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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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Karthigeyan M, Kumar P, Salunke P, Rohilla M, Chatterjee D, Ahuja CK. Cerebrospinal Fluid Spread in a Child with Pleomorphic Xanthoastrocytoma: Report with Cytopathologic Evidence. World Neurosurg 2020; 145:443-447. [PMID: 33075575 DOI: 10.1016/j.wneu.2020.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pleomorphic xanthoastrocytoma (PXA), a relatively uncommon, World Health Organization grade II tumor of astrocytic origin, occurs in children and in general carries good prognosis. The recently identified anaplastic PXA (grade III) type shows poor outcome. Rarely, these said tumors can display an aggressive clinical course with features of leptomeningeal spread. Such cases are mostly seen in adults, with rare instances reported in the pediatric age group. CASE DESCRIPTION In this report, we describe an 8-year-old child with anaplastic PXA with a rapid downhill course due to cerebrospinal fluid spread. This child is perhaps the first pediatric report in which the cerebrospinal fluid dissemination was established on cytology. CONCLUSIONS The case is an indicator of the need for craniospinal screening protocol in patients with PXA, especially the anaplastic variety, both at the time of initial diagnosis and follow-up.
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Affiliation(s)
- Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research, Sector 12, Chandigarh, India
| | - Pankaj Kumar
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education & Research, Sector 12, Chandigarh, India
| | - Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research, Sector 12, Chandigarh, India
| | - Manish Rohilla
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education & Research, Sector 12, Chandigarh, India.
| | - Debjyoti Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education & Research, Sector 12, Chandigarh, India
| | - Chirag Kamal Ahuja
- Department of Neuroradiology, Postgraduate Institute of Medical Education & Research, Sector 12, Chandigarh, India
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Matsumoto Y, Kobayashi M, Shingu K, Tateishi A, Ohya M, Sano K, Negishi T, Shigeto S, Kobayashi T, Hara Y, Kakizawa Y, Kanno H. An anaplastic pleomorphic xanthoastrocytoma with periventricular extension: An autopsy case report and review of the literature. Neuropathology 2020; 40:507-514. [PMID: 32578272 DOI: 10.1111/neup.12666] [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: 11/14/2019] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 11/28/2022]
Abstract
Pleomorphic xanthoastrocytomas (PXAs) are rare low-grade astrocytic tumors that typically present as superficial nodular cystic tumors of the cerebrum attached to the leptomeninx. Histologically, they are pleomorphic, hypercellular glial neoplasms. Despite the presence of microscopic pleomorphism, patients' postoperative prognosis is generally good. Anaplastic PXAs (APXAs) have a high mitotic index and patients with APXAs have a worse prognosis than patients with PXAs. Here, we report an autopsy case of APXA initially diagnosed as PXA. After gross total resection, the tumor recurred and was diagnosed as an APXA; thereafter, the patient died. An autopsy revealed that the tumor had relapsed at the primary site and had spread to the leptomeningeal space while concurrently invading the cerebrum including the periventricular area forming multifocal lesions. The histological findings of the autopsy were similar to those for epithelioid glioblastoma (EGBM) and small cell glioblastoma (SCGBM). In particular, the periventricular area with multifocal lesions was composed of SCGBM-like cells. It has been shown that multifocal lesions are frequently identified in patients with SCGBM. This is the first histopathologically confirmed case of APXA-related tumor presenting with periventricular extension and multifocal lesion formation. The periventricular extension might be a feature of PXAs and APXAs. However, suspected periventricular spread on imaging in past cases of PXAs and APXAs might instead represent the malignant transformation of these tumors to glioblastoma-like high-grade tumors, which often show SCGBM-like histological patterns.
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Affiliation(s)
- Yuki Matsumoto
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Mikiko Kobayashi
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kunihiko Shingu
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Ayako Tateishi
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Maki Ohya
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kenji Sano
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan.,Department of Pathology, Iida Municipal Hospital, Iida, Japan
| | - Tatsuya Negishi
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Shohei Shigeto
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Tatsuya Kobayashi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Neurosurgery, Ichinose Neurosurgical Hospital, Matsumoto, Japan
| | - Yosuke Hara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Neurosurgery, Asama Nanroku Komoro Medical Center, Komoro, Japan
| | - Yukinari Kakizawa
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Japan
| | - Hiroyuki Kanno
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
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Tan D, Lai LT, Daly CD, Tran V, Maingard J, Timms C. Spinal Pleomorphic Xanthoastrocytoma: Case Report and Literature Review. World Neurosurg 2020; 141:25-32. [PMID: 32442731 DOI: 10.1016/j.wneu.2020.05.117] [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: 02/10/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
Pleomorphic xanthoastrocytoma (PXA) is an uncommon central nervous system neoplasm with an overall favorable survival prognosis. Metastatic spread of PXA to the spinal cord and the cauda equina is rare and may have a different clinicopathologic course. Treatment and prognostic outcomes, in this context, are not well defined. We discuss a case of a 30-year-old patient with known cerebral PXA presenting with metastatic spinal anaplastic PXA and present a literature analysis of treatment outcomes.
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Affiliation(s)
- Darius Tan
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - Leon T Lai
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
| | | | - Vu Tran
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - Julian Maingard
- Department of Radiology, Monash Health, Melbourne, Australia; Department of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Craig Timms
- Department of Neurosurgery, Monash Health, Melbourne, Australia
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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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Fazlollahi L, Remotti HE, Iuga A, Yang HM, Lagana SM, Sepulveda AR. HER2 Heterogeneity in Gastroesophageal Cancer Detected by Testing Biopsy and Resection Specimens. Arch Pathol Lab Med 2017; 142:516-522. [PMID: 28782986 DOI: 10.5858/arpa.2017-0039-oa] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
CONTEXT - In advanced gastric, esophageal, and gastroesophageal junction adenocarcinomas (GE-GEJ-AC) that overexpress ERBB2 (erb-b2 receptor tyrosine kinase 2 or HER2), anti-HER2 monoclonal antibody therapy confers survival benefit. To select patients for treatment, HER2 expression and gene amplification are evaluated by immunohistochemistry (IHC) and in situ hybridization. OBJECTIVE - To determine whether GE-GEJ-AC tested for HER2 on biopsy specimens of a primary tumor show different IHC scores and/or HER2 amplification by in situ hybridization in matched resection specimens, potentially changing therapy eligibility. DESIGN - Immunohistochemistry and silver in situ hybridization were performed in biopsy and/or resection specimens from 100 patients. HER2 testing was performed in matched resection and biopsy specimens of 15 cases to determine whether GE-GEJ-AC with IHC scores of 0, 1+, and 2+ in biopsy and resection specimens had different IHC and silver in situ hybridization results. RESULTS - The IHC 3+ cases showed HER2 amplification in 4 of 5 cases (80%), and IHC scores of 0, 1+, and 2+ showed 3.5%, 14.3%, and 23.5% HER2 amplification by silver in situ hybridization. Among the 15 paired biopsy and resection specimens, 9 (60%) had at least pT2 stage GE-GEJ-AC with HER2 IHC scores of 0, 1+, or 2+ in the biopsy, and 2 of those 9 cases (22%) had IHC 3+ and HER2 amplification by silver in situ hybridization on the resection specimen. CONCLUSIONS - Our data suggest that HER2 testing should be repeated on resection specimens of GE-GEJ-AC with HER2 IHC scores of negative (0 and 1+) or equivocal (2+) and in situ hybridization amplification negative biopsy specimen results to evaluate for HER2 heterogeneity when patients are being considered for anti-HER2 therapy.
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Affiliation(s)
| | | | | | | | | | - Antonia R Sepulveda
- From the Department of Pathology and Cell Biology, Columbia University Medical Center, New York Presbyterian Hospital, New York
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Zhao X, Jiang X, Wang X. Spinal pleomorphic xanthoastrocytoma companied with periventricular tumor. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:1036-1040. [PMID: 25755815 PMCID: PMC4348886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/22/2014] [Indexed: 06/04/2023]
Abstract
Pleomorphic xanthoastrocytoma (PXA) is a low grade tumor that occurs in supratentorial area of children and young adult. In the previous reports, PXA of spinal cord or multicentre was extremely rare. A 60-year-old patient of spinal PXA and periventricular tumor presented with waist pain and weakness of double legs for one month. Neuroimaging showed that a lesion at the level of L2-L3 and periventricular tumor. Postoperative microscopy indicated that WHO grade II PXA. Photomicrograph of the lesion showed spindle cells, marked nuclear and cytoplasmic pleomorphism, with foamy cytoplasm. Immunohistochemical staining showed that GFAP and S-100 were positive. This is a rare case of synchronous multicentric PXA. Physicians should be realized multicentric dissemination by meninges or cerebrospinal fluid in PXA patients. It is important to describe the particular case in order to better understanding of clinical features.
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Affiliation(s)
- Xintong Zhao
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical CollegeWuhu, Anhui Province, P.R. China
| | - Xiaochun Jiang
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical CollegeWuhu, Anhui Province, P.R. China
| | - Xiangming Wang
- Department of Pathology, Yijishan Hospital, Wannan Medical CollegeWuhu, Anhui Province, P.R. China
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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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