1
|
Shabo E, Zoubaa S, Gielen GH, Clauberg R, Wispel C, Pietsch T, Vatter H, Sarikaya-Seiwert S. Posterior fossa astroblastoma: a case report of an extremely rare tumor with challenging diagnosis in a child and a review of literature. Childs Nerv Syst 2025; 41:112. [PMID: 39953192 PMCID: PMC11828785 DOI: 10.1007/s00381-025-06768-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Accepted: 02/05/2025] [Indexed: 02/17/2025]
Abstract
A 7-year-old boy presented to the hospital with recurrent nausea and vomiting over 2 weeks. A cranial MRI revealed a large heterogeneous lesion in the posterior fossa extending from the fourth ventricle to the foramen magnum with contact to the brainstem. The lesion showed moderate diffusion restriction and multiple small cystic components. The child underwent gross total resection. The primary histological findings suggested proliferative active tumor without further definition. The extended histological examination 3 weeks later confirmed the diagnosis of astroblastoma. Due to complete resection and full recovery of the patient, watchful waiting with radiological follow-up was recommended. Astroblastoma is an extremely rare tumor especially in the posterior fossa. However, it should be considered as a differential diagnosis in every tumor presenting the discussed radiological and histological features, especially in young aged patients.
Collapse
Affiliation(s)
- Ehab Shabo
- Department of Neurosurgery, Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, Bonn, 53127, Germany.
| | - Saida Zoubaa
- Department of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn, Bonn, 53127, Germany
| | - Gerrit H Gielen
- Department of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn, Bonn, 53127, Germany
| | - Ralf Clauberg
- Department of Neuroradiology, University Hospital Bonn, Bonn, 53127, Germany
| | - Christian Wispel
- Section of Pediatric Neurosurgery, Department of Neurosurgery, Rheinische, Friedrich-Wilhelms-University, University Hospital Bonn, Bonn, 53127, Germany
| | - Torsten Pietsch
- Department of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn, Bonn, 53127, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, Bonn, 53127, Germany
| | - Sevgi Sarikaya-Seiwert
- Section of Pediatric Neurosurgery, Department of Neurosurgery, Rheinische, Friedrich-Wilhelms-University, University Hospital Bonn, Bonn, 53127, Germany
| |
Collapse
|
2
|
Das S, Gupta D, Dan Charan B, Sahu S, Suri V, Garg A, Tandon V, Suri A, Sharma MC. Astroblastoma: A molecularly defined entity, its clinico-radiological & pathological analysis of eight cases and review of literature. Pathol Res Pract 2024; 263:155616. [PMID: 39413458 DOI: 10.1016/j.prp.2024.155616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 09/01/2024] [Accepted: 09/25/2024] [Indexed: 10/18/2024]
Abstract
Astroblastoma, a unique entity of glial tumor, predominantly occur in young women with distinctive MN1 rearrangement, Given its limited documentation in existing literature, we report eight cases of astroblastoma, detailing their clinical, radiological, and histopathological characteristics along with molecular analysis. We conducted a retrospective analysis of our neuropathology archive database spanning the past 8 years. We included all cases that underwent Magnetic Resonance Imaging (MRI), surgical resection, histopathological examination, molecular testing, and follow-up. Histopathological examination involving immunohistochemistry and Fluorescence In Situ Hybridization (FISH) was carried out for all cases. All tumors were found to be located in the supratentorial region (cerebral hemisphere). The median age of the group was 35.1 years, with a female-to-male ratio of 1.6:1. The most common clinical presentation was headache. Morphologically, all tumors exhibited astroblastic features with pseudorosettes and perivascular hyalinization. Immunohistochemistry consistently revealed positivity for EMA and variable immunoreactivity for GFAP, OLIG2, and D2-40. Fluorescence In Situ Hybridization (FISH) analysis conducted for all cases showed MN1 rearrangement in 7 cases. The mean follow-up period was 45 months (ranging from 12 to 105 months). Radiotherapy was administered for high-grade and recurrent astroblastomas. All patients are currently alive and in good health. Astroblastomas are uncommon central nervous system (CNS) tumors with characteristics morphology and molecular signatures. They typically carry a favorable prognosis. High level suspicion is required for their diagnosis and molecular analysis is must to distinguish them from other morphological mimics.
Collapse
Affiliation(s)
- Sumanta Das
- Neuropathology Laboratory, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Gupta
- Department of Pathology, Command Hospital, Lucknow, India
| | - Bheru Dan Charan
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, India; Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Saumya Sahu
- Neuropathology Laboratory, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Neuropathology Laboratory, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Neuropathology Laboratory, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
| |
Collapse
|
3
|
Joshi PR, Pandey SB, Manandhar U, GC S, Sedain G. Cerebral astroblastoma radiologically mimicking pilocytic astrocytoma: A case report. Clin Case Rep 2022; 10:e05781. [PMID: 35498346 PMCID: PMC9036196 DOI: 10.1002/ccr3.5781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
| | | | - Usha Manandhar
- Department of Pathology Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Saroj GC
- Maharajgunj Medical Campus Kathmandu Nepal
| | - Gopal Sedain
- Department of Neurosurgery Tribhuvan University Teaching Hospital Kathmandu Nepal
| |
Collapse
|
4
|
Jeon C, Kim B, Choi JW. Clinicoradiological and histopathological characteristics and treatment outcomes of cerebral astroblastoma in children: a single-institution experience. J Neurosurg Pediatr 2022; 29:513-519. [PMID: 35180693 DOI: 10.3171/2022.1.peds21389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Astroblastoma (AB) is a rare glial tumor. The optimal treatment and prognosis of this tumor remain unclear. The authors retrospectively analyzed the clinical characteristics, neuroimaging findings, histopathological results, and treatment outcomes of 7 patients with AB. METHODS The study comprised 7 patients with pathologically proven AB who were surgically treated at Samsung Medical Center from November 1994 to January 2019. Clinicoradiological, histopathological, and surgical records were reviewed. RESULTS The patients included 5 girls (71.4%) and 2 boys (28.6%), with a median age of 13 years. All patients showed contrast enhancement on preoperative MRI: 5 ABs (71.4%) showed a concomitant solid and cystic appearance, and 2 (28.6%) demonstrated a solid appearance. ABs in 6 patients (85.7%) showed a well-circumscribed, characteristic "bubbly" appearance on T2-weighted MRI. Gross-total resection (GTR) was achieved in all cases (100%). Six patients (85.7%) were diagnosed with high-grade AB and 1 (14.3%) with low-grade AB. Six (85.7%) of the 7 patients received adjuvant treatment after resection, including 5 (83.3%) with AB who received chemotherapy and radiotherapy and 1 (16.7%) who received proton therapy alone. The median clinical follow-up duration was 96 months (range 48-189 months). Two patients experienced recurrence, and all patients in this series were alive at the last follow-up. CONCLUSIONS In this study, the clinicoradiological and histopathological features of AB were described. Based on the authors' limited experience with 7 cases, resection with the goal of GTR is currently the mainstream treatment for AB, and adjuvant radiation treatment should be considered after surgery.
Collapse
Affiliation(s)
- Chiman Jeon
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
| | - Binnari Kim
- 2Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jung Won Choi
- 1Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
| |
Collapse
|
5
|
Kurokawa R, Baba A, Kurokawa M, Ota Y, Hassan O, Capizzano A, Kim J, Johnson T, Srinivasan A, Moritani T. Neuroimaging of astroblastomas: A case series and systematic review. J Neuroimaging 2021; 32:201-212. [PMID: 34816541 DOI: 10.1111/jon.12948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Astroblastoma is a rare type of glial tumor, histologically classified into two types with different prognoses: high and low grade. We aimed to investigate the CT and MRI findings of astroblastomas by collecting studies with analyzable neuroimaging data and extracting the imaging features useful for tumor grading. METHODS We searched for reports of pathologically proven astroblastomas with analyzable neuroimaging data using PubMed, Scopus, and Embase. Sixty-five studies with 71 patients with astroblastomas met the criteria for a systematic review. We added eight patients from our hospital, resulting in a final study cohort of 79 patients. The proportion of high-grade tumors was compared in groups based on the morphology (typical and atypical) using Fisher's exact test. RESULTS High- and low-grade tumors were 35/71 (49.3%) and 36/71 (50.7%), respectively. There was a significant difference in the proportion of high-grade tumors based on the tumor morphology (typical morphology: high-grade = 33/58 [56.9%] vs. atypical morphology, 2/13 [15.4%], p = .012). The reviews of neuroimaging findings were performed using the images included in each article. The articles had missing data due to the heterogeneity of the collected studies. CONCLUSIONS Detailed neuroimaging features were clarified, including tumor location, margin status, morphology, CT attenuation, MRI signal intensity, and contrast enhancement pattern. The classification of tumor morphology may help predict the tumor's histological grade, contributing to clinical care and future oncologic research.
Collapse
Affiliation(s)
- Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Omar Hassan
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Aristides Capizzano
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - John Kim
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy Johnson
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Toshio Moritani
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
6
|
Singh K, Garg S, Rani S, Sandhu P. High-Grade Intraventricular Astroblastoma in a Young Adult: A Rare and Controversial Tumor to Manage. Asian J Neurosurg 2021; 16:567-574. [PMID: 34660370 PMCID: PMC8477834 DOI: 10.4103/ajns.ajns_430_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/09/2021] [Accepted: 03/02/2021] [Indexed: 11/04/2022] Open
Abstract
Astroblastoma is a rare primary central nervous system tumor of controversial site of origin. They account for 0.45-2.8% of all primary neuroepithelial central nervous system. It has been reported in paediatric age group with bimodal age distribution affecting more females with male to female ratio being 1:11. Astroblastomas are controversial and challenging tumors in terms of diagnosis and therapeutics. Since it carries an unpredictable disease course it needs a regular follow up even for low grade tumor. Authors have tried various schedules of post op radiotherapy after maximum safe resection. Various chemotherapeutic drugs combination have also been tried without much success. We here report a 35 years old female patient who was diagnosed with high grade astroblastoma referred for post-operative radiotherapy after gross total resection. Since it is extremely rare tumor, its treatment still not well defined and also makes it difficult conduct studies to examine tumor characteristics.
Collapse
Affiliation(s)
- Karuna Singh
- Department of Radiation oncology, Advanced Cancer Institute, Bathinda, Punjab, India
| | - Shipra Garg
- Department of Radiation Oncology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Shilp Rani
- Department of Pathology, Advanced Cancer Institute, Bathinda, Punjab, India
| | - Parvinder Sandhu
- Department of Surgical, Advanced Cancer Institute, Bathinda, Punjab, India
| |
Collapse
|
7
|
Yapıcıer Ö, Demir MK, Özdamarlar U, Kılıç D, Akakın A, Kılıç T. Posterior fossa astroblastoma in a child: a case report and a review of the literature. Childs Nerv Syst 2019; 35:1251-1255. [PMID: 30859299 DOI: 10.1007/s00381-019-04113-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/05/2019] [Indexed: 01/13/2023]
Abstract
A 4-year-old girl presented to the hospital with a progressive headache, difficulty walking, and persistent daily vomiting for 3 weeks. Papilledema was observed on fundoscopic examination. A large left cerebellovermian tumor with "bubbly" appearance was discovered. Total removal of the tumor mass was performed, and a diagnosis of low-grade astroblastoma was made. Adjuvant radiotherapy was performed due to the risk of recurrence. The patient is disease-free and has been kept on close follow-up for 6 months. The occurrence of posterior fossa astroblastoma has been rarely reported in the literature. Thus, when a "bubby" appearance enhancing cystic solid tumor is located on the cerebellar hemisphere in a child, an astroblastoma should also be included in the differential diagnosis.
Collapse
Affiliation(s)
- Özlem Yapıcıer
- Department of Pathology, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, Istanbul, Turkey
| | - Mustafa Kemal Demir
- Department of Radiology,, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, 11. kisim, Yasemin Apt, D blok. Daire 35 Ataköy, 34158, Istanbul, Turkey.
| | - Umut Özdamarlar
- Department of Radiology,, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, 11. kisim, Yasemin Apt, D blok. Daire 35 Ataköy, 34158, Istanbul, Turkey
| | - Deniz Kılıç
- Bahçeşehir University School of Medicine, Istanbul, Turkey
| | - Akın Akakın
- Department of Neurosurgery, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, Istanbul, Turkey
| | - Türker Kılıç
- Department of Neurosurgery, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, Istanbul, Turkey
| |
Collapse
|
8
|
Mallick S, Benson R, Venkatesulu B, Melgandi W, Rath GK. Patterns of care and survival outcomes in patients with astroblastoma: an individual patient data analysis of 152 cases. Childs Nerv Syst 2017; 33:1295-1302. [PMID: 28477040 DOI: 10.1007/s00381-017-3410-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/07/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Astroblastoma (AB) is a rare tumor with significant dilemma regarding diagnostic criteria, behavior, and optimum treatment. MATERIALS AND METHODS We searched PubMed, Google Search, and Cochrane Library for eligible studies with the following search words: astroblastoma, high-grade astroblastoma, and anaplastic astroblastoma till July 1, 2016, published in English language and collected data regarding age, sex, site of disease, pathological grade, treatment received, and survival. RESULTS Data of 152 patients were retrieved from 63 publications. Median age was 16 years (range 0-71). Females were affected twice more frequently than male (70.3 vs. 29.7%). Tumors were most commonly located in the frontal (39%) followed by parietal lobe (26.7%). Fifty-two and 25% of the patients had headache and seizure at presentation, 76.3% of the patients underwent a gross total resection, 41 out of 89 had a high-grade tumor, and 56 patients received adjuvant radiation with a median dose of 54 Gy (range 20-72). Adjuvant chemotherapy was used in 23 patients. Temozolomide was the most common drug used in 30% of the patients. A combination of cisplatin, etoposide with vincristine, or ifosfamide was used in 17%. Median follow-up duration was 37 months (range 1-238). Median progression-free survival and OS were 36 and 184 months, respectively. Patients with a higher-grade tumor had significantly worse OS with HR 5.260 and p = 0.001. Forty patients experienced local progression. Sixty-five percent patients underwent surgery while 50% underwent radiation as salvage. CONCLUSION AB has two distinct grades with higher-grade tumors having significantly poor survival. Maximal safe surgery followed by adjuvant radiation and temozolomide should be advocated for these tumors.
Collapse
Affiliation(s)
- Supriya Mallick
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - Rony Benson
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Wineeta Melgandi
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Goura K Rath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
9
|
Samples DC, Henry J, Yu FF, Bazan C, Tarasiewicz I. A case of astroblastoma: Radiological and histopathological characteristics and a review of current treatment options. Surg Neurol Int 2016; 7:S1008-S1012. [PMID: 28144474 PMCID: PMC5234270 DOI: 10.4103/2152-7806.195583] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background: Astroblastoma is a rare neuroepithelial tumor that often originates in the cerebral hemisphere of children and young adults. Diagnosis of this obscure neoplasm can be difficult because these tumors are so infrequently encountered and share common radiological and neuropathological features of other glial neoplasms. As such, it should be included in the differential diagnosis of astrocytoma and ependymoma if the clinical and radiographic features suggest it. Standardized treatment of astroblastomas remains under dispute because of the lack of knowledge regarding the tumor and a paucity of studies in the literature. Case Description: We present a case of a low-grade astroblastoma diagnosed in a 30-year-old female with seizures, headache, and vision changes. She underwent gross total resection and, without evidence of high-grade features, adjuvant therapy was not planned postoperatively. Post-operative surveillance suggested early recurrence, warranting referral to radiation therapy. Patient ended up expiring despite adjuvant therapy secondary to extensive recurrence and tumor metastasis. Conclusions: Astroblastoma must be considered in the differential of supratentorial tumors in children and young adults. Treatment of such, as suggested by most recent literature, includes gross total resection and adjuvant radiotherapy for lesions exhibiting high-grade features.
Collapse
Affiliation(s)
- Derek C Samples
- Department of Neurological Surgery, University of Texas Health Science Center, San Antonio, Texas, USA
| | - James Henry
- Department of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Fang Frank Yu
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Carlos Bazan
- Department of Radiology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Izabela Tarasiewicz
- Department of Neurological Surgery, University of Texas Health Science Center, San Antonio, Texas, USA
| |
Collapse
|
10
|
Cunningham DA, Lowe LH, Shao L, Acosta NR. Neuroradiologic characteristics of astroblastoma and systematic review of the literature: 2 new cases and 125 cases reported in 59 publications. Pediatr Radiol 2016; 46:1301-8. [PMID: 27048363 DOI: 10.1007/s00247-016-3607-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/30/2016] [Accepted: 03/03/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Astroblastoma is a rare tumor of uncertain origin most commonly presenting in the cerebrum of children and young adults. The literature contains only case reports and small series regarding its radiologic features. This systematic review is the largest study of imaging findings of astroblastoma to date and serves to identify features that might differentiate it from other neoplasms. OBJECTIVE This study describes the imaging features of astroblastoma based on a systematic review of the literature and two new cases. MATERIALS AND METHODS We conducted a PubMed and Google Scholar database search that identified 59 publications containing 125 cases of pathology-confirmed astroblastoma, and we also added two new cases from our own institution. Data collected include patient age, gender, tumor location, morphology, calcifications and calvarial changes. We recorded findings on CT, MRI, diffusion-weighted imaging (DWI), MR spectroscopy, positron emission tomography (PET) and catheter angiography. RESULTS Age at diagnosis ranged 0-70 years (mean 18 years; median 14 years). Female-to-male ratio was 8:1. Of 127 cases, 66 reported CT, 78 reported MRI and 47 reported both findings. Not all authors reported all features, but the tumor features reported included supratentorial in 96% (122/127), superficial in 72% (48/67), well-demarcated in 96% (79/82), mixed cystic-solid in 93% (79/85), and enhancing in 99% (78/79). On CT, 84% (26/31) of astroblastomas were hyperattenuated, 73% (27/37) had calcifications and 7 cases reported adjacent calvarial erosion. Astroblastomas were hypointense on T1-W in 58% (26/45) and on T2-W in 50% (23/46) of MRI sequences. Peritumoral edema was present in 80% (40/50) of cases but was typically described as slight. Six cases included DWI findings, with 100% showing restricted diffusion. On MR spectroscopy, 100% (5/5) showed nonspecific tumor spectra with elevated choline and decreased N-acetylaspartate (NAA). PET revealed nonspecific reduced uptake of [F-18] 2-fluoro-2-deoxyglucose ((18)F-FDG) and increased uptake of [11C]-Methionine in 100% (3/3) of cases. Catheter angiography findings (n=12) were variable, including hypervascularity in 67%, arteriovenous shunting in 33% and avascular areas in 25%. CONCLUSION Astroblastomas occur most often in adolescent girls. Imaging often shows a supratentorial, superficial, well-defined, cystic-solid enhancing mass. On CT, most are hyperattenuated, have calcifications, and may remodel adjacent bone if superficial. MRI characteristically reveals a hypointense mass on T1-W and T2-W sequences with restricted diffusion. MR spectroscopy, PET and catheter angiography findings are nonspecific.
Collapse
Affiliation(s)
- Danielle A Cunningham
- University of Missouri-Kansas City School of Medicine, 2411 Holmes St., Kansas City, MO, 64108, USA.
| | - Lisa H Lowe
- University of Missouri-Kansas City School of Medicine, 2411 Holmes St., Kansas City, MO, 64108, USA
- Department of Radiology, Children's Mercy Hospital and Clinics, Kansas City, MO, USA
| | - Lei Shao
- University of Missouri-Kansas City School of Medicine, 2411 Holmes St., Kansas City, MO, 64108, USA
- Department of Pathology, Children's Mercy Hospital and Clinics, Kansas City, MO, USA
| | - Natasha R Acosta
- University of Missouri-Kansas City School of Medicine, 2411 Holmes St., Kansas City, MO, 64108, USA
- Department of Radiology, Truman Medical Center, Kansas City, MO, USA
| |
Collapse
|
11
|
Asha U, Mahadevan A, Sathiyabama D, Ravindra T, Sagar BKC, Bhat DI, Aravinda HR, Pandey P, Vilanilam GC. Lack of IDH1 mutation in astroblastomas suggests putative origin from ependymoglial cells? Neuropathology 2015; 35:303-11. [PMID: 25786545 DOI: 10.1111/neup.12194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 12/17/2014] [Accepted: 12/22/2014] [Indexed: 11/29/2022]
Abstract
Astroblastomas are extremely rare neuroepithelial tumors of uncertain histogenesis, affecting children and young adults, and constitute a new addition to the WHO 2000 classification of CNS tumors. We report the largest series of nine cases diagnosed in a single institute over the last 13 years and review published literature. Mean age at presentation was 12.8 years (range: 22 months to 27years). Seven out of nine cases were supratentorial (frontal/frontoparietal - three, parieto-occipital - three, parafalcine - one), one was intraventricular and another was optochaismatic/suprasellar. Five cases were high grade (anaplastic) astroblastomas with Ki-67 labeling index of 8-10%. Immunohistochemical and ultrastructural evidence suggesting origin from cells intermediate between ependymocytes and astrocytes is presented. The histogenetic origin of these tumors remains speculative. But the lack of Isocitrate dehydrogenase 1 (IDH1) mutation as detected by immunohistochemistry in this study, which is similar to ependymomas supports putative origin from ependymoglial cells. Out of the nine cases, recurrence was noted in one case, 12 months after gross total resection with progression to high grade in the recurrent tumor. There is no recommended treatment protocol due to the rarity of this entity and prognostic factors are yet to be established.
Collapse
Affiliation(s)
- Unchagi Asha
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dhinakaran Sathiyabama
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Thakkar Ravindra
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - B K Chandrashekar Sagar
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dhananjaya Ishwar Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Paritosh Pandey
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - George C Vilanilam
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| |
Collapse
|
12
|
de la Garma VHE, Arcipreste AA, Vázquez FP, Aguilar RR, Castruita UO, Guerra RM. High-grade astroblastoma in a child: Report of one case and review of literature. Surg Neurol Int 2014; 5:111. [PMID: 25101206 PMCID: PMC4123262 DOI: 10.4103/2152-7806.137532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 05/19/2014] [Indexed: 12/02/2022] Open
Abstract
Background: Astroblastoma is a rare glial neoplastic lesion that affects children and adolescents; its histogenesis remains uncertain. It is considered to account for 0.5% of all glial neoplasms, and two different subtypes have been defined based upon histologic characteristics. Case Description: We present the case of a 9-year-old girl who presented with headache, motor symptoms, and seizures few days before she was admitted to our institution. Computed tomography (CT) and magnetic resonance imaging (MRI) scans showed an intra-axial heterogeneous frontoparietal lesion with a striking “bubbly” appearance in MRI T2-weighted sequences and features of intracranial hypertension. Gross total resection of the tumor was achieved and the histopathologic diagnosis revealed high-grade astroblastoma. We reviewed the current published cases of astroblastoma to highlight the demographic, clinical, radiologic, and pathologic data. Conclusion: Astroblastomas are a distinct clinicopathologic entity, with well-described radiologic, pathologic, and cytogenetic features. Its recurrence is high and efforts must be made to elucidate the role and usefulness of radiotherapy and chemotherapy in these tumors.
Collapse
|
13
|
Janz C, Buhl R. Astroblastoma: report of two cases with unexpected clinical behavior and review of the literature. Clin Neurol Neurosurg 2014; 125:114-24. [PMID: 25108699 DOI: 10.1016/j.clineuro.2014.07.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/06/2014] [Accepted: 07/13/2014] [Indexed: 11/25/2022]
Abstract
Astroblastoma is a rare, mostly supratentorial glial tumor, occurring predominantly in children and young adults with female preponderance. Due to the rarity, with only about 230 reported cases, treatment strategies are still to be discussed. We describe two more cases to add to the clinical experiences with this tumor entity. In both of these cases, the clinical behavior did not follow the expectations based on histopathological classification. Case 1: A sixteen-year old female presented with a six month history of intermittent headaches, nausea and dizziness. MRI scans revealed a left parietooccipital mass lesion with bubbly contrast enhancement and marked peritumoral edema. After gross total tumor resection the histology gave the diagnosis of low grade astroblastoma. Fifteen months later, the patient was operated on a local recurrence and received postoperative radiotherapy, with the histology still being that of low grade astroblastoma. Two years later, a meningeally based tumor nodule frontal of the former tumor bed was removed, now diagnosed as high grade astroblastoma. Eighteen months later, a fourth operation with excision of two more meningeally based tumor nodules of high-grade astroblastoma followed. Chemotherapy was suggested, but the patient decided against it. The last MRI follow-up 14 months after last operation showed no further recurrence so far. Case 2: A 24-year old female presented with a four week history of vomiting and headaches with focal seizures affecting her left arm. CT and MRI scans revealed a superficial partly cystic right temporal mass lesion with few edema and macrocalcifications and adjacent bone atrophy. Despite dural invasion, total tumor resection could be performed. MRI scans six months later showed no recurrence. The patient refused further MRI controls but did not show any clinical signs or symptoms suggesting tumor recurrence four years after the operation. In order to find more predictive tools that might help to determine the individual clinical course and treatment, we performed a review of the literature, analyzing 29 cases with detailed data on clinical history, MRI/CT characteristics, histopathological subtyping, treatment details and a follow-up of at least 12 months. We found, that low-grade astroblastoma with marked peritumoral edema has a tendency to early recurrence and suggest that it should be treated by combined surgery and radiotherapy. In high-grade astroblastoma with well defined tumor borders and few peritumoral edema, the prognosis may be better than expected for a high-grade glioma, if GTR is possible.
Collapse
Affiliation(s)
- Claudia Janz
- Städtisches Klinikum Solingen, Neurochirurgische Klinik, Gotenstrasse 1, 42563 Solingen, Germany.
| | - Ralf Buhl
- Städtisches Klinikum Solingen, Neurochirurgische Klinik, Gotenstrasse 1, 42563 Solingen, Germany
| |
Collapse
|
14
|
Ahmed KA, Allen PK, Mahajan A, Brown PD, Ghia AJ. Astroblastomas: A Surveillance, Epidemiology, and End Results (SEER)-Based Patterns of Care Analysis. World Neurosurg 2014; 82:e291-7. [DOI: 10.1016/j.wneu.2013.10.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/18/2013] [Accepted: 10/12/2013] [Indexed: 10/26/2022]
|
15
|
Shen F, Chen LC, Yao Y, Zhou LF. Astroblastoma: rare incidence and challenges in the pattern of care. World Neurosurg 2014; 82:e125-7. [PMID: 24607547 DOI: 10.1016/j.wneu.2014.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 03/04/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Fang Shen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Ling-Chao Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yu Yao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Liang-Fu Zhou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
| |
Collapse
|
16
|
Clinical features and post-surgical outcome of patients with astroblastoma. J Clin Neurosci 2011; 18:750-4. [DOI: 10.1016/j.jocn.2010.11.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 11/02/2010] [Indexed: 11/20/2022]
|
17
|
Recurrent astroblastoma treated with gamma knife radiosurgery. J Neurooncol 2010; 103:751-4. [DOI: 10.1007/s11060-010-0430-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Accepted: 09/20/2010] [Indexed: 10/19/2022]
|