protoplasmic astrocytoma is a rare variant of diffuse low grade astrocytoma with characteristic histological and imaging features. It has been suggested that protoplasmic astrocytoma represents a variant of dysembryoplastic neuroepithelial tumors (DNET), as they share histologic and imaging features. Currently, protoplasmic astrocytoma is classified as a subtype of diffuse low-grade astrocytoma.
Classification
Protoplasmic astrocytoma is a subtype of astrocytoma and is included in the classification of astrocytoma. For more information about the classification of astrocytoma, click here.
Pathophysiology
Gross Pathology
- Protoplasmic astrocytoma appear to have a predilection for the frontal and temporal lobes.
Microscopic Pathology
- On microscopic histopathological analysis, protoplasmic astrocytoma is characterized by:[1]
Immunohistochemistry
- Protoplasmic astrocytoma is demonstrated by positivity to tumor marker such as GFAP.
Causes
Differentiating Protoplasmic Astrocytoma from other Diseases
- Protoplasmic astrocytoma must be differentiated from:
Epidemiology and Demographics
Age
- Protoplasmic astrocytoma is a rare disease that tends to affect young adults.
- The mean age at diagnosis is 32 years.
Gender
- Males are more commonly affected with protoplasmic astrocytoma than females. The male to female ratio is approximately 1.67 to 1.[2]
Risk Factors
There are no established risk factors for protoplasmic astrocytoma.
Screening
There is insufficient evidence to recommend routine screening for protoplasmic astrocytoma.
Natural History, Complications and Prognosis
Natural History
- If left untreated, patients with protoplasmic astrocytoma may progress to develop seizures, focal neurological deficits, and hydrocephalus.[3]
- Protoplasmic astrocytoma is a slow growing tumor with an indolent course.
Complications
- Common complication of protoplasmic astrocytoma include:[3]
Diagnosis
Diagnostic Study of Choice
The diagnosis of protoplasmic astrocytoma is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
History and Symptoms
- When evaluating a patient for protoplasmic astrocytoma, you should take a detailed history of the presenting symptom (onset, duration, and progression), other associated symptoms, and a thorough family and past medical history review.
- Symptoms of protoplasmic astrocytoma include:[3]
Physical Examination
CT
- Head CT scan is helpful in the diagnosis of protoplasmic astrocytoma. On CT scan, protoplasmic astrocytoma is characterized by:[4]
- Hypodense mass
- Positive mass effect
- No enhancement
- Cystic or fluid attenuation, due to the aforementioned prominent mucinous microcystic component
MRI
- The possibility that a primary cerebral neoplasm represents a protoplasmic astrocytoma should be considered in a patient with a large frontal or temporal tumor that has a very high signal on T2 with a large proportion of the tumor showing substantial T2 FLAIR suppression.[5]
- Brain MRI is helpful in the diagnosis of protoplasmic astrocytoma. On MRI, protoplasmic astrocytoma is characterized by:[4][6]
| MRI component | Findings |
|---|---|
|
T1 |
|
|
T2 |
|
|
Fluid-attenuated inversion recovery (FLAIR) |
|
|
T1 with contrast |
|
|
Diffusion weighted imaging (DWI) |
|
Other Imaging Findings
Magnetic Resonance Spectroscopy
- MR spectroscopy may be helpful in the diagnosis of protoplasmic astrocytoma, which demonstrates elevated choline/creatine ratio.[4]
Magnetic Resonance Perfusion
- MR perfusion may be helpful in the diagnosis of protoplasmic astrocytoma, which demonstrates no elevation of relative cerebral blood volume (rCBV).[4]
Electroencephalogram
- Electroencephalogram (EEG) is performed in cases of protoplasmic astrocytoma to record the continuous electrical activity of the brain and locate the seizure activity.[7]
Biopsy
- Biopsy of the protoplasmic astrocytoma tumor, taken through a needle during a simple surgical procedure, helps to confirm the diagnosis.[8]
Treatment
- The treatment of protoplasmic astrocytoma depends on the clinical presentation, tumor size, and location.[8]
- Surgery: The predominant therapy for protoplasmic astrocytoma is surgical resection.[8]
- Radiotherapy: Radiotherapy may be used in protoplasmic astrocytoma post-operatively or at the time of recurrence or progression.[9]
- Chemotherapy: Chemotherapy may have a role in recurrent and de-differentiated tumors.[9]
Treatment of protoplasmic astrocytoma | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Surgery | Radiotherapy | Chemotherapy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Pathology of protoplasmic astrocytoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/protoplasmic-astrocytoma. Accessed on January 8, 2016
- Scant cytoplasm
- Rounded prominent nuclear contour
- Flaccid processes
- Low cellular density
- Mild nuclear atypia (enlarged, irregular contour, hyperchromasia, and coarsened nuclear chromatin pattern)
- Mucinous fluid containing microcystic spaces (prominent feature)
- Abscence of mitoses, microvascular proliferation, and necrosis
- temporal and frontal lobes were the most likely site of origin.<ref name="pmid7785654">Prayson RA, Estes ML (1995). "Protoplasmic astrocytoma. A clinicopathologic study of 16 tumors". Am J Clin Pathol. 103 (6): 705–9. doi:10.1093/ajcp/103.6.705. PMID 7785654.
- ↑ Prayson RA, Estes ML (1995). "Protoplasmic astrocytoma. A clinicopathologic study of 16 tumors". Am J Clin Pathol. 103 (6): 705–9. doi:10.1093/ajcp/103.6.705. PMID 7785654.
- ↑ 3.0 3.1 3.2 Clinical presentation of protoplasmic astrocytoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/protoplasmic-astrocytoma. Accessed on January 8, 2016
- ↑ 4.0 4.1 4.2 4.3 Radiological features of protoplasmic astrocytoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/protoplasmic-astrocytoma. Accessed on January 8, 2016
- ↑ Tay KL, Tsui A, Phal PM, Drummond KJ, Tress BM (2011). "MR imaging characteristics of protoplasmic astrocytomas". Neuroradiology. 53 (6): 405–11. doi:10.1007/s00234-010-0741-2. PMID 20644924.
- ↑ Radiographic features of low grade infiltrative astrocytoma. Dr Ahmed Abd Rabou and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/low-grade-infiltrative-astrocytoma. Accessed on January 8, 2016
- ↑ Radiographic features of fibrillary astrocytoma. Dr Henry Knipe and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/fibrillary-astrocytoma. Accessed on January 4, 2016
- ↑ 8.0 8.1 8.2 Treatment and prognosis of protoplasmic astrocytoma. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/protoplasmic-astrocytoma. Accessed on January 8, 2016
- ↑ 9.0 9.1 Treatment and prognosis of low grade infiltrative astrocytoma. Dr Ahmed Abd Rabou and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/low-grade-infiltrative-astrocytoma. Accessed on January 8, 2016