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==Overview==
==Overview==
[[Biopsy]] is helpful in the diagnosis of astrocytomas. Findings suggestive diagnostic of astrocytoma include normal cells with slow growth rate, biphasic pattern (dense fibrillar tissue within loose myxoid tissue), [[Calcification]], Vascular hyalinization and Nested fibrotic pattern in [[pilocytic astrocytoma]], [[Atypia|atypical cells]], relatively slow mitosis rate, diffusely infiltrate [[neuropil]] and poorly defined [[cytoplasm]] in [[diffuse astrocytoma]], [[Pleomorphism|pleomorphic]] and [[malignant]] cells, High [[mitosis]] rate, hyperchromatosis and prominent small [[Blood vessel|vessels]] in [[anaplastic astrocytoma]], [[Pleomorphism|Pleomorphic]] cells, Naked nuclei, Multi-focal [[necrosis]], Pseudopalisading pattern, Scattered pyknotic nuclear debris in the center, Micro-vascular proliferation and Vascular [[thrombi]] in [[Glioblastoma multiforme|glioblastoma multiform]].


==Other Diagnostic Studies==
==Other Diagnostic Studies==
Biopsy is helpful in the diagnosis of astrocytomas:
[[Biopsy]] is helpful in the diagnosis of astrocytomas:<ref name="pmid11465400">{{cite journal |vauthors=Jackson RJ, Fuller GN, Abi-Said D, Lang FF, Gokaslan ZL, Shi WM, Wildrick DM, Sawaya R |title=Limitations of stereotactic biopsy in the initial management of gliomas |journal=Neuro-oncology |volume=3 |issue=3 |pages=193–200 |date=July 2001 |pmid=11465400 |pmc=1920616 |doi=10.1093/neuonc/3.3.193 |url=}}</ref><ref name="pmid12748009">{{cite journal |vauthors=McGirt MJ, Villavicencio AT, Bulsara KR, Friedman AH |title=MRI-guided stereotactic biopsy in the diagnosis of glioma: comparison of biopsy and surgical resection specimen |journal=Surg Neurol |volume=59 |issue=4 |pages=277–81; discussion 281–2 |date=April 2003 |pmid=12748009 |doi= |url=}}</ref><ref name="pmid11345717">{{cite journal |vauthors=Son BC, Kim MC, Choi BG, Kim EN, Baik HM, Choe BY, Naruse S, Kang JK |title=Proton magnetic resonance chemical shift imaging (1H CSI)-directed stereotactic biopsy |journal=Acta Neurochir (Wien) |volume=143 |issue=1 |pages=45–9; discussion 49–50 |date=2001 |pmid=11345717 |doi= |url=}}</ref>
* Astrocytomas are histologically heterogenous
* Astrocytomas are histologically heterogenous.
* Obtaining small specimen from astrocytomas might lead to false diagnosis.
* Obtaining small specimen from astrocytomas might lead to false diagnosis.
* For lesions with areas of contrast enhancement the specimen should be obtained from those areas.
* For lesions with areas of contrast enhancement the specimen should be obtained from those areas.
* For lesions with no intra-tumor enhancement the specimen should be obtained from the center of the tumor.
* For lesions with no intra-tumor enhancement the specimen should be obtained from the center of the [[tumor]].
Findings suggestive of/diagnostic of astrocytoma include:
Pathological findings diagnostic of astrocytoma include:<ref name=":0">{{cite book | last = Mattle | first = Heinrich | title = Fundamentals of neurology : an illustrated guide | publisher = Thieme | location = Stuttgart New York | year = 2017 | isbn = 9783131364524 }}</ref><ref>{{cite book | last = Nafussi | first = Awatif | title = Tumor diagnosis : practical approach and pattern analysis | publisher = Arnold Distributed in the U.S.A. by Oxford University Press | location = London New York | year = 2005 | isbn = 0340809442 }}</ref><ref>{{cite book | last = Schniederjan | first = Matthew | title = Biopsy interpretation of the central nervous system | publisher = Wolters Kluwer/Lippincott Williams & Wilkins Health | location = Philadelphia | year = 2011 | isbn = 9780781799935 }}</ref>
*On microscopic histopathological analysis, characteristic findings of astrocytoma is:<ref name=":0">{{cite book | last = Mattle | first = Heinrich | title = Fundamentals of neurology : an illustrated guide | publisher = Thieme | location = Stuttgart New York | year = 2017 | isbn = 9783131364524 }}</ref>
* [[Pilocytic astrocytoma|Pilocytic]]:
**Grade 1: Cells appearance is normal and growth rate is slow.
** Cells appearance is normal and growth rate is slow.
**Grade 2: There might be some atypical cells inside tumor. Mitosis rate is relatively slow.
** Biphasic pattern (dense fibrillar tissue within loose myxoid tissue)
**Grade 3 and 4: Tumor cells are anaplastic and malignant with high mitosis rate.
** [[Calcification]]
** Vascular hyalinization
** Nested fibrotic pattern
* [[Diffuse astrocytoma|Diffuse]]:  
** There might be some [[Atypia|atypical cells]] inside [[tumor]].  
** Mitosis rate is relatively slow.
** Diffusely infiltrate [[neuropil]]
** Poorly defined [[cytoplasm]]
* [[Anaplastic astrocytoma|Anaplastic]]:
** [[Tumor]] cells are [[Pleomorphism|pleomorphic]] and [[malignant]]
** High [[mitosis]] rate
** Hyperchromatosis
** Prominent small [[Blood vessel|vessels]]
* [[Glioblastoma multiforme|Glioblastoma]]:
** [[Pleomorphism|Pleomorphic]] cells
** Naked nuclei
** Multi-focal [[necrosis]]
** Pseudopalisading pattern
** Scattered pyknotic nuclear debris in the center
** Micro-vascular proliferation
** Vascular [[thrombi]]
Molecular findings diagnostic of astrocytoma include:<ref>{{cite book | last = Ellison | first = David | title = Neuropathology : a reference text of CNS pathology | publisher = Mosby | location = Edinburgh New York | year = 2013 | isbn = 0723435154 }}</ref>
 
{{Family tree/start}}
{{Family tree |boxstyle=text-align: left; | | | | | | | | | | | | | | | A01 | | | | | | | | | | | |A01=• Stem cell<br>• Precursor cell<br>• Glial cell<br> }}
{{Family tree | | | | | | | |,|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|.| | | | | }}
{{Family tree | | | | | | | B01 | | | | | | B02 | | | | | | B03 | | | | B01=IDH1 mutation|B02=• 10q loss<br>• PTEN mutation<br>• EGFR overexpression<br>• MDM2 overexpression<br>|B03=• KIAA1549-BRAF fusion<br>• MAPK/ERK abnormalities<br>}}
{{Family tree | | | | | | | |!| | | | | | | |!| | | | | | | |!| | | | | }}
{{Family tree | | | | | | | C01 | | | | | | C02 | | | | | | C03 | | | | C01=• p53 mutation<br>• PDGF/PDGFRA overexpression<br>|C02=Primary glioblastoma
grade IV|C03=Pilocytic astrocytoma grade I}}
{{Family tree | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | }}
{{Family tree | | | | | | | D01 | | | | | | | | | | | | | | | | | | | | D01=Diffuse astrocytoma grade II}}
{{Family tree | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | }}
{{Family tree | | | | | | | E01 | | | | | | | | | | | | | | | | | | | | E01=Chr 19q loss}}
{{Family tree | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | }}
{{Family tree | | | | | | | F01 | | | | | | | | | | | | | | | | | | | | F01=Anaplastic astocytoma grade III}}
{{Family tree | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | }}
{{Family tree | | | | | | | G01 | | | | | | | | | | | | | | | | | | | | G01=10q loss}}
{{Family tree | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | }}
{{Family tree | | | | | | | H01 | | | | | | | | | | | | | | | | | | | | H01=Glioblastoma (secondary) grade IV}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
 
{{Family tree/end}}


==References==
==References==

Latest revision as of 19:11, 14 January 2019

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

Overview

Biopsy is helpful in the diagnosis of astrocytomas. Findings suggestive diagnostic of astrocytoma include normal cells with slow growth rate, biphasic pattern (dense fibrillar tissue within loose myxoid tissue), Calcification, Vascular hyalinization and Nested fibrotic pattern in pilocytic astrocytoma, atypical cells, relatively slow mitosis rate, diffusely infiltrate neuropil and poorly defined cytoplasm in diffuse astrocytoma, pleomorphic and malignant cells, High mitosis rate, hyperchromatosis and prominent small vessels in anaplastic astrocytoma, Pleomorphic cells, Naked nuclei, Multi-focal necrosis, Pseudopalisading pattern, Scattered pyknotic nuclear debris in the center, Micro-vascular proliferation and Vascular thrombi in glioblastoma multiform.

Other Diagnostic Studies

Biopsy is helpful in the diagnosis of astrocytomas:[1][2][3]

  • Astrocytomas are histologically heterogenous.
  • Obtaining small specimen from astrocytomas might lead to false diagnosis.
  • For lesions with areas of contrast enhancement the specimen should be obtained from those areas.
  • For lesions with no intra-tumor enhancement the specimen should be obtained from the center of the tumor.

Pathological findings diagnostic of astrocytoma include:[4][5][6]

Molecular findings diagnostic of astrocytoma include:[7]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Stem cell
• Precursor cell
• Glial cell
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IDH1 mutation
 
 
 
 
 
• 10q loss
• PTEN mutation
• EGFR overexpression
• MDM2 overexpression
 
 
 
 
 
• KIAA1549-BRAF fusion
• MAPK/ERK abnormalities
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• p53 mutation
• PDGF/PDGFRA overexpression
 
 
 
 
 
Primary glioblastoma grade IV
 
 
 
 
 
Pilocytic astrocytoma grade I
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Diffuse astrocytoma grade II
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chr 19q loss
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Anaplastic astocytoma grade III
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
10q loss
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Glioblastoma (secondary) grade IV
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

References

  1. ↑ Jackson RJ, Fuller GN, Abi-Said D, Lang FF, Gokaslan ZL, Shi WM, Wildrick DM, Sawaya R (July 2001). "Limitations of stereotactic biopsy in the initial management of gliomas". Neuro-oncology. 3 (3): 193–200. doi:10.1093/neuonc/3.3.193. PMC 1920616. PMID 11465400.
  2. ↑ McGirt MJ, Villavicencio AT, Bulsara KR, Friedman AH (April 2003). "MRI-guided stereotactic biopsy in the diagnosis of glioma: comparison of biopsy and surgical resection specimen". Surg Neurol. 59 (4): 277–81, discussion 281–2. PMID 12748009.
  3. ↑ Son BC, Kim MC, Choi BG, Kim EN, Baik HM, Choe BY, Naruse S, Kang JK (2001). "Proton magnetic resonance chemical shift imaging (1H CSI)-directed stereotactic biopsy". Acta Neurochir (Wien). 143 (1): 45–9, discussion 49–50. PMID 11345717.
  4. ↑ Mattle, Heinrich (2017). Fundamentals of neurology : an illustrated guide. Stuttgart New York: Thieme. ISBN 9783131364524.
  5. ↑ Nafussi, Awatif (2005). Tumor diagnosis : practical approach and pattern analysis. London New York: Arnold Distributed in the U.S.A. by Oxford University Press. ISBN 0340809442.
  6. ↑ Schniederjan, Matthew (2011). Biopsy interpretation of the central nervous system. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health. ISBN 9780781799935.
  7. ↑ Ellison, David (2013). Neuropathology : a reference text of CNS pathology. Edinburgh New York: Mosby. ISBN 0723435154.

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