Protoplasmic astrocytoma: Difference between revisions
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:*Mucinous fluid containing microcystic spaces (prominent feature) | :*Mucinous fluid containing microcystic spaces (prominent feature) | ||
:*Abscence of [[mitoses]], microvascular proliferation, and [[necrosis]] | :*Abscence of [[mitoses]], microvascular proliferation, and [[necrosis]] | ||
:*temporal and frontal lobes were the most likely site of origin.<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> | |||
===Immunohistochemistry=== | ===Immunohistochemistry=== | ||
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===Gender=== | ===Gender=== | ||
*Males are more commonly affected with protoplasmic astrocytoma than females. The male to female ratio is approximately 1.67 to 1. | *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> | ||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
Revision as of 19:04, 15 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.
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:Closing
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Immunohistochemistry
- Protoplasmic astrocytoma is demonstrated by positivity to tumor marker such as GFAP.
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.[1]
Natural History, Complications and Prognosis
Natural History
- If left untreated, patients with protoplasmic astrocytoma may progress to develop seizures, focal neurological deficits, and hydrocephalus.[2]
- Protoplasmic astrocytoma is a slow growing tumor with an indolent course.
Complications
- Common complication of protoplasmic astrocytoma include:[2]
History and Symptoms
History
- 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
- Symptoms of protoplasmic astrocytoma include:[2]
CT
- Head CT scan is helpful in the diagnosis of protoplasmic astrocytoma. On CT scan, protoplasmic astrocytoma is characterized by:[3]
- 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.[4]
- Brain MRI is helpful in the diagnosis of protoplasmic astrocytoma. On MRI, protoplasmic astrocytoma is characterized by:[3][5]
| 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.[3]
Magnetic Resonance Perfusion
- MR perfusion may be helpful in the diagnosis of protoplasmic astrocytoma, which demonstrates no elevation of relative cerebral blood volume (rCBV).[3]
Electroencephalogram
- Electroencephalogram (EEG) is performed in cases of protoplasmic astrocytoma to record the continuous electrical activity of the brain and locate the seizure activity.[6]
Biopsy
- Biopsy of the protoplasmic astrocytoma tumor, taken through a needle during a simple surgical procedure, helps to confirm the diagnosis.[7]
Treatment
- The treatment of protoplasmic astrocytoma depends on the clinical presentation, tumor size, and location.[7]
- Surgery: The predominant therapy for protoplasmic astrocytoma is surgical resection.[7]
- Radiotherapy: Radiotherapy may be used in protoplasmic astrocytoma post-operatively or at the time of recurrence or progression.[8]
- Chemotherapy: Chemotherapy may have a role in recurrent and de-differentiated tumors.[8]
Treatment of protoplasmic astrocytoma | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Surgery | Radiotherapy | Chemotherapy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ 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.
- ↑ 2.0 2.1 2.2 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
- ↑ 3.0 3.1 3.2 3.3 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
- ↑ 7.0 7.1 7.2 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
- ↑ 8.0 8.1 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