WCTN: World Collaborative Textbook of Neurosurgery
Last modified by Max Gosey on 2010/06/14 05:48
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1 = Astrocytoma =
2
3 == General Characteristics ==
4
5 Astrocytomas tend to grow along fiber tracts, versus in brain parenchyma.
6
7 == Diagnosis ==
8
9 Diagnosis is made largely from adequate MR imaging of the head. Histological studies may confirm diagnosis.
10
11 === Imaging ===
12
13 When malignancy is suspected, the highest priority for imaging is magnetic resonance. CT imaging may assist in the decision to perform a lumbar puncture.
14
15 === Lumbar Puncture ===
16
17 Perform only if intracranial pressure is shown to be normal.
18
19 ==== Histology of CSF ====
20
21 Tell me what you'd see in CSF
22
23 ==== Protein counts of CSF ====
24
25 Which proteins would suggest astrocytoma?
26
27 ==== Volume of CSF ====
28
29 Tell me what kind of volume you'd expect.
30
31 == Grades ==
32
33 Grade I astrocytic tumors: pilocytic astrocytoma, desmoplastic infantile astrocytoma, and subependymal giant cell astrocytoma
34 Grade II astrocytoma: low-grade, diffuse fibrillary astrocytoma (nuclear atypia and no or rare mitoses)
35 Grade III astrocytoma: anaplastic astrocytoma (nuclear atypia and marked mitotic activity)
36 Grade IV astrocytoma: glioblastoma (atypia, mitoses, and microvascular proliferation or necrosis)
37
38
39 == Grade I astrocytomas ==
40
41 In general, grade I astrocytomas are benign and resemble nothing more than an increased mass of astrocytes. They grow somewhere...
42
43 ==== Pilocytic ====
44
45 ====== Definition ======
46
47 Pilocytic astrocytomas are relatively common. They are well differentiated and are essentially just hyperplastic astrocytes.
48
49 ====== Prognosis ======
50
51 As compared to [[meningiomas>>http://noddle.myxwiki.org/xwiki/bin/view/Chapter19/Section%2019.2%3A%20Meningiomas]], [[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
55 Desmoplastic are different.
56
57 ==== Subependymal giant cell ====
58
59 These are giant.
60
61 == Grade II astrocytomas ==
62
63 ==== Diffuse fibrillary astrocytoma ====
64
65 In contrast to pilocytic astrocytomas, diffuse fibrillary astrocytomas show nuclear atypia. They usually do not show marked mitosis.
66
67
68 == Grade III astrocytomas ==
69
70 ==== Anaplastic ====
71
72 ====== General characteristic of anaplastic neoplasms ======
73
74 Anaplastic astrocytomas show significant growth rates (i.e., mitosis). This makes for poorer prognosis and less predictability in terms of their anatomical location.
75
76 ====== Particular considerations in treatment ======
77
78 Due to their high rate of mitotic activity, colchicine and other drugs that prevent microtubule polymerization may be effective.
79
80
81 == Grade IV astrocytomas: Glioblastoma ==
82
83 === Histological characteristics ===
84
85 As with lower-grade astrocytomas, glioblastomas show hyperplasia, nuclear atypia, and mitotic activity. Additionally, they exhibit microvascular proliferation, making them capable of metastasis.
86
87 === Prognosis ===
88
89 Glioblastomas are bad mothers. Call your family and spend as much time with them as possible.
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