WCTN: World Collaborative Textbook of Neurosurgery
Last modified by Max Gosey on 2010/06/14 05:48
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Max Gosey 5.2 1 = Astrocytoma =
Max Gosey 7.1 2
3 == General Characteristics ==
4
Max Gosey 5.2 5 Astrocytomas tend to grow along fiber tracts, versus in brain parenchyma.
Max Gosey 1.1 6
Max Gosey 7.1 7 == Diagnosis ==
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Max Gosey 5.2 9 Diagnosis is made largely from adequate MR imaging of the head. Histological studies may confirm diagnosis.
Max Gosey 7.1 10
11 === Imaging ===
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Max Gosey 5.2 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.
Max Gosey 7.1 14
15 === Lumbar Puncture ===
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Max Gosey 5.2 17 Perform only if intracranial pressure is shown to be normal.
Max Gosey 7.1 18
19 ==== Histology of CSF ====
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Max Gosey 5.2 21 Tell me what you'd see in CSF
Max Gosey 7.1 22
23 ==== Protein counts of CSF ====
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Max Gosey 5.2 25 Which proteins would suggest astrocytoma?
Max Gosey 7.1 26
27 ==== Volume of CSF ====
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Max Gosey 5.2 29 Tell me what kind of volume you'd expect.
Max Gosey 1.1 30
Max Gosey 7.1 31 == Grades ==
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Max Gosey 5.2 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)
Max Gosey 1.1 37
Max Gosey 2.1 38
Max Gosey 7.1 39 == Grade I astrocytomas ==
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Max Gosey 5.2 41 In general, grade I astrocytomas are benign and resemble nothing more than an increased mass of astrocytes. They grow somewhere...
Max Gosey 2.1 42
Max Gosey 7.1 43 ==== Pilocytic ====
44
45 ====== Definition ======
46
Max Gosey 5.2 47 Pilocytic astrocytomas are relatively common. They are well differentiated and are essentially just hyperplastic astrocytes.
Max Gosey 2.1 48
Max Gosey 7.1 49 ====== Prognosis ======
Max Gosey 2.1 50
Max Gosey 8.1 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.
Max Gosey 7.1 52
53 ==== Desmoplastic infantile ====
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Max Gosey 5.2 55 Desmoplastic are different.
Max Gosey 2.1 56
Max Gosey 7.1 57 ==== Subependymal giant cell ====
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Max Gosey 5.2 59 These are giant.
Max Gosey 2.1 60
Max Gosey 7.1 61 == Grade II astrocytomas ==
Max Gosey 2.1 62
Max Gosey 7.1 63 ==== Diffuse fibrillary astrocytoma ====
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Max Gosey 5.2 65 In contrast to pilocytic astrocytomas, diffuse fibrillary astrocytomas show nuclear atypia. They usually do not show marked mitosis.
Max Gosey 1.1 66
Max Gosey 3.1 67
Max Gosey 7.1 68 == Grade III astrocytomas ==
69
70 ==== Anaplastic ====
71
72 ====== General characteristic of anaplastic neoplasms ======
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Max Gosey 5.2 74 Anaplastic astrocytomas show significant growth rates (i.e., mitosis). This makes for poorer prognosis and less predictability in terms of their anatomical location.
Max Gosey 2.1 75
Max Gosey 7.1 76 ====== Particular considerations in treatment ======
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Max Gosey 5.2 78 Due to their high rate of mitotic activity, colchicine and other drugs that prevent microtubule polymerization may be effective.
Max Gosey 1.1 79
Max Gosey 3.1 80
Max Gosey 7.1 81 == Grade IV astrocytomas: Glioblastoma ==
82
83 === Histological characteristics ===
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Max Gosey 5.2 85 As with lower-grade astrocytomas, glioblastomas show hyperplasia, nuclear atypia, and mitotic activity. Additionally, they exhibit microvascular proliferation, making them capable of metastasis.
Max Gosey 7.1 86
87 === Prognosis ===
88
Max Gosey 5.2 89 Glioblastomas are bad mothers. Call your family and spend as much time with them as possible.
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