Astrocytoma Biopsy: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
 
(3 intermediate revisions by the same user not shown)
Line 3: Line 3:
{{CMG}}; {{AE}} {{Ammu}}
{{CMG}}; {{AE}} {{Ammu}}
==Overview==
==Overview==
Tumor biopsy findings associated with astrocytoma include microcystic [[tumor]] [[matrix]], [[gemistocytes]], [[rosenthal fibres]] and [[hyalinisation]] of [[blood vessel]]s. High grade [[tumor]]s are charecterized by high [[cellularity]], [[pleomorphism]], [[nuclear atypia]], increased mitotic activity, [[necrosis]] and [[microvascular]] proliferation.
Tumor biopsy findings associated with astrocytoma include microcystic [[tumor]] [[matrix]], [[gemistocytes]], [[rosenthal fibres]] and [[hyalinization]] of [[blood vessel]]s. High grade [[tumor]]s are characterized by high [[cellularity]], [[pleomorphism]], [[nuclear atypia]], increased mitotic activity, [[necrosis]] and [[microvascular]] proliferation.
 
==Biopsy==
==Biopsy==
* If doctors think there may be an astrocytoma, a [[biopsy]] may be done to remove a sample of [[tissue]]. For [[tumor]]s in the [[brain]], a part of the [[skull]] is removed and a [[needle]] is used to remove [[tissue]]. Sometimes, the [[needle]] is guided by a computer. A pathologist views the [[tissue]] under a [[microscope]] to look for [[cancer]] [[cell]]s. If [[cancer cell]]s are found, the doctor may remove as much [[tumor]] as safely possible during the same [[surgery]]. Because it can be hard to tell the difference between types of [[brain tumor]]s, you may want to have your child's [[tissue]] sample checked by a [[pathologist]] who has experience in diagnosing [[brain tumor]]s.
* If doctors think there may be an astrocytoma, a [[biopsy]] may be done to remove a sample of [[tissue]]. For [[tumor]]s in the [[brain]], a part of the [[skull]] is removed and a [[needle]] is used to remove [[tissue]]. Sometimes, the [[needle]] is guided by a computer. A pathologist views the [[tissue]] under a [[microscope]] to look for [[cancer]] [[cell]]s. If [[cancer cell]]s are found, the doctor may remove as much [[tumor]] as safely possible during the same [[surgery]]. Because it can be hard to tell the difference between types of [[brain tumor]]s, you may want to have your child's [[tissue]] sample checked by a [[pathologist]] who has experience in diagnosing [[brain tumor]]s.
Line 15: Line 14:
* Often microcystic spaces containing mucinous [[fluid]] are present, a typical finding in fibrillary astrocytomas, but even more characteristic and pronounced in protoplasmic astrocytomas.
* Often microcystic spaces containing mucinous [[fluid]] are present, a typical finding in fibrillary astrocytomas, but even more characteristic and pronounced in protoplasmic astrocytomas.
* The occasional occurrence of [[gemistocytes]] in a diffuse astrocytoma does not justify the [[diagnosis]] of gemistocytic astrocytoma. Gemistocytic astrocytomas tend to progress more rapidly to anaplastic astrocytoma and secondary glioblastoma than fibrillary astrocytoma although they share the WHO grade II.
* The occasional occurrence of [[gemistocytes]] in a diffuse astrocytoma does not justify the [[diagnosis]] of gemistocytic astrocytoma. Gemistocytic astrocytomas tend to progress more rapidly to anaplastic astrocytoma and secondary glioblastoma than fibrillary astrocytoma although they share the WHO grade II.
* [[Mitoses]], microvascular proliferation and necrosis are absent (if present they suggest a high grade tumour). Like all tumours derived from astrocytes, fibrillary astrocytomas stain with glial fibrillary acidic protein (gFAP).
* [[Mitoses]], [[microvascular proliferation]] and [[necrosis]] are absent (if present they suggest a high grade [[tumor]]). Like all [[tumor]]s derived from [[astrocytes]], fibrillary astrocytomas [[stain]] with [[glial fibrillary acidic protein]] (gFAP).
===Anaplastic astrocytomas<ref name=Radiopaedia 2015 Anaplastic astrocytoma>{{cite web | title = Anaplastic astrocytoma [Dr Bruno Di Muzio and Dr Frank Gaillard]| url = http://radiopaedia.org/articles/anaplastic-astrocytoma }}</ref>===
===Anaplastic astrocytomas<ref name=Radiopaedia 2015 Anaplastic astrocytoma>{{cite web | title = Anaplastic astrocytoma [Dr Bruno Di Muzio and Dr Frank Gaillard]| url = http://radiopaedia.org/articles/anaplastic-astrocytoma }}</ref>===
* The key feature present in anaplastic astrocytomas, absent in low grade tumours is mitotic activity and cellular pleomorphism.
* The key feature present in anaplastic astrocytomas, absent in low grade [[tumor]]s is [[mitotic activity]] and cellular [[pleomorphism]].
 
===Pilocytic astrocytoma<ref name=Radiopaedia 2015 Pilocytic astrocytomas >{{cite web | title = Pilocytic astrocytomas  [Dr Bruno Di Muzio and Dr Frank Gaillard]| url = http://radiopaedia.org/articles/pilocytic-astrocytoma }}</ref>===  
===Pilocytic astrocytoma<ref name=Radiopaedia 2015 Pilocytic astrocytomas >{{cite web | title = Pilocytic astrocytomas  [Dr Bruno Di Muzio and Dr Frank Gaillard]| url = http://radiopaedia.org/articles/pilocytic-astrocytoma }}</ref>===  
* The term pilocytic refers to the the elongated hair-like projections from the neoplastic cells. The presence of eosinophilic Rosenthal fibres is a characteristic feature, and hyalinisation of blood vessels is also common.<ref>{{cite book | last = Drevelegas | first = Antonios | title = Imaging of brain tumors with histological correlations | publisher = Springer | location = Berlin New York | year = 2011 | isbn = 3540876502 }}</ref>
* The term pilocytic refers to the the elongated [[hair]]-like projections from the [[neoplastic cell]]s. The presence of eosinophilic [[Rosenthal fibre]]s is a characteristic feature, and [[hyalinisation]] of [[blood vessel]]s is also common.<ref>{{cite book | last = Drevelegas | first = Antonios | title = Imaging of brain tumors with histological correlations | publisher = Springer | location = Berlin New York | year = 2011 | isbn = 3540876502 }}</ref>
 
===Pilomyxoid Astrocytomas<ref name=Radiopaedia 2015 Pilomyxoid astrocytoma>{{cite web | title = Pilomyxoid astrocytoma [Dr Bruno Di Muzio and Dr Imran Jindani]| url = http://radiopaedia.org/articles/pilomyxoid-astrocytoma }}</ref>===
===Pilomyxoid Astrocytomas<ref name=Radiopaedia 2015 Pilomyxoid astrocytoma>{{cite web | title = Pilomyxoid astrocytoma [Dr Bruno Di Muzio and Dr Imran Jindani]| url = http://radiopaedia.org/articles/pilomyxoid-astrocytoma }}</ref>===
* Features typically found in pilocytic astrocytomas, such as and Rosenthal fibres, eosinophilic granular bodies and calcification are uncommon or absent in PMAs<ref name="pmid23888217">{{cite journal| author=Pereira FO, Lombardi IA, Mello AY, Romero FR, Ducati LG, Gabarra RC et al.| title=Pilomyxoid astrocytoma of the brainstem. | journal=Rare Tumors | year= 2013 | volume= 5 | issue= 2 | pages= 65-7 | pmid=23888217 | doi=10.4081/rt.2013.e17 | pmc=PMC3719112 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23888217  }} </ref><ref name="pmid20551536">{{cite journal| author=Azad S, Kudesia S, Chawla N, Azad R, Singhal M, Rai SM et al.| title=Pilomyxoid astrocytoma. | journal=Indian J Pathol Microbiol | year= 2010 | volume= 53 | issue= 2 | pages= 294-6 | pmid=20551536 | doi=10.4103/0377-4929.64283 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20551536  }} </ref>. These tumours also lack the biphasic appearance (dense cellular areas alternating with loose cystic areas) usually present in PAs.
* Features typically found in pilocytic astrocytomas, such as and [[rosenthal fibre]]s, [[eosinophilic]] granular bodies and [[calcification]] are uncommon or absent in pilomyxoid astrocytomas<ref name="pmid23888217">{{cite journal| author=Pereira FO, Lombardi IA, Mello AY, Romero FR, Ducati LG, Gabarra RC et al.| title=Pilomyxoid astrocytoma of the brainstem. | journal=Rare Tumors | year= 2013 | volume= 5 | issue= 2 | pages= 65-7 | pmid=23888217 | doi=10.4081/rt.2013.e17 | pmc=PMC3719112 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23888217  }} </ref><ref name="pmid20551536">{{cite journal| author=Azad S, Kudesia S, Chawla N, Azad R, Singhal M, Rai SM et al.| title=Pilomyxoid astrocytoma. | journal=Indian J Pathol Microbiol | year= 2010 | volume= 53 | issue= 2 | pages= 294-6 | pmid=20551536 | doi=10.4103/0377-4929.64283 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20551536  }} </ref>. These [[tumor]]s also lack the biphasic appearance (dense cellular areas alternating with loose cystic areas) usually present in pilomyxoid astrocytomas.


===Subependymal Giant Cell Astrocytoma<ref name=Radiopaedia052015>{{cite web | title = Subependymal giant cell astrocytoma [Dr Bruno Di Muzio and Dr Jeremy Jones]| url = http://radiopaedia.org/articles/subependymal-giant-cell-astrocytoma }}</ref>===
===Subependymal Giant Cell Astrocytoma<ref name=Radiopaedia052015>{{cite web | title = Subependymal giant cell astrocytoma [Dr Bruno Di Muzio and Dr Jeremy Jones]| url = http://radiopaedia.org/articles/subependymal-giant-cell-astrocytoma }}</ref>===
* Histologically, subependymal nodules and subependymal giant cell tumours are indistinguishable, and the distinction lies in the potential of a subependymal giant cell tumour for growth and mass effect.<ref name="pmid15505165">{{cite journal| author=Goh S, Butler W, Thiele EA| title=Subependymal giant cell tumors in tuberous sclerosis complex. | journal=Neurology | year= 2004 | volume= 63 | issue= 8 | pages= 1457-61 | pmid=15505165 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15505165  }} </ref>
* Histologically, subependymal nodules and subependymal [[giant cell]] [[tumor]]s are indistinguishable, and the distinction lies in the potential of a subependymal giant cell [[tumor]] for growth and [[mass effect]].<ref name="pmid15505165">{{cite journal| author=Goh S, Butler W, Thiele EA| title=Subependymal giant cell tumors in tuberous sclerosis complex. | journal=Neurology | year= 2004 | volume= 63 | issue= 8 | pages= 1457-61 | pmid=15505165 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15505165  }} </ref>


===Pleomorphic xanthoastrocytomas (PXA)<ref name=Radiopaedia072015>{{cite web | title = Pleomorphic xanthoastrocytomas [Dr Bruno Di Muzio and Dr Frank Gaillard]| url = http://radiopaedia.org/articles/pleomorphic-xanthoastrocytoma }}</ref> ===
===Pleomorphic xanthoastrocytomas (PXA)<ref name=Radiopaedia072015>{{cite web | title = Pleomorphic xanthoastrocytomas [Dr Bruno Di Muzio and Dr Frank Gaillard]| url = http://radiopaedia.org/articles/pleomorphic-xanthoastrocytoma }}</ref> ===
* Microscopically the margins are not as well defined. Spindle cells, polygonal cells, multi-nucleated cells and lipid laden xanthomatous astrocytes are identified. Even more pleomorphic is the appearance of the nuclei. Endothelial proliferation is rare.  
* Microscopically the margins are not as well defined. [[Spindle cell]]s, [[polygonal cell]]s, multi-nucleated [[cell]]s and [[lipid]] laden xanthomatous [[astrocytes]] are identified. Even more pleomorphic is the appearance of the [[nuclei]]. [[Endothelial proliferation]] is rare.  


===Oligoastrocytomas<ref name=Radiopaedia082015>{{cite web | title = Oligoastrocytomas [Dr Bruno Di Muzio and Dr Frank Gaillard]| url = http://radiopaedia.org/articles/oligoastrocytoma }}</ref>===
===Oligoastrocytomas<ref name=Radiopaedia082015>{{cite web | title = Oligoastrocytomas [Dr Bruno Di Muzio and Dr Frank Gaillard]| url = http://radiopaedia.org/articles/oligoastrocytoma }}</ref>===
* Malignancy histologic features such as high cellularity, pleomorphism, nuclear atypia, and increased mitotic activity are usually found in the OA anaplastic. Necrosis and microvascular proliferation may also be present.
* Malignancy histologic features such as high cellularity, [[pleomorphism]], [[nuclear atypia]], and increased mitotic activity are usually found in the OA anaplastic. [[Necrosis]] and [[microvascular proliferation]] may also be present.
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 20:22, 24 August 2015

Astrocytoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Astrocytoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-Ray

Echocardiography and Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Study

Case #1

Astrocytoma Biopsy On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Astrocytoma Biopsy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Astrocytoma Biopsy

CDC on Astrocytoma Biopsy

Astrocytoma Biopsy in the news

Blogs on Astrocytoma Biopsy

Directions to Hospitals Treating Astrocytoma

Risk calculators and risk factors for Astrocytoma Biopsy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

Tumor biopsy findings associated with astrocytoma include microcystic tumor matrix, gemistocytes, rosenthal fibres and hyalinization of blood vessels. High grade tumors are characterized by high cellularity, pleomorphism, nuclear atypia, increased mitotic activity, necrosis and microvascular proliferation.

Biopsy

Low grade infiltrative astrocytoma[1]

  • Diffuse low grade astrocytomas are predominantly composed of a microcystic tumour matrix within which are embedded fibrillary neoplastic astrocytes with mild nuclear atypia and a low cellular density.
  • Often microcystic spaces containing mucinous fluid are present, a typical finding in fibrillary astrocytomas, but even more characteristic and pronounced in protoplasmic astrocytomas.
  • The occasional occurrence of gemistocytes in a diffuse astrocytoma does not justify the diagnosis of gemistocytic astrocytoma. Gemistocytic astrocytomas tend to progress more rapidly to anaplastic astrocytoma and secondary glioblastoma than fibrillary astrocytoma although they share the WHO grade II.
  • Mitoses, microvascular proliferation and necrosis are absent (if present they suggest a high grade tumor). Like all tumors derived from astrocytes, fibrillary astrocytomas stain with glial fibrillary acidic protein (gFAP).

Anaplastic astrocytomas

Pilocytic astrocytoma

Pilomyxoid Astrocytomas

  • Features typically found in pilocytic astrocytomas, such as and rosenthal fibres, eosinophilic granular bodies and calcification are uncommon or absent in pilomyxoid astrocytomas[3][4]. These tumors also lack the biphasic appearance (dense cellular areas alternating with loose cystic areas) usually present in pilomyxoid astrocytomas.

Subependymal Giant Cell Astrocytoma[5]

  • Histologically, subependymal nodules and subependymal giant cell tumors are indistinguishable, and the distinction lies in the potential of a subependymal giant cell tumor for growth and mass effect.[6]

Pleomorphic xanthoastrocytomas (PXA)[7]

Oligoastrocytomas[8]

References

  1. "Low grade infiltrative astrocytoma [Dr Bruno Di Muzio and Dr Frank Gaillard]".
  2. Drevelegas, Antonios (2011). Imaging of brain tumors with histological correlations. Berlin New York: Springer. ISBN 3540876502.
  3. Pereira FO, Lombardi IA, Mello AY, Romero FR, Ducati LG, Gabarra RC; et al. (2013). "Pilomyxoid astrocytoma of the brainstem". Rare Tumors. 5 (2): 65–7. doi:10.4081/rt.2013.e17. PMC 3719112. PMID 23888217.
  4. Azad S, Kudesia S, Chawla N, Azad R, Singhal M, Rai SM; et al. (2010). "Pilomyxoid astrocytoma". Indian J Pathol Microbiol. 53 (2): 294–6. doi:10.4103/0377-4929.64283. PMID 20551536.
  5. "Subependymal giant cell astrocytoma [Dr Bruno Di Muzio and Dr Jeremy Jones]".
  6. Goh S, Butler W, Thiele EA (2004). "Subependymal giant cell tumors in tuberous sclerosis complex". Neurology. 63 (8): 1457–61. PMID 15505165.
  7. "Pleomorphic xanthoastrocytomas [Dr Bruno Di Muzio and Dr Frank Gaillard]".
  8. "Oligoastrocytomas [Dr Bruno Di Muzio and Dr Frank Gaillard]".

Template:WH Template:WS