Changes for page Section 19.1: Astrocytic Tumors

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1	1	= Astrocytoma =
2		-==General Characteristics==
	2	+
	3	+== General Characteristics ==
	4	+
3	3	Astrocytomas tend to grow along fiber tracts, versus in brain parenchyma.
4	4
5		-==Diagnosis==
	7	+== Diagnosis ==
	8	+
6	6	Diagnosis is made largely from adequate MR imaging of the head. Histological studies may confirm diagnosis.
7		-===Imaging===
	10	+
	11	+=== Imaging ===
	12	+
8	8	When malignancy is suspected, the highest priority for imaging is magnetic resonance. CT imaging may assist in the decision to perform a lumbar puncture.
9		-===Lumbar Puncture===
	14	+
	15	+=== Lumbar Puncture ===
	16	+
10	10	Perform only if intracranial pressure is shown to be normal.
11		-====Histology of CSF====
	18	+
	19	+==== Histology of CSF ====
	20	+
12	12	Tell me what you'd see in CSF
13		-====Protein counts of CSF====
	22	+
	23	+==== Protein counts of CSF ====
	24	+
14	14	Which proteins would suggest astrocytoma?
15		-====Volume of CSF====
	26	+
	27	+==== Volume of CSF ====
	28	+
16	16	Tell me what kind of volume you'd expect.
17	17
18		-==Grades==
	31	+== Grades ==
	32	+
19	19	Grade I astrocytic tumors: pilocytic astrocytoma, desmoplastic infantile astrocytoma, and subependymal giant cell astrocytoma
20	20	Grade II astrocytoma: low-grade, diffuse fibrillary astrocytoma (nuclear atypia and no or rare mitoses)
21	21	Grade III astrocytoma: anaplastic astrocytoma (nuclear atypia and marked mitotic activity)
...	...	@@ -22,40 +22,54 @@
22	22	Grade IV astrocytoma: glioblastoma (atypia, mitoses, and microvascular proliferation or necrosis)
23	23
24	24
25		-==Grade I astrocytomas==
	39	+== Grade I astrocytomas ==
	40	+
26	26	In general, grade I astrocytomas are benign and resemble nothing more than an increased mass of astrocytes. They grow somewhere...
27	27
28		-====Pilocytic====
29		-======Definition======
	43	+==== Pilocytic ====
	44	+
	45	+====== Definition ======
	46	+
30	30	Pilocytic astrocytomas are relatively common. They are well differentiated and are essentially just hyperplastic astrocytes.
31	31
32		-======Prognosis======
33		-As compared to [[pediatric medulloblastomas>>]] and [[glioblastomas>>]], prognosis for pilocytic astrocytoma is good. Patients are expected to live in xyz% of cases.
	49	+====== Prognosis ======
34	34
35		-====Desmoplastic infantile====
	51	+As compared to [[pediatric medulloblastomas>>http://en.wikipedia.org/wiki/Medulloblastoma]] and [[glioblastomas>>http://en.wikipedia.org/wiki/Glioblastoma]], prognosis for pilocytic astrocytoma is good. Patients are expected to live in xyz% of cases.
	52	+
	53	+==== Desmoplastic infantile ====
	54	+
36	36	Desmoplastic are different.
37	37
38		-====Subependymal giant cell====
	57	+==== Subependymal giant cell ====
	58	+
39	39	These are giant.
40	40
	61	+== Grade II astrocytomas ==
41	41
42		-==Grade II astrocytomas==
43		-====Diffuse fibrillary astrocytoma====
	63	+==== Diffuse fibrillary astrocytoma ====
	64	+
44	44	In contrast to pilocytic astrocytomas, diffuse fibrillary astrocytomas show nuclear atypia. They usually do not show marked mitosis.
45	45
46	46
47		-==Grade III astrocytomas==
48		-====Anaplastic====
49		-======General characteristic of anaplastic neoplasms======
	68	+== Grade III astrocytomas ==
	69	+
	70	+==== Anaplastic ====
	71	+
	72	+====== General characteristic of anaplastic neoplasms ======
	73	+
50	50	Anaplastic astrocytomas show significant growth rates (i.e., mitosis). This makes for poorer prognosis and less predictability in terms of their anatomical location.
51	51
52		-======Particular considerations in treatment======
	76	+====== Particular considerations in treatment ======
	77	+
53	53	Due to their high rate of mitotic activity, colchicine and other drugs that prevent microtubule polymerization may be effective.
54	54
55	55
56		-==Grade IV astrocytomas: Glioblastoma==
57		-===Histological characteristics===
	81	+== Grade IV astrocytomas: Glioblastoma ==
	82	+
	83	+=== Histological characteristics ===
	84	+
58	58	As with lower-grade astrocytomas, glioblastomas show hyperplasia, nuclear atypia, and mitotic activity. Additionally, they exhibit microvascular proliferation, making them capable of metastasis.
59		-===Prognosis===
60		-Glioblastomas are bad mothers. Call your family and spend as much time with them as possible.
61	61
	87	+=== Prognosis ===
	88	+
	89	+Glioblastomas are bad mothers. Call your family and spend as much time with them as possible.