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Mallick S, Giridhar P, Benson R, Melgandi W, Rath GK. Demography, Pattern of Care, and Survival in Patients with Xanthoastrocytoma: A Systematic Review and Individual Patient Data Analysis of 325 Cases. J Neurosci Rural Pract 2019; 10:430-437. [PMID: 31595115 PMCID: PMC6779544 DOI: 10.1055/s-0039-1697873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives Xanthoastrocytoma (XA) is a low-grade glial tumor seen in young adults and there is lack of robust data on treatment of this rare tumor. In this systematic review and individual patient's data analysis, we aimed to look into the demography, pattern of care, survival outcomes, and prognostic factors in patients with both Grade II and III XA. Methods A comprehensive search was conducted with the Medical Subject Heading terms: "Xanthoastrocytoma; Pleomorphic Xanthoastrocytoma; Anaplastic Xanthoastrocytoma; Xanthoastrocytoma AND treatment; and Anaplastic Xanthoastrocytoma AND survival" to find all possible publications. Results A total of 325 individual patients from a total of 138 publications pertaining to XA were retrieved. Median age of the entire cohort was 19 years. About 56.1% of the patients underwent a gross total resection (GTR) and 31.4% underwent a subtotal resection. Nearly, 76.6% of the patients had a Grade II tumor and adjuvant radiation was delivered in 27.4% of the patients. Estimated 2- and 5-year progression-free survival (PFS) were 68.5 and 51.2%, respectively. Age, grade, and extent of surgery were significant factors affecting PFS. Estimated 2- and 5-year overall survival (OS) was 88.8 and 78%, respectively. The median OS for Grade II and Grade III tumors were 209 and 49 months, respectively. Age and extent of surgery were significant factors affecting OS. Conclusion XA is a disease of young adults with favorable prognosis. Younger patients (<20 years), patients who undergo a GTR, and patients with a lower grade tumor have a better treatment outcome.
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Affiliation(s)
- Supriya Mallick
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Prashanth Giridhar
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rony Benson
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Wineeta Melgandi
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Goura Kishor Rath
- Department of Radiation Oncology, B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Demirci Otluoğlu G, Özek MM. A rare clinical presentation: a pleomorphic xanthoastrocytoma presenting with intracerebral haemorrhage and metastasizing vigorously-case report and review of the literature. Childs Nerv Syst 2019; 35:355-362. [PMID: 30182181 DOI: 10.1007/s00381-018-3960-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 08/20/2018] [Indexed: 11/29/2022]
Abstract
Metastasis of an intracranial tumour is not a common situation in our daily neurosurgical practice. Pleomorphic xanthoastrocytoma is also a rare glial tumour with relatively a favourable prognosis among other CNS pathologies. Here, we present an anaplastic pleomorphic xanthoastrocytoma case which shows both haematogenous and lymphatic metastasis which is described first time in the up-to-date literature. Our case is a 17-year-old male operated for a right occipital intra-axial lesion with a diagnosis of anaplastic pleomorphic xanthoastrocytoma which recurs 5 years later and metastasize vigorously through haematogenous and lymphatic routes. A rare-presenting symptom for this pathology is also intracerebral haemorrhage. This is the ninth case report in the literature which presents initially with this entity.
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Affiliation(s)
- Gülden Demirci Otluoğlu
- Division of Pediatric Neurosurgery, Acıbadem University School of Medicine, Altunizade Mah. Yurtcan Sk. NO:1, 34662, Üsküdar/İstanbul, Turkey.
| | - M Memet Özek
- Division of Pediatric Neurosurgery, Acıbadem University School of Medicine, Altunizade Mah. Yurtcan Sk. NO:1, 34662, Üsküdar/İstanbul, Turkey
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Primary anaplastic pleomorphic xanthoastrocytoma in adults. Case report and review of literature. Int J Surg Case Rep 2016; 27:183-188. [PMID: 27639203 PMCID: PMC5026690 DOI: 10.1016/j.ijscr.2016.08.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 08/09/2016] [Accepted: 08/15/2016] [Indexed: 12/02/2022] Open
Abstract
A case report and literature review of anaplastic pleomorphic xanthoastrocytoma in adults. The tumor shows an aggressive clinical course compared with its benign variant. APXA shows histological characteristics comparable with grade III astrocytomas.
Background Pleomorphic xanthoastrocytoma (PXA) classified as a low Grade (WHO II) astrocytic neoplasm. It is known for its relatively favorable prognosis. It most commonly occurs in young adults. Malignant progression in PXA has been frequently reported since its first description in 1979; however, the presentation of a primary anaplastic PXA tumor with an aggressive clinical course in adults is rare especially in the later age group. Case description We present a case of primary anaplastic PXA in a 53 year old male that manifested with an early recurrence pattern at 9 weeks. Treatment performed was surgical excision and external beam radiotherapy. The aforementioned tumor followed an aggressive clinical course. Tumor cells exhibited the characteristic expression of GFAP (Glial fibrillary acidic protein), higher proliferative index (8–10%) on Ki-67 staining along with the presence of increased mitoses ( >5/10hpf). A review of previously reported primary anaplastic pleomorphic xanthoastrocytoma cases in adults with histological features was also done. Conclusion Our review of all reported cases of APXA in adults concludes that the clinical behavior of this tumor varies considerably from its benign variant. Early disease recurrence in anaplastic pleomorphic xanthoastrocytomas is associated with fatal outcomes. As per our review of literature it is seen that anaplastic variant of PXA shows histological characteristics as well as clinical course comparable with Grade III astrocytomas. We recommend further evaluation of PXA with anaplastic features regarding their genetic characteristics to understand the origin as well as behavior of this tumor.
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A case of osteoclast-like giant cell-rich epithelioid glioblastoma with BRAF V600E mutation. Brain Tumor Pathol 2015; 33:57-62. [PMID: 26602910 DOI: 10.1007/s10014-015-0239-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Abstract
Epithelioid glioblastomas (E-GBMs) are rare, highly aggressive tumors consisting of closely packed tumor cells with smooth, round cell borders and abundant eosinophilic cytoplasm. They tend to affect younger patients compared with conventional GBM. BRAF V600E mutation is characteristically found in approximately 50% of all E-GBMs, compared with a low frequency of this mutation in conventional GBM. Here, we report an unusual case of glioma involving the right frontal lobe, basal ganglia and thalamus in an HIV-positive 30-year-old man on antiretroviral therapy. The lesion was composed of abundant discohesive, monotonous epithelioid cells with extensive necrosis, spindle and polyhedral cells, low-grade oligoastrocytoma-like areas, sarcomatous components, and numerous osteoclast-like giant cells (OLGCs) intermingled with epithelioid tumor cells. As the epithelioid cells accounted for more than one-third of the tumor, a pathological diagnosis of E-GBM was made. BRAF V600E mutation was detected in both oligoastrocytoma-like and epithelioid cell components. Similar to previously reported findings on E-GBM associated with low-grade glioma, this case suggested that low-grade astrocytic glioma with BRAF V600E mutation progressed to E-GBM. OLGCs are rarely observed in gliomas, and this is the first case report of E-GBM associated with abundant OLGC infiltration.
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Ida CM, Rodriguez FJ, Burger PC, Caron AA, Jenkins SM, Spears GM, Aranguren DL, Lachance DH, Giannini C. Pleomorphic Xanthoastrocytoma: Natural History and Long-Term Follow-Up. Brain Pathol 2014; 25:575-86. [PMID: 25318587 DOI: 10.1111/bpa.12217] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/08/2014] [Indexed: 12/13/2022] Open
Abstract
Prognostic significance of histological anaplasia and BRAF V600E mutation were retrospectively evaluated in 74 patients with pleomorphic xanthoastrocytoma (PXA). Median age at diagnosis was 21.5 years (31 pediatric, 43 adult) and median follow-up 7.6 years. Anaplasia (PXA-AF), defined as mitotic index ≥ 5/10 HPF and/or presence of necrosis, was present in 33 cases. BRAF V600E mutation was detected in 39 (of 60) cases by immunohistochemical and/or molecular analysis, all negative for IDH1 (R132H). Mitotic index ≥ 5/10 HPF and necrosis were associated with decreased overall survival (OS; P = 0.0005 and P = 0.0002, respectively). In all cases except two, necrosis was associated with mitotic index ≥ 5/10 HPF. Patients with BRAF V600E mutant tumors had significantly longer OS compared with those without BRAF V600E mutation (P = 0.02). PXA-AF patients, regardless of age, had significantly shorter OS compared with those without (P = 0.0003). Recurrence-free survival was significantly shorter for adult PXA-AF patients (P = 0.047) only. Patients who either recurred or died ≤ 3 years from diagnosis were more likely to have had either PXA-AF at first diagnosis (P = 0.008) or undergone a non-gross total resection procedure (P = 0.004) as compared with patients who did not. This study provides further evidence that PXA-AF behaves more aggressively than PXA and may qualify for WHO grade III "anaplastic" designation.
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Affiliation(s)
- Cristiane M Ida
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Peter C Burger
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Alissa A Caron
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sarah M Jenkins
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Grant M Spears
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Montano N, Papacci F, Cioni B, Gaudino S, Della Pepa GM, Conforti G, Bonaventura RD, Novello M, Lauriola L, Meglio M. Primary multicentric anaplastic pleomorphic xanthoastrocytoma with atypical features. J Clin Neurosci 2013; 20:1605-8. [DOI: 10.1016/j.jocn.2012.09.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 09/04/2012] [Accepted: 09/11/2012] [Indexed: 10/26/2022]
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Dabner M, Robbins P, Thomas A. Sarcomatoid transformation of a pleomorphic xanthoastrocytoma. Pathology 2012. [DOI: 10.1016/s0031-3025(16)32745-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vu TM, Liubinas SV, Gonzales M, Drummond KJ. Malignant potential of pleomorphic xanthoastrocytoma. J Clin Neurosci 2011; 19:12-20. [PMID: 22137880 DOI: 10.1016/j.jocn.2011.07.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 07/14/2011] [Accepted: 07/16/2011] [Indexed: 10/14/2022]
Abstract
Pleomorphic xanthoastrocytoma (PXA) is a low-grade astrocytic tumour that occasionally progresses to a higher grade. We have extensively reviewed the literature on the potential for malignant transformation of PXA. An illustrative case of a PXA transforming to glioblastoma multiforme is presented.
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Affiliation(s)
- Tamara M Vu
- Department of Neurosurgery, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia
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Paldino MJ, Faerber EN, Poussaint TY. Imaging tumors of the pediatric central nervous system. Radiol Clin North Am 2011; 49:589-616, v. [PMID: 21807164 DOI: 10.1016/j.rcl.2011.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Primary tumors of the central nervous system (CNS) are the second most common neoplasms in children and the leading cause of death in this patient population. The primary objective of this article is to describe the most common pediatric brain tumors and to offer an overview of their respective imaging features, primarily on magnetic resonance imaging. Precise anatomic characterization is essential for developing an appropriate differential diagnosis. Once equipped with this critical information, physicians should be better able to make firm diagnoses, leading to improved disease management and patient outcomes in the setting of CNS tumors of childhood.
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Affiliation(s)
- Michael J Paldino
- Division of Neuroradiology, Department of Radiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
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Vajtai I, Stibal A, von Gunten M, Kappeler A, Vassella E, Frank S. Glycogen-rich pleomorphic xanthoastrocytoma with clear-cell features: confirmatory report of a rare variant with implications for differential diagnosis. Pathol Res Pract 2011; 207:256-61. [PMID: 21282017 DOI: 10.1016/j.prp.2010.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 12/20/2010] [Indexed: 10/18/2022]
Abstract
Central nervous system space-occupying lesions with clear-cell features encompass a nosologically heterogeneous array, ranging from reactive histiocytic proliferations to neuroepithelial or meningothelial neoplasms of various grades and to metastases. In the face of such differential diagnostic breadth, recognizing cytoplasmic lucency as part of the morphological spectrum of some low grade gliomas will directly have an impact on patient care. We describe a prevailing clear-cell change in an epileptogenic left temporal pleomorphic xanthoastrocytoma surgically resected from a 36-year-old man. Mostly subarachnoid and focally calcified, the tumor was composed of fascicles of moderately atypical spindle cells with optically lucent cytoplasm that tended to intermingle with a desmoplastic mesh of reticulin fibers. Immunohistochemically, coexpression of S100 protein, vimentin, GFAP, and CD34 was noted. Conversely, neither punctate staining for EMA nor positivity for CD68 was seen. Mitotic activity was absent, and the MIB1 labeling index was 2-3% on average. Diastase-sensitive PAS-positive granula indicated clear-cell change to proceed from glycogen storage. Electron microscopy showed tumor cell cytoplasm to be largely obliterated by non-lysosomal-bound pools of glycogen, while hardly any fat vacuole was encountered. Neither ependymal-derived organelles nor annular lamellae suggesting oligodendroglial differentiation were detected. The latter differential diagnosis was further invalidated by lack of codeletion of chromosomal regions 1p36 and 19q13 on molecular genetic testing. By significantly interfering with pattern recognition as an implicit approach in histopathology, clear-cell change in pleomorphic xanthoastrocytoma is likely to suspend its status as a "classic", and to prompt more deductive differential diagnostic strategies to exclude look-alikes, especially clear-cell ependymoma and oligodendroglioma.
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Affiliation(s)
- Istvan Vajtai
- Neuropathology Service, Institute of Pathology, University of Bern, Bern, Switzerland.
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TSUTSUMI S, ABE Y, YASUMOTO Y, ITO M. Anaplastic Pleomorphic Xanthoastrocytoma With a Component of Anaplastic Astrocytoma Presenting as Skull Base Tumor Followed by Downward Extracranial Extension -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:1108-12. [DOI: 10.2176/nmc.50.1108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Satoshi TSUTSUMI
- Department of Neurological Surgery, Juntendo University Urayasu Hospital
| | - Yusuke ABE
- Department of Neurological Surgery, Juntendo University Urayasu Hospital
| | - Yukimasa YASUMOTO
- Department of Neurological Surgery, Juntendo University Urayasu Hospital
| | - Masanori ITO
- Department of Neurological Surgery, Juntendo University Urayasu Hospital
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