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Price A, O'Leary S, Malkova K, D'Souza P, Ogasawara C, Felicella MM, Karas PJ. Awake resection of recurrent astroblastoma with intraoperative 5-ALA-induced fluorescence: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23526. [PMID: 37903423 PMCID: PMC10618070 DOI: 10.3171/case23526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Astroblastoma is a rare neoplasm characterized as a circumscribed glial neoplasm most often arising in the frontoparietal cerebral hemispheres in older children. OBSERVATIONS We report an intriguing case of an astroblastoma recurrence 21 years after gross-total resection and radiation. A 32-year-old right-handed female presented to the emergency department for a generalized tonic-clonic seizure. She had a history of bipolar disorder, intractable migraines, and prior seizures linked to an astroblastoma previously resected three times. Magnetic resonance imaging on the current visit showed growth of the recurrent lesion to a 3.8-cm maximal diameter. Left-sided awake craniotomy was performed to remove the tumor while using speech mapping and 5-aminolevulinic acid (5-ALA). Targeted next-generation sequencing of the tumor revealed in-frame MN1::BEND2 fusion transcripts. LESSONS We found that 5-ALA can be used in astroblastoma patients to assist in gross-total resection, which is important for long-term survival. Our astroblastoma case demonstrated classic astroblastoma morphology, with typical perivascular astroblastic rosettes, and was brightly fluorescent after 5-ALA administration.
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Affiliation(s)
- Anthony Price
- 1John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Texas; and
- Departments of2Neurosurgery, and
| | - Sean O'Leary
- 1John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Texas; and
- Departments of2Neurosurgery, and
| | - Kseniia Malkova
- 3Pathology, The University of Texas Medical Branch at Galveston, Texas
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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.
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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
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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.
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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
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Sun M, Wang C, Jiang F, Fang X, Guo B. Diagnostic value and clinical significance of ultrasound combined with CT in cystic renal cell carcinoma. Oncol Lett 2019; 18:1395-1401. [PMID: 31423203 PMCID: PMC6607404 DOI: 10.3892/ol.2019.10422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/28/2019] [Indexed: 12/20/2022] Open
Abstract
This study investigated the value and clinical significance of ultrasound combined with CT in the diagnosis of cystic renal cell carcinoma. A total of 85 patients with cystic renal cell carcinoma, who were admitted to the Oncology Department of Yantai Yuhuangding Hospital Affiliated to Qingdao University from December 2015 to April 2017, were selected as the study group, and 70 patients with benign renal cyst, who were examined in Yantai Yuhuangding Hospital Affiliated to Qingdao University, were selected as the benign group. The patients in the two groups were examined by ultrasound and CT. The diagnostic value of ultrasound, CT, and ultrasound combined with CT in cystic renal cell carcinoma was analyzed. The sensitivity of ultrasound combined with CT was significantly higher than that of CT and ultrasound (P<0.05). The specificity and diagnostic coincidence rate of ultrasound combined with CT were significantly higher than those of CT (P<0.05). For unicapsular kidney cancer, there was no significant difference among ultrasound, CT and ultrasound combined with CT in the diagnosis of septum and wall nodule (P>0.05). For polycystic kidney cancer, there was no significant difference among ultrasound, CT and ultrasound combined with CT in the diagnosis of the presence or absence of septum (P>0.05). Ultrasound was significantly better than CT in cyst wall confounding (P<0.05). Ultrasound combined with CT was significantly better than ultrasound in calcification and blood supply of tumors (P<0.05). In conclusion, the accuracy of ultrasound combined with CT is higher than that of ultrasound or that of CT in the diagnosis of cystic renal cell carcinoma, which can be beneficial in accurately carrying out clinical diagnosis, reduce the incidence of missed diagnosis and misdiagnosis caused by a single diagnosis and treatment. Ultrasound combined with CT is good for clinical screening and can guide clinical symptomatic treatment, which is worthy of generalizing in clinic.
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Affiliation(s)
- Minghui Sun
- Department of Medical Ultrasonics, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Chao Wang
- CT Room, People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
| | - Fei Jiang
- Radiology Department, People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
| | - Xiuhong Fang
- Radiology Department, People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
| | - Bingcheng Guo
- Department of Ultrasound, Jining No. 1 People's Hospital, Jining, Shandong 272100, P.R. China
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Abstract
Astroblastoma is an uncommon neuroepithelial primary tumor of the brain which is of uncertain origin. We present a case of high-grade astroblastoma in an 18-year-old female with a severe headache, loss of appetite, vomiting and generalized weakness. The patient had undergone a right frontoparietal craniotomy. Large subfalcine meningioma was excised. The lesion was suspected to be a meningioma. Primary radiological investigation revealed a 6.8 cm × 5.8 cm × 5.4 cm lesion. Although the radiological and intraoperative findings were of an extra-axial tumor, the histology and immunophenotype was of an astroblastoma. The patient was treated with cyclophosphamide, cisplatin and etoposide chemotherapy regimen. The patient was later treated with bi-weekly bevacizumab. The patient had improved symptomatically post-chemotherapy. However, there was no significant difference in lesion size. The patient died after 2 weeks. The prognosis of patients with astroblastoma is extremely poor as observed in our case.
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Affiliation(s)
- Sagar Bhalerao
- Department of Medical Oncology, HCG Manavata Cancer Centre, Nashik, India
| | - Rajnish Nagarkar
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, India
| | - Aditya Adhav
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, India
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Shin SA, Ahn B, Kim SK, Kang HJ, Nobusawa S, Komori T, Park SH. Brainstem astroblastoma with MN1 translocation. Neuropathology 2018; 38:631-637. [PMID: 30238518 DOI: 10.1111/neup.12514] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 12/27/2022]
Abstract
Astroblastoma is a rare glial neoplasm that occurs mostly in the cerebral hemisphere of children, adolescents and young adults. Although astroblastic perivascular pseudorosettes are unique histopathology of this neoplasm, diagnosis is usually challenging. Recently, it was discovered that the meningioma 1 gene (MN1)-altered pediatric central nervous system high-grade neuroepithelial tumors are actually astroblastomas. This case report presents a rare brainstem astroblastoma, with an unusual immunoprofile: negative for glial fibrillary acidic protein and oligodendrocyte transcription factor 2, but with a robust expression of pancytokeratin and epithelial membrane antigen. The diagnosis was confirmed based on the detection of MN1 rearrangement in a fluorescence in situ hybridization study, in addition to typical histopathology. Here we discuss the diagnostic pitfalls and unclear grading system along with a literature review.
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Affiliation(s)
- Sun Ah Shin
- Department of Pathology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bokyung Ahn
- Department of Pathology, Korea University Anam Hospital, Seoul, Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Seoul, Korea
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Komori
- Department of Pathology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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