Anaplastic astrocytoma

Imaging of a brain tumor with focal enhancement of contrast agent (whitish spots) corresponding to the image of an anaplastic astrocytoma

Histological picture of an anaplastic astrocytoma

As Anaplastic Astrocytoma , a malignant brain tumor is referred to, which is characterized by diffuse growth, increased cell density and mitotic figures. It arises from a certain cell population of the central nervous system, the astrocytes . According to the WHO classification of tumors of the central nervous system, the tumor corresponds to a grade III tumor.

Epidemiology and Clinic

Anaplastic astrocytomas typically occur in the medullary bed (white matter) of the brain in adults. The maximum age is between 35 and 45 years when the diagnosis is made. The ratio of men to women is 1.6 to 1. Another accumulation occurs in childhood, whereby the brain stem is particularly affected. The tumors can arise de novo or as a progression from a diffuse astrocytoma WHO grade II. The tumor diffusely infiltrates the surrounding brain tissue without completely destroying it, so that the affected brain structures appear enlarged. On imaging, the tumor shows pronounced edema in the area and, as a rule, focal enhancement of the contrast medium.

Clinically, an anaplastic astrocytoma is manifested by intracranial pressure and frequent seizures.

Neuropathology

Biopsy specimens of the tumor usually show pleomorphic cells, an increased cell density and nuclear division figures . The proliferation activity of the tumor is usually above 5%. Using immunohistochemical methods, the astrocytic origin of the tumor can be confirmed by detecting GFAP . In more than half of the tumors, mutations of the Tp53 protein and isocitrate dehydrogenase can be detected in the tumor.

therapy

The current standard therapy consists of surgical removal of the tumor ( resection ) as much as possible, followed by radiation therapy . Due to the infiltrative growth, complete removal is de facto impossible, which is why recurrences are the rule.

forecast

The tumor usually progresses to glioblastoma within two years . Anaplastic tumors without evidence of an IDH mutation show a worse course than glioblastomas with such a mutation.

Individual evidence

↑ ^a ^b ^c Uwe Schlegel: Neurooncology . Georg Thieme, Stuttgart 2003, ISBN 978-3-13-109062-1 , p. 6-7 .
↑ Volkher Engelbrecht, Michael Forsting: MRT and MRA of the head: indication - choice of examination parameters - interpretation of findings . Georg Thieme, Stuttgart 2007, ISBN 978-3-13-103532-5 , p. 63 .
^ ^A ^b Klaus Poeck, Werner Hacke: Neurology . 12th edition. Springer, Berlin 2006, ISBN 978-3-540-29998-1 , pp. 309 .
^ ^A ^b Matthias Simon: Glioma surgery . Springer, Berlin 2017, ISBN 978-3-662-48694-8 , pp. 14-15 .

[Schlegel-1] Uwe Schlegel: Neurooncology . Georg Thieme, Stuttgart 2003, ISBN 978-3-13-109062-1 , p. 6-7 .

[2] Volkher Engelbrecht, Michael Forsting: MRT and MRA of the head: indication - choice of examination parameters - interpretation of findings . Georg Thieme, Stuttgart 2007, ISBN 978-3-13-103532-5 , p. 63 .

[Poeck-3] A ^b Klaus Poeck, Werner Hacke: Neurology . 12th edition. Springer, Berlin 2006, ISBN 978-3-540-29998-1 , pp. 309 .

[Simon-4] A ^b Matthias Simon: Glioma surgery . Springer, Berlin 2017, ISBN 978-3-662-48694-8 , pp. 14-15 .