Astrocytoma Biopsy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]


Tumor biopsy findings associated with astrocytoma include microcystic tumor matrix, gemistocytes, rosenthal fibres and hyalinization of blood vessels. High grade tumors are characterized by high cellularity, pleomorphism, nuclear atypia, increased mitotic activity, necrosis and microvascular proliferation.


Low grade infiltrative astrocytoma[1]

  • Diffuse low grade astrocytomas are predominantly composed of a microcystic tumour matrix within which are embedded fibrillary neoplastic astrocytes with mild nuclear atypia and a low cellular density.
  • Often microcystic spaces containing mucinous fluid are present, a typical finding in fibrillary astrocytomas, but even more characteristic and pronounced in protoplasmic astrocytomas.
  • The occasional occurrence of gemistocytes in a diffuse astrocytoma does not justify the diagnosis of gemistocytic astrocytoma. Gemistocytic astrocytomas tend to progress more rapidly to anaplastic astrocytoma and secondary glioblastoma than fibrillary astrocytoma although they share the WHO grade II.
  • Mitoses, microvascular proliferation and necrosis are absent (if present they suggest a high grade tumor). Like all tumors derived from astrocytes, fibrillary astrocytomas stain with glial fibrillary acidic protein (gFAP).

Anaplastic astrocytomas[2]

Pilocytic astrocytoma[3]

Pilomyxoid Astrocytomas[5]

  • Features typically found in pilocytic astrocytomas, such as and rosenthal fibres, eosinophilic granular bodies and calcification are uncommon or absent in pilomyxoid astrocytomas[6][7]. These tumors also lack the biphasic appearance (dense cellular areas alternating with loose cystic areas) usually present in pilomyxoid astrocytomas.

Subependymal Giant Cell Astrocytoma[8]

  • Histologically, subependymal nodules and subependymal giant cell tumors are indistinguishable, and the distinction lies in the potential of a subependymal giant cell tumor for growth and mass effect.[9]

Pleomorphic xanthoastrocytomas (PXA)[10]



  1. "Low grade infiltrative astrocytoma [Dr Bruno Di Muzio and Dr Frank Gaillard]".
  2. "Anaplastic astrocytoma [Dr Bruno Di Muzio and Dr Frank Gaillard]".
  3. "Pilocytic astrocytomas [Dr Bruno Di Muzio and Dr Frank Gaillard]".
  4. Drevelegas, Antonios (2011). Imaging of brain tumors with histological correlations. Berlin New York: Springer. ISBN 3540876502.
  5. "Pilomyxoid astrocytoma [Dr Bruno Di Muzio and Dr Imran Jindani]".
  6. Pereira FO, Lombardi IA, Mello AY, Romero FR, Ducati LG, Gabarra RC; et al. (2013). "Pilomyxoid astrocytoma of the brainstem". Rare Tumors. 5 (2): 65–7. doi:10.4081/rt.2013.e17. PMC 3719112. PMID 23888217.
  7. Azad S, Kudesia S, Chawla N, Azad R, Singhal M, Rai SM; et al. (2010). "Pilomyxoid astrocytoma". Indian J Pathol Microbiol. 53 (2): 294–6. doi:10.4103/0377-4929.64283. PMID 20551536.
  8. "Subependymal giant cell astrocytoma [Dr Bruno Di Muzio and Dr Jeremy Jones]".
  9. Goh S, Butler W, Thiele EA (2004). "Subependymal giant cell tumors in tuberous sclerosis complex". Neurology. 63 (8): 1457–61. PMID 15505165.
  10. "Pleomorphic xanthoastrocytomas [Dr Bruno Di Muzio and Dr Frank Gaillard]".
  11. "Oligoastrocytomas [Dr Bruno Di Muzio and Dr Frank Gaillard]".