Astrocytoma II

Diffuse Astrocytoma

Diffuse Astrocytoma are well differentiated at cellular level and grow slowly and without sharp borders into the surrounding brain tissue. They are ascribed to WHO grade II and are classified as less benign tumours. Many of the diffuse astrocytoma show a malignant transformation over the years.
 

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Histology of Diffuse Astrocytoma

  • fibrillar astrocytoma: permeated from glia fibres, middle cell desity protoplasmic
  • astrocytoma: no increase of glia fibres, middle cell density gemistocytic
  • astrocytoma: comprise much cytoplasm, high cell density

 

Epidemology of Diffuse Astrocytoma

  • peak age between 30 and 40
  • occur in less than 10 % of patients under 20 years
  • men are effected a little more often

 

Symptoms of Diffuse Astrocytoma

  • strongly depending on localisation of the tumour
  • main symptom: epileptic seizures
  • signs of intracranial pressure (headache, nausea, emesis, lethargy)
  • <mental disorders (changes in personality</li>
  • neurological deficits (sensory disturbances, pain, paralysis)
  • many patients are symptom free for a long time before first symptoms occur

 

Diagnosing Diffuse Astrocytoma

  • MRI, CT and biopsy
  • possibly additional PET- and SPECT examinations
  • not contrast-enhancing and not clearly defined
  • sometimes small edema
  • in few cases calcification, cysts and small contrast-enhancing areas)
  • main location: frontal- and temporal lobe, but can occur in the whole central nervous system
  • more frequent in patients with neurofibromatosis type I
  • erroneous diagnosis: stroke

 

Therapy of Diffuse Astrocytoma

  • complete as possible surgical removal
  • possibly radiotherapy
  • in small children rather chemotherapy than radiation

 

Therapy of Recurrent Diffuse Astrocytoma

  • re-operation
  • (second) irradiation
  • chemotherapy with different drugs
  • experimental treatments

 

Aftercare of Diffuse Astrocytoma

  • postoperative imaging 72 after surgery to determine further therapy
  • next imaging six weeks after therapy (MRI)
  • subsequently every three months, if results are steady every six months
  • in individual cases neurological examinations
  • in case of progression or contrast-enhancement additional PET or SPECT

 

Course of Diffuse Astrocytoma

  • mostly lokal infiltrating growth
  • tend to transformation into a higher graded glioma (anaplastic astrocytoma, glioblastoma)

 

Prognosis of Diffuse Astrocytoma

  • depending on histology, localisation and surgical removal oft he tumour
  • fibrillar astrocytoma has a favourable prognosis than gemistocytic astrocytoma

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