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Aljendi R, Knifaty MA, Amin M, Diab S, Ali MS, Alshehabi Z. A Recurrent Pleomorphic Xanthoastrocytoma in the Cerebellum in a Young Adult: A Case Report and Review of the Literature. Case Rep Neurol 2023; 15:54-62. [PMID: 36938309 PMCID: PMC10018421 DOI: 10.1159/000529741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/08/2023] [Indexed: 02/19/2023] Open
Abstract
Pleomorphic xanthoastrocytoma (PXA) is a rare glioma. It accounts for less than 1% of all astrocytomas. About 98% of PXAs originate supratentorially with the temporal lobe being the most common location. Cases of infratentorial PXAs are rarely reported in the medical literature. The tumor presents with a wide variation of symptoms based on the neuroanatomy involved with the location and size of the tumor, with seizures being the most reported symptom. The diagnosis depends on histological and clinical features along with radiologic features. We searched the keywords "Pleomorphic xanthastrocytoma, PXA, cerebellum, infratentorium, astrocytoma, gliomas" in the PubMed database; from 1979 to the current date, 28 cases were found in the medical literature featuring PXA in the infratentorium. We present the 29th case in the literature and the first in Syria. Our patient had a lesion in the right cerebellum and presented with a history of intermittent headache for 5 months followed by progressive gait disturbances and blurry vision and was misdiagnosed at the time of presentation with a high-grade glioma which is a common confusion because of the histological and clinical similarities. The patient underwent a suboccipital craniotomy, and adjuvant therapy with a combination of radiotherapy and chemotherapy with temozolomide was initiated at first. Then, the patient presented with a relapse of symptoms and went through another surgery where frozen sections suggested the diagnosis of PXA; further histopathological and immunohistochemical studies confirmed the diagnosis. Alongside highlighting the diagnostic challenge of this rare tumor, we did a brief review of the literature.
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Affiliation(s)
- Ruba Aljendi
- Faculty of Medicine, Cancer Research Center, Tishreen University, Lattakia, Syria
| | - Mohammed Amr Knifaty
- Tishreen University Hospital, Cancer Research Center, Tishreen University, Lattakia, Syria
| | - Mohammed Amin
- Tishreen University Hospital, Cancer Research Center, Tishreen University, Lattakia, Syria
| | - Souliman Diab
- Tishreen University Hospital, Cancer Research Center, Tishreen University, Lattakia, Syria
| | | | - Zuheir Alshehabi
- Department of Pathology, Cancer Research Center, Tishreen University, Lattakia, Syria
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Yamada R, Inoue H, Kuroda JI, Furuta T, Moritsubo M, Shinojima N, Mukasa A, Mikami Y. Melanotic pilocytic astrocytoma. Neuropathology 2022; 43:197-199. [PMID: 36161674 DOI: 10.1111/neup.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Rin Yamada
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Hirotaka Inoue
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Jun-Ichiro Kuroda
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Takuya Furuta
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Mayuko Moritsubo
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Naoki Shinojima
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
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Lee Y, Chang M, Chou Y. Cytologic and histologic features of pigmented pleomorphic xanthoastrocytoma: A case report and literature review. Diagn Cytopathol 2022; 50:E240-E243. [DOI: 10.1002/dc.24966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/17/2022] [Accepted: 04/07/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Yueh Lee
- Department of Anatomy and Pathology Taipei City Hospital Heping Branch Taipei Taiwan
| | - Min‐Hsiang Chang
- Department of Anatomical Pathology Far Eastern Memorial Hospital New Taipei City Taiwan
| | - Yueh‐Hung Chou
- Department of Anatomical Pathology Far Eastern Memorial Hospital New Taipei City Taiwan
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Kim SH, Hwang K, Lee KS, Choe G, Kim CY. Cerebellar Pleomorphic Xanthoastrocytoma with BRAF V600E Mutation. World Neurosurg 2020; 139:577-581. [PMID: 32348888 DOI: 10.1016/j.wneu.2020.04.113] [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: 03/24/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pleomorphic xanthoastrocytoma (PXA) is a rare type of astrocytoma with a peak incidence from 10 to 19 years of age. PXA is found most commonly in the supratentorium. When it is present in atypical areas such as the infratentorium, it is often overlooked as a potential differential diagnosis. CASE DESCRIPTION This report discusses the case of an 18-year-old woman with a pure PXA in the left cerebellum. The case consists of interesting pathologic and molecular features which do not align with the literature about PXA: a positive finding for BRAF V600E mutation and a negative finding for cluster of differentiation 34 expression. A review of pure PXA cases in the infratentorium has also been completed. CONCLUSIONS To our knowledge, this is the first case of PXA in the infratentorium with BRAF V600E mutation. The case also highlights the clinical relevance of including PXA as a differential diagnosis for lesions of the infratentorium.
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Affiliation(s)
- Sang Ho Kim
- School of Medicine, The University of Auckland, Auckland, New Zealand; Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
| | - Kyu Sang Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
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Luna LP, da Ponte IM, Oliveira IB, Ramos F, Gerson G. Pleomorphic xanthoastrocytoma in the posterior fossa: a case report with advanced neuroimaging findings. Clin Imaging 2020; 63:30-34. [PMID: 32120310 DOI: 10.1016/j.clinimag.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/30/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
Pleomorphic xanthoastrocytoma (PXA) is a rare glioma usually occurring in children and young adults. It is a benign World Health Organization (WHO) grade II tumor that accounts for <1% of all astrocytomas. Its occurrence in the infratentorial compartment is rare, and the cerebellum is the most common of the unusual locations. Few case reports have described conventional imaging features of these tumors, but none has reported the advanced magnetic resonance (MR) neuroimaging features in dynamic susceptibility perfusion-weighted imaging (DSC-PWI), diffusion weighted-imaging (DWI) and MR spectroscopy. Therefore, the purpose of this study is to report a case of PXA in the cerebellum of a 28-year-old patient and discuss the MR advanced imaging characteristics compared to the more common PXA supratentorial type.
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Affiliation(s)
- Licia Pacheco Luna
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, 21287 Baltimore, USA; Department of Radiology, Hospital Geral de Fortaleza, 900 Ávila Goulart Street, Papicu, Fortaleza 60175-295, Brazil.
| | - Isabelle Meneses da Ponte
- Department of Radiology, Hospital Geral de Fortaleza, 900 Ávila Goulart Street, Papicu, Fortaleza 60175-295, Brazil
| | - Isabella Bezerra Oliveira
- Department of Radiology, Hospital Geral de Fortaleza, 900 Ávila Goulart Street, Papicu, Fortaleza 60175-295, Brazil
| | - Francisco Ramos
- Department of Neurosurgery, Hospital Geral de Fortaleza, 900 Ávila Goulart Street, Papicu, Fortaleza 60175-295, Fortaleza, Brazil
| | - Gunter Gerson
- Department of Pathology, Hospital Universitário Walter Cantídio, 1290 Pastor Samuel Munguba St, Rodolfo Teófilo, 60430-372 Fortaleza, Brazil
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Mallick S, Giridhar P, Benson R, Melgandi W, Rath GK. Demography, Pattern of Care, and Survival in Patients with Xanthoastrocytoma: A Systematic Review and Individual Patient Data Analysis of 325 Cases. J Neurosci Rural Pract 2019; 10:430-437. [PMID: 31595115 PMCID: PMC6779544 DOI: 10.1055/s-0039-1697873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives
Xanthoastrocytoma (XA) is a low-grade glial tumor seen in young adults and there is lack of robust data on treatment of this rare tumor. In this systematic review and individual patient's data analysis, we aimed to look into the demography, pattern of care, survival outcomes, and prognostic factors in patients with both Grade II and III XA.
Methods
A comprehensive search was conducted with the Medical Subject Heading terms: “Xanthoastrocytoma; Pleomorphic Xanthoastrocytoma; Anaplastic Xanthoastrocytoma; Xanthoastrocytoma AND treatment; and Anaplastic Xanthoastrocytoma AND survival” to find all possible publications.
Results
A total of 325 individual patients from a total of 138 publications pertaining to XA were retrieved. Median age of the entire cohort was 19 years. About 56.1% of the patients underwent a gross total resection (GTR) and 31.4% underwent a subtotal resection. Nearly, 76.6% of the patients had a Grade II tumor and adjuvant radiation was delivered in 27.4% of the patients. Estimated 2- and 5-year progression-free survival (PFS) were 68.5 and 51.2%, respectively. Age, grade, and extent of surgery were significant factors affecting PFS. Estimated 2- and 5-year overall survival (OS) was 88.8 and 78%, respectively. The median OS for Grade II and Grade III tumors were 209 and 49 months, respectively. Age and extent of surgery were significant factors affecting OS.
Conclusion
XA is a disease of young adults with favorable prognosis. Younger patients (<20 years), patients who undergo a GTR, and patients with a lower grade tumor have a better treatment outcome.
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Affiliation(s)
- Supriya Mallick
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Prashanth Giridhar
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rony Benson
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Wineeta Melgandi
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Goura Kishor Rath
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Gupta S, Mehrotra A, Pal L, Bhaisora KS, Jaiswal AK, Kumar R. An Infratentorial Pure Pleomorphic Xanthoastrocytoma Arising from Middle Cerebellar Peduncle: A Rare Location of an Uncommon Tumor. World Neurosurg 2017; 111:335-340. [PMID: 29288852 DOI: 10.1016/j.wneu.2017.12.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pleomorphic xanthoastrocytomas are rare tumors of glial origin comprising <1% of all astrocytic tumors of brain. These tumors are rare in the infratentorial compartment and were not known to arise from the middle cerebellar peduncle. CASE DESCRIPTION We discuss the case of a 16-year-boy who presented with altered sensorium and features of increased intracranial pressure and was found to have a 4 × 4 × 3 cm mass arising from the middle cerebellar peduncle. CONCLUSION We also discuss the histopathologic features of these tumors suggesting their resemblance to other maldevelopmental tumors, the rarity of pure World Health Organization grade II pleomorphic xanthoastrocytoma in the infratentorial compartment, as well as the appropriate management.
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Affiliation(s)
- Shruti Gupta
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Lily Pal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Singh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Gupta RK, Saran RK, Sharma MC, Srivastava AK, Garg L. Melanosomal melanin pigment in pleomorphic xanthoastrocytoma, evidence for neuronal-glial origin: A case report with review of the literature. Neuropathology 2016; 37:116-121. [PMID: 27645472 DOI: 10.1111/neup.12344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 12/01/2022]
Abstract
We describe a unique case of pleomorphic xanthoastrocytoma (PXA) in a 19-year-old male presenting with the chief complaint of seizures. On radiology, the tumor was located in the temporal lobe. It was cortically based and solid cystic in nature. Light microscopy showed pleomorphic large polygonal cells with inclusions, nuclear clustering, lipidization, and foamy cytoplasm intermingled with spindle cells arranged in sweeping pattern and focally containing cytoplasmic brownish black pigment. The pigment stained black with Fontana-Masson stain and bleached with potassium permanganate. Gomori silver stain showed reticulin fibers surrounding individual tumor cells as well as groups of cells. On immunohistochemistry, tumor cells were positive for GFAP, S-100 and focally for synaptophysin and CD34 but negative for HMB-45. CD34 revealed a specific membranous pattern around individual cells as well as groups of cells along the fibers replicating a reticulin pattern. The ultrastructural examination showed supporting melanosomes, thus confirming the melanin pigment. Sequencing for BRAF V600E showed a heterozygous mutation. To our knowledge only five cases of PXA with melanin pigment have been reported and none of which described BRAF V600E mutation analysis. This case provides further insight into the origin and pathogenesis of pigmented astrocytic tumor, additionally highlighting the characteristic CD34 staining pattern.
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Affiliation(s)
| | | | - Mehar C Sharma
- Department of Pathology All India Institute of Medical Sciences, New Delhi, India
| | | | - Lalit Garg
- Department of Radiodiagnosis, G B Pant Institute of Post Graduate medical Education and Research (G I P M E R), New Delhi, India
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9
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Pigmented ganglioglioma in a patient with chronic epilepsy and cortical dysplasia. J Clin Neurosci 2016; 24:17-21. [DOI: 10.1016/j.jocn.2015.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/14/2015] [Indexed: 11/16/2022]
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10
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Ida CM, Rodriguez FJ, Burger PC, Caron AA, Jenkins SM, Spears GM, Aranguren DL, Lachance DH, Giannini C. Pleomorphic Xanthoastrocytoma: Natural History and Long-Term Follow-Up. Brain Pathol 2014; 25:575-86. [PMID: 25318587 DOI: 10.1111/bpa.12217] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/08/2014] [Indexed: 12/13/2022] Open
Abstract
Prognostic significance of histological anaplasia and BRAF V600E mutation were retrospectively evaluated in 74 patients with pleomorphic xanthoastrocytoma (PXA). Median age at diagnosis was 21.5 years (31 pediatric, 43 adult) and median follow-up 7.6 years. Anaplasia (PXA-AF), defined as mitotic index ≥ 5/10 HPF and/or presence of necrosis, was present in 33 cases. BRAF V600E mutation was detected in 39 (of 60) cases by immunohistochemical and/or molecular analysis, all negative for IDH1 (R132H). Mitotic index ≥ 5/10 HPF and necrosis were associated with decreased overall survival (OS; P = 0.0005 and P = 0.0002, respectively). In all cases except two, necrosis was associated with mitotic index ≥ 5/10 HPF. Patients with BRAF V600E mutant tumors had significantly longer OS compared with those without BRAF V600E mutation (P = 0.02). PXA-AF patients, regardless of age, had significantly shorter OS compared with those without (P = 0.0003). Recurrence-free survival was significantly shorter for adult PXA-AF patients (P = 0.047) only. Patients who either recurred or died ≤ 3 years from diagnosis were more likely to have had either PXA-AF at first diagnosis (P = 0.008) or undergone a non-gross total resection procedure (P = 0.004) as compared with patients who did not. This study provides further evidence that PXA-AF behaves more aggressively than PXA and may qualify for WHO grade III "anaplastic" designation.
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Affiliation(s)
- Cristiane M Ida
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Peter C Burger
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Alissa A Caron
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sarah M Jenkins
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Grant M Spears
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Costa S, Marques J, Pereira P, Firmo C, Pimentel J. 23-year-old man with a superficial cortical brain tumor. Brain Pathol 2012; 22:429-32. [PMID: 22497616 DOI: 10.1111/j.1750-3639.2012.00590.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 23-year-old male presented with a tonic-clonic generalized seizure. Neuroradiological examination revealed a superficial cystic mass with a mural nodule in the right fronto-parietal lobe. Histological and immunohistochemical examination were consistent with a pigmented (melanin producing) desmoplastic ganglioglioma.These tumors have been first described in childhood, one of them displaying melanin deposits. Only twenty cases of non-infantile desmoplastic gangliogliomas have been reported in the literature, none of them pigmented. According to the clinical and histomorphology (including the desmoplastic component) features, the differential diagnosis should include the ganglioglioma, the xanthoastrocytoma pleomorphic (both tumors also with pigmented forms) and the superficial desmoplastic infantile astrocytoma.
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12
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Vu TM, Liubinas SV, Gonzales M, Drummond KJ. Malignant potential of pleomorphic xanthoastrocytoma. J Clin Neurosci 2011; 19:12-20. [PMID: 22137880 DOI: 10.1016/j.jocn.2011.07.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 07/14/2011] [Accepted: 07/16/2011] [Indexed: 10/14/2022]
Abstract
Pleomorphic xanthoastrocytoma (PXA) is a low-grade astrocytic tumour that occasionally progresses to a higher grade. We have extensively reviewed the literature on the potential for malignant transformation of PXA. An illustrative case of a PXA transforming to glioblastoma multiforme is presented.
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Affiliation(s)
- Tamara M Vu
- Department of Neurosurgery, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia
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13
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Xiong J, Chu SG, Mao Y, Wang Y. Pigmented pleomorphic xanthoastrocytoma: a rare variant and literature review. Neuropathology 2011; 31:88-92. [PMID: 20573030 DOI: 10.1111/j.1440-1789.2010.01132.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A 16-year-old male teenager presented with seizure and loss of consciousness for 20 min. Magnetic resonance imaging demonstrated a mass occupying the right medial temporal lobe. Histological examination revealed a non-pigmented area with spindle-shaped and large xanthomatous pleomorphic cells and a pigmented region with pigmented neoplastic cells with fascicular arrangement. Immunohistochemical studies showed the tumor was positive for GFAP and low index of Ki-67. Considering the patient's history, clinical data and pathological findings, we rendered a rare variant named pigmented pleomorphic xanthoastrocytoma.
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Affiliation(s)
- Ji Xiong
- Department of Neuropathology, Institute of Neurology, Huashan Hospital of Fudan University, Shanghai, China
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