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Astrocytic Tumors

An informative slide show


What are astrocytic tumors?

Astrocytic tumors refer to tumors that arise from


the nervous system. These tumors begin in cells
called astrocytes, which are are star-shaped brain
cells that help keeps nerve cells healthy.
Astrocytes are a type of glial cell. Glial cells are
supportive cells for the neurons; astrocytes
primarily deal with maintaing neuronal metabolism
and neurotransmission.
Astrocyte
Classification

Astrocytic tumors encompass a wide variety of cells that


affect both te central and peripheral nervous system. When
the World Health Organization (WHO) refers to astrocytic
tumors, they typically categorize the tumors into these
groups:
• Pilocytic Astrocytoma (WHO Grade I)
• Pleomorphic Xanthoastrocytoma (WHO Grade II)
• Diffuse Astrocytoma (WHO Grade II)
• Anaplastic Astrocytoma (WHO Grade III)
• Glioblastoma (WHO Grade IV)
Pilocytic Astrocytoma

Pilocytic astrocytomas are tumors that are relatively slow


growing tumors that are typically found in younger people.
Pilocytic astrocytomas are tumors that are composed of cells
that are associated with Rosenthal fibers, giving them the
name pilocytic (Cells that look as if they are composed from
hair).
Locations
Pilocytic astrocytomas are most commonly located in the
cerebellum of children, with rare cases of these tumors in
elderly patients.
Pilocytic Astrocytomas

Symptoms
Headaches, hormone imbalances and intracranial pressure
are typical symptoms. Due to the slow growing nature of
pilocytic astrocytomas, the tumors appear to be lesions that
are gradually evolving.
Histology
The majority of astrocytic tumors are soft, grey and seperate.
Other characteristics are the formation of cysts, necrosis and
calcification.
Pilocytic Astrocytomas
Cytology
The cells often contain round or oval nuclei, a modest size
and small network process.
Rosenthal fibers can also be found in pilocytic astroctyomas.
These tumors are also very vascular, with possible regressive
changes.
Prognosis
The prognosis for pilocytic astrocytomas is typically a long
life, which may result in death after a long period of time.
Particular problems may arise when dealing with tumors
located in the brain stem or hypothalamus. However, most
people diagnosed with this tumor typically survive much
longer than those with other tumors of the nervous system.
Pilocytic Astrocytoma
Pleomorphic Xanthoastrocytoma

Pleomorphic Xanthoastrocytomas are tumors with a WHO


grade of II.
Occurence
Less than 1% of astrocytic tumors are caused by pleomorphic
xanthoastrocytomas. The majority, about two-thirds, of these
cases occur in those under age 18, but there have been
reports of the elderly being afflicted also.
Locations
Typically, the outer surface of the brain is affected,
particularly the meninges and cerebrum. Also, about 98% of
all cases were located above the spinal cord and cerebellum.
The majority were found in the temporal lobe.
Pleomorphic Xanthoastrocytoma

Symptoms
Seizures are typical of those diagnosed with pleomorphic
xanthoastrocytoma. These tumors are attached to the
meninges and can be accompanied by a cyst. Their location
are the causes for the seizures.
Histopathology
As the name "pleomorphic" suggests, these tumors are
capable of taking many shapes, including a large variation in
composition, number of nuclei per cell, staining and size. The
use of the word "xantho" refers to the build up of fat deposits
littered throughout the tumor.
Pleomorphic Xanthoastrocytoma

Prognosis
While there is little evidence of genetic suspectiblity, there are
studies that show that pleomorphic xanthoastrocytomas can
be caused by additions or subtractions of chromosomes
and/or genes. However, there is hope for those diagnosed
with this tumor. Even though the neoplasm can give rise to a
multitude of shapes, it's not as malignant as other
pleomorphic tumors. Approximately 70% of those who have
this tumor survive past ten years.
Pleomorphic Xanthoastrocytoma
Diffuse Astrocytoma
A diffuse astrocytoma is a tumor that can arise from
astrocytes, and instead of staying concentrated in one spot, it
spreads and penetrates throughout the brain.
Occurence
Out of all neoplasms arising from astrocytes, the diffuse
astrocytoma accounts for approximately 10-15%. This
astrocytoma usually strikes young adults, with a predominant
display in the 30-39 range, for both males and females.
However, only about 1.4 new cases are shown for every 1
million people per year.
Symptoms
Seizures, personality changes, and more subtle changes,
such as vision or motor problems are all symptoms. This is
due to the localization of the tumors.
Diffuse Astrocytoma

Appearance
Diffuse astrocytomas appear on CT scans as a mass of
identical cells. It is possible to see other changes, such as
cysts or calcification. Unfortunately, the penetrating nature of
this tumor means that anatomically the boundary between
cancerous and normal tissue is hard to define. Instead of
destruction, this tumor tends to enlarge and warp the shape
and size of the area it effects. Both multiple microcysts or one
large cysts is possible to be noted of, which can change the
texture and appearance of the tumor.
Diffuse Astrocytoma
Fibrillary Astrocytoma
Of the three types of diffuse astroctyomas, the fibrillary astrocytma is
the most common. It's composed of cells with quantities of minute
fibers, or fibrils. Hence the name, fibrillary. Some of the ways to
diagnose this tumor is by the presence of abnormal nuclei, moderate
cell density, rare miotitc divisions, and an abundance of microcysts.
Gemistocytic Astrocytoma
This tumor is noted to contain gemistocytic astrocytes, which are
plump cells, due to an abundance of cytoplasm, nuclear atypia and
glial filaments. These tumors are inclined to turn into anaplastic
astrocytomas, and ultimately glioblastomas.
Protoplasmic Astrocytomas
A rare form of diffuse astrocytomas, small cell bodies, few filaments,
and minimal GFAP presentation are typical for this type of tumor.
Diffuse Astrocytoma

Prognosis
While always dependent on the individual, most statistics
show people living up to 6-8 years after diagnosis of a diffuse
astrocytoma. After about 4-5 years, this tumor usually
descends into a glioblastoma. A more positive prognosis is
given to younger patients, but the size of the tumor can also
be a factor, typically the larger in size, the more likely to
speed into a glioblastoma.
Diffuse Astrocytoma
Anaplastic Astrocytoma

Anaplastic Astrocytomas are WHO grade III tumors.


Anaplasia is a distinctive feature, which means that the cells
are lacking differentiation. These tumors are malignant
astrocytomas that are noted by extensive infiltration,
abnormal nuclei, increased spreading and heightened
concentrations of cells. These tumors can arise from either
diffuse astrocytomas or without any precursor tumors.
Occurence
These neoplasms afflict middle aged men the most, with a
mean age of 45 years old. Also, men are slightly more
affected than women. Similar to diffuse astrocytomas, the
cerebral lobes are the most commonly affected.
Anaplastic Atrocytoma

Symptoms
The symptoms are similar to diffuse astrocytomas, with an
increase in neurological problems, such as pressure, seizures
or other problems, like vision or motor issues.
Appearance
Instead of destruction, anaplastic astrocytomas prefer to
infiltrate tissues surrounding the tumor, causing enlargement
of the affected tissues. Grossly, it is difficult to tell the
difference between an anaplastic astrocytoma or a diffuse
astrocytoma. Increased cellularity and tumor size are the
main markers when viewing at a macroscopic level.
Anaplastic Astrocytoma
Histopathology
When viewing the neoplasm at a microscopic level, the
characteristics of an anaplastic astrocytoma are discernible
abnormalaties in the nuclei and mitotic activity. The increased
mitotic activity is particularly noted, because in comparison to
many of the other types of brain tumors, mitotic activity is
noted primarily in anaplastic astrocytomas and glioblastomas.
Prognosis
Two years is the typical estimate for those diagnosed with
anaplastic astrocytoma, but this is primarly due to the
tendency of progression towards a glioblastoma. Typical of
many diseases, elderly patients afflicted by this neoplasm
usually have a worse prognosis.
Anaplastic Astrocytoma
Glioblastoma
Both the most common and most malignant brain tumor
arising from astrocytes, the characteristics of a glioblastoma
(GBM) are abnormal nuclei, many different cell forms,
increased reproduction of cells, blood clots, multiudes of
blood vessels and tissue death. The primary demographic
affected by GBMs are elderly individuals.
Occurence
Accounting for approximately 15% of all brain tumors, and 60-
75% of all astrocytic tumors, there are about 3-4 cases of
GBM for every 100,000 individuals per year. The average age
of those afflicted with a glioblastoma is approximately 60
years old, with men being slightly more prone than women.
The cerebral hemispheres (temporal, parietal, front, and
occipital lobes) are the primary source of these tumors.
Glioblastoma
Symptoms
Symptoms arising from a glioblastoma are similar to other
brain tumors, with headache, nausea, epileptic seizures and
personality changes being typical. Strokes, or similar
phenomenon, can also occur.
Appearance
The tumors are large, and can easily be the size of an entire
lobe. Typically, the neoplasm is the same throughout, with
little differentiation shown. The tumor is typically grey, with
some yellow areas due to fat necrosis. The hyperceullarity, or
vast amount of cells, cause the tumor itself to be soft mass.
However, necrosis can change both shape, texture and color
of the tumor.
Glioblastoma
Growth
Glioblastomas are well known for their ability and tendency to
spread quickly through the brain, particularly into the
structures of the brain (lobes). While the tumor can spread in
many directions and form many different shapes, the mass is
connected, so new tumor masses can be formed all across
the brain, creating what appears to multiple center points of
cancerous growth. Due to the nature of the GBM, it doesn't
typically infiltrate the brain fluid, so the tumor doesn't
metastasize. Certain genes in a glioblastoma can help
infiltration through the extracellular matrix when activated.
There is speculation when it comes to multiple centers of
growth. While it appears as if there are multiple tumors, it may
in fact be just one spread out across the brain.
Glioblastoma
Histopathology
Glioblastomas are made up of poorly differentiated cells that
are quickly undergoing mitosis. Also, dead tissue (necrosis)
and increased concentration of blood vessels are important
for diagnosing a GBM. These tumors can take many different
forms, giving it the synonymous name "Glioblastoma
Multiforme". Epethelial tissue is not uncommon. Another
characteristic of a glioblastoma is the presence of
multinucleated giant cells, along with gemistocytes and
granular cells. While lipidized cells (cells with a high fat
content), perivascular lymphocytes (a white blood cell found
near blood vessels), and metaplasia (differentiation of cells,
as compared to anaplasia) are found in a few cases of
glioblastoma, the appearance of an abundance of small blood
vessels is imperative to the labeling of a glioblastoma.
Glioblastoma
Prognosis
Unfortunately, the prognosis of an individual with glioblastoma is
very grim. Studies based in Switzerland and Canada show that
less than 20% of patients survive longer than a year, and less than
3% survive past three years. Age is the biggest factor, with
younger patients facing a much better prognosis than elderly
victims.
Treatment
Treating a glioblastoma is a very tough challenge. There is typically
little difference in prognosis even after aggresive treatment, using
radiation, surgery, etc. Problems arise due to the blood brain
barrier, lack of response due to vast changes in genomic
information and spread of the tumor to nearly every part of the
brain, including the brain stem. In order to full combat a
glioblastoma, a wide range of medicines would have to be used to
counter all of the defects of the tumor cells.
Glioblastoma
Glioblastoma
● The pictures below are from my mentorship,
taken from an older female with a GBM.