Astrocytoma diagnostic study of choice: Difference between revisions
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== Overview == | == Overview == | ||
There is no single diagnostic study of choice for the diagnosis of astrocytoma, but astrocytoma can be diagnosed based on clinical presentation, imaging studies and [[biopsy]] results.The various investigations must be performed in the following order: [[Physical examination]], imaging study ([[MRI]] is the preferred imaging technique) and tumor [[biopsy]]. | |||
== Diagnostic Study of Choice == | == Diagnostic Study of Choice == | ||
=== Study of choice === | === Study of choice === | ||
There is no single diagnostic study of choice for the diagnosis of astrocytoma, but astrocytoma can be diagnosed based on clinical presentation, imaging studies and biopsy results. | There is no single diagnostic study of choice for the diagnosis of astrocytoma, but astrocytoma can be diagnosed based on clinical presentation, imaging studies and [[biopsy]] results. | ||
Investigations: | Investigations: | ||
* Among the patients who present with clinical signs of intracranial mass, the tumor biopsy is the most specific test for the diagnosis. | * Among the patients who present with clinical signs of [[intracranial mass]], the [[tumor]] [[biopsy]] is the most specific test for the diagnosis. | ||
* Among the patients who present with clinical signs of intracranial mass, the imaging study is the most sensitive test for diagnosis. | * Among the patients who present with clinical signs of [[intracranial mass]], the imaging study is the most sensitive test for diagnosis. | ||
===== Diagnostic results ===== | ===== Diagnostic results ===== | ||
The following findings on performing MRI are confirmatory for astrocytoma:<ref name="pmid17964028">{{cite journal |vauthors=Sathornsumetee S, Rich JN, Reardon DA |title=Diagnosis and treatment of high-grade astrocytoma |journal=Neurol Clin |volume=25 |issue=4 |pages=1111–39, x |date=November 2007 |pmid=17964028 |doi=10.1016/j.ncl.2007.07.004 |url=}}</ref><ref name="pmid22819718">{{cite journal |vauthors=Pedersen CL, Romner B |title=Current treatment of low grade astrocytoma: a review |journal=Clin Neurol Neurosurg |volume=115 |issue=1 |pages=1–8 |date=January 2013 |pmid=22819718 |doi=10.1016/j.clineuro.2012.07.002 |url=}}</ref> | The following findings on performing [[MRI]] are confirmatory for astrocytoma:<ref name="pmid17964028">{{cite journal |vauthors=Sathornsumetee S, Rich JN, Reardon DA |title=Diagnosis and treatment of high-grade astrocytoma |journal=Neurol Clin |volume=25 |issue=4 |pages=1111–39, x |date=November 2007 |pmid=17964028 |doi=10.1016/j.ncl.2007.07.004 |url=}}</ref><ref name="pmid22819718">{{cite journal |vauthors=Pedersen CL, Romner B |title=Current treatment of low grade astrocytoma: a review |journal=Clin Neurol Neurosurg |volume=115 |issue=1 |pages=1–8 |date=January 2013 |pmid=22819718 |doi=10.1016/j.clineuro.2012.07.002 |url=}}</ref> | ||
* Low grade astrocytoma (pilocytic and diffuse astrocytoma) | * [[Low grade astrocytoma]] ([[Pilocytic astrocytoma|pilocytic]] and [[Diffuse astrocytomas|diffuse astrocytoma]]) | ||
** T1: Decreased resonance in comparison to surrounding brain tissue | ** T1: Decreased resonance in comparison to surrounding [[brain]] tissue | ||
** T2: Increased resonance in comparison to surrounding brain tissue | ** T2: Increased resonance in comparison to surrounding [[brain]] tissue | ||
* High grade astrocytoma | * [[High grade astrocytomas|High grade astrocytoma]] | ||
** Anaplastic astrocytomas | ** [[Anaplastic astrocytoma|Anaplastic astrocytomas]] | ||
*** Hypointense T1 | *** Hypointense T1 | ||
*** Hyperintense T2 | *** Hyperintense T2 | ||
*** There might be some contrast enhancement and edema | *** There might be some contrast enhancement and [[edema]] | ||
** Glioblastoma multiform | ** [[Glioblastoma multiforme|Glioblastoma multiform]] | ||
*** Irregular ring-nodular enhancing lesions | *** Irregular ring-nodular enhancing lesions | ||
*** Central necrosis | *** Central [[necrosis]] | ||
*** Surrounding vasogenic edema | *** Surrounding [[vasogenic edema]] | ||
The following findings on performing biopsy are confirmatory for astrocytoma: | |||
'''''For more information on MRI findings, [[Astrocytoma MRI|click here]].''''' | |||
The following findings on performing [[biopsy]] are confirmatory for astrocytoma: | |||
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> | 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> | ||
* Pilocytic: | * [[Pilocytic astrocytoma|Pilocytic]]: | ||
** Cells appearance is normal and growth rate is slow. | ** Cells appearance is normal and growth rate is slow. | ||
** Biphasic pattern (dense fibrillar tissue within loose myxoid tissue | ** Biphasic pattern (dense fibrillar tissue within loose myxoid tissue) | ||
** Calcification | ** [[Calcification]] | ||
** Vascular hyalinization | ** Vascular hyalinization | ||
** Nested fibrotic pattern | ** Nested fibrotic pattern | ||
* Diffuse: | * [[Diffuse astrocytomas|Diffuse]]: | ||
** There might be some atypical cells inside tumor. | ** There might be some atypical cells inside [[tumor]]. | ||
** Mitosis rate is relatively slow. | ** [[Mitosis]] rate is relatively slow. | ||
** Diffusely infiltrate neuropil | ** Diffusely infiltrate [[neuropil]] | ||
** Poorly defined cytoplasm | ** Poorly defined [[cytoplasm]] | ||
* Anaplastic: | * [[Anaplastic astrocytoma|Anaplastic]]: | ||
** Tumor cells are pleomorphic and | ** [[Tumor]] cells are [[pleomorphic]] and [[malignant]] | ||
** High mitosis rate | ** High [[mitosis]] rate | ||
** Hyperchromatosis | ** Hyperchromatosis | ||
** Prominent small vessels | ** Prominent small vessels | ||
* Glioblastoma: | * [[Glioblastoma multiforme|Glioblastoma]]: | ||
** Pleomorphic cells | ** [[Pleomorphic]] cells | ||
** Naked nuclei | ** Naked nuclei | ||
** Multi-focal necrosis | ** Multi-focal [[necrosis]] | ||
** Pseudopalisading pattern | ** Pseudopalisading pattern | ||
** Scattered pyknotic nuclear debris in the center | ** Scattered pyknotic nuclear debris in the center | ||
** Micro-vascular proliferation | ** Micro-vascular proliferation | ||
** Vascular thrombi | ** Vascular [[thrombi]] | ||
'''''For more information on biopsy findings, [[Astrocytoma other diagnostic studies|click here]].''''' | |||
===== Sequence of Diagnostic Studies ===== | ===== Sequence of Diagnostic Studies ===== | ||
The various investigations must be performed in the following order: | The various investigations must be performed in the following order: | ||
* | * [[Physical examination]] | ||
* Imaging study (MRI is the preferred imaging technique) | * Imaging study ([[MRI]] is the preferred imaging technique) | ||
* Tumor biopsy | * Tumor [[biopsy]] | ||
=== Diagnostic Criteria === | === Diagnostic Criteria === | ||
Latest revision as of 16:03, 10 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
There is no single diagnostic study of choice for the diagnosis of astrocytoma, but astrocytoma can be diagnosed based on clinical presentation, imaging studies and biopsy results.The various investigations must be performed in the following order: Physical examination, imaging study (MRI is the preferred imaging technique) and tumor biopsy.
Diagnostic Study of Choice
Study of choice
There is no single diagnostic study of choice for the diagnosis of astrocytoma, but astrocytoma can be diagnosed based on clinical presentation, imaging studies and biopsy results.
Investigations:
- Among the patients who present with clinical signs of intracranial mass, the tumor biopsy is the most specific test for the diagnosis.
- Among the patients who present with clinical signs of intracranial mass, the imaging study is the most sensitive test for diagnosis.
Diagnostic results
The following findings on performing MRI are confirmatory for astrocytoma:[1][2]
- Low grade astrocytoma (pilocytic and diffuse astrocytoma)
- High grade astrocytoma
- Anaplastic astrocytomas
- Hypointense T1
- Hyperintense T2
- There might be some contrast enhancement and edema
- Glioblastoma multiform
- Irregular ring-nodular enhancing lesions
- Central necrosis
- Surrounding vasogenic edema
- Anaplastic astrocytomas
For more information on MRI findings, click here.
The following findings on performing biopsy are confirmatory for astrocytoma:
Pathological findings diagnostic of astrocytoma include:[3][4][5]
- Pilocytic:
- Cells appearance is normal and growth rate is slow.
- Biphasic pattern (dense fibrillar tissue within loose myxoid tissue)
- Calcification
- Vascular hyalinization
- Nested fibrotic pattern
- Diffuse:
- Anaplastic:
- Tumor cells are pleomorphic and malignant
- High mitosis rate
- Hyperchromatosis
- Prominent small vessels
- Glioblastoma:
- Pleomorphic cells
- Naked nuclei
- Multi-focal necrosis
- Pseudopalisading pattern
- Scattered pyknotic nuclear debris in the center
- Micro-vascular proliferation
- Vascular thrombi
For more information on biopsy findings, click here.
Sequence of Diagnostic Studies
The various investigations must be performed in the following order:
- Physical examination
- Imaging study (MRI is the preferred imaging technique)
- Tumor biopsy
Diagnostic Criteria
There are no established criteria for the diagnosis of astrocytoma.
References
- ↑ Sathornsumetee S, Rich JN, Reardon DA (November 2007). "Diagnosis and treatment of high-grade astrocytoma". Neurol Clin. 25 (4): 1111–39, x. doi:10.1016/j.ncl.2007.07.004. PMID 17964028.
- ↑ Pedersen CL, Romner B (January 2013). "Current treatment of low grade astrocytoma: a review". Clin Neurol Neurosurg. 115 (1): 1–8. doi:10.1016/j.clineuro.2012.07.002. PMID 22819718.
- ↑ Mattle, Heinrich (2017). Fundamentals of neurology : an illustrated guide. Stuttgart New York: Thieme. ISBN 9783131364524.
- ↑ 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.
- ↑ Schniederjan, Matthew (2011). Biopsy interpretation of the central nervous system. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health. ISBN 9780781799935.