This document discusses astrocytoma, a type of brain tumor. It begins by describing a patient case and then defines astrocytomas as tumors derived from astrocyte cells in the brain or spinal cord. Astrocytes normally provide support to neurons. The document grades astrocytomas from I to IV based on malignancy. Grade IV, glioblastoma multiforme, is the most malignant and common. While causes are unknown, risk factors include prior radiation exposure and genetic conditions. Higher grade tumors appear more irregular and have abnormal cell growth. Symptoms depend on the location and severity of invasion in the brain. Prognosis for glioblastoma is poor, with average survival being 15 months after optimal treatment.

1. ASTROCYTOMA
Zagada, Timothy M.

2. CASE
• 34 year old male
• Has recurrent severe headache of 8 weeks
• Initially relieved by Mefenamic Acid.
• 1 day PTA, the patient noted weakness of the left upper
extremity.
• Few minutes PTA, he had seizures thus consulted and
subsequently admitted.
• CT Scan revealed a mass over the right cerebral
hemisphere.

3. • Glioma- most common group of primary brain tumors
• Glial cells- support and protection for neurons. They are
thus known as the "supporting cells" of the nervous
system
Four main functions of glial cells:
1. To surround neurons and hold them in place
2. To supply nutrients and oxygen to neurons
3. To insulate one neuron from another
4. To destroy pathogens and remove dead neurons.

4. • Astrocyte- star-shaped glial cells in the brain and spinal cord.
• the most abundant cell of the human brain.
• many functions, including
• biochemical support of endothelial cells that form the blood–brain
barrier
• provision of nutrients to the nervous tissue
• maintenance of extracellular ion balance
• role in the repair and scarring process of the brain and spinal cord
following traumatic injuries.
• Astrocytoma- derived from an immortalized astrocyte

5. ETIOLOGY
• The exact cause is unknown
• Astrocytomas of all grades have been associated with
cranial therapeutic irradiation
• People who have certain rare genetic conditions such as
neurofibromatosis or Li-Fraumeni syndrome
• People over the age of 65 are diagnosed with brain
cancer at a rate four times higher than younger people.

6. Etiology
• mutations affecting p53
• overexpression of platelet-derived growth
factor α (PDGF-A) and its receptor
• Disruption of tumor suppressor genes
• RB and p16/CDKNaA
• tumor suppressor on chromosome 19q
most common in
the low-grade
astrocytomas
transition to higher
grade astrocytoma

7. Grading
Grade Astrocytoma Description
I
Pilocytic
astrocytoma
Slow growing astrocytomas, benign, and
associated with long-term survival.
II
Low-grade
(fibrillary)
astrocytoma
Consist of relatively slow-growing astrocytomas,
usually considered benign that sometimes evolve
into more malignant or as highergrade tumors.
III
Anaplastic
astrocytoma
It is often related to seizures, neurologic deficits,
headaches, or changes in mental status.
IV
Glioblastoma
multiforme (GBM)
Most malignant primary brain tumor. Grow and
spread to other parts of the brain quickly; they
can become very large before producing
symptom, which often begin abruptly

8. MORPHOLOGY
• Low grade astrocytomas
appear as greyish white areas
in the cerebral or cerebellar
hemisphere that tend to
"erase" normal structures and
enlarge the area in which they
arise
• High grade astrocytomas such
as the glioblastoma multiforme
are multiform in their
appearance being firm to
necrotic and yellow, grey
, brown and/or hemorrhagic.

9. MORPHOLOGY
• low grade astrocytomas have
mainly oval pale nuclei with
indistinct cytoplasmic borders and
fibrillary processes with only mild
pleomorphism

10. MORPHOLOGY
• higher the grade, the more cellular, the more pleomorphic and
the more basophilic the tumor cell nuclei become.
• Glioblastoma- very pleomorphic and basophilic nuclei are seen
as are necrosis, mitotic figures and capillary endothelial
proliferation.
Tumor cells collect along the edges of the necrotic regions, producing a histologic pattern referred
to as pseudo-palisading

11. PATHOGENESIS AND
CLINICAL MANIFESTATION
• Astrocytomas act as progressive mass lesions of the brain
parenchyma causing progressive loss of function in the areas
invaded
• Brain irritation- seizures
• increased intracranial mass- headaches
• Brain invasion;
• Frontal lobe-gradual changes in mood and personality, paralysis
on one side of the body
• Temporal lobe-problems with coordination, speech, and memory
• Parietal lobe-problems with sensation, writing, or fine motor
skills
• Cerebellum-problems with coordination and balance
• Occipital lobe-problems with vision, visual hallucinations

12. What is the current prognosis for patient
with Glioblastoma multiforme?
• Prognosis for individuals with glioblastoma is very
poor, although the use of newer chemotherapeutic agents
has provided some benefit
• With current optimal treatment, consisting of :
• Resection
• Radiation therapy
• Chemotherapy
• The mean length of survival after diagnosis has increased to 15
months
• 25% of such patients are alive after 2 years.
• Survival is substantially shorter in older patients, for those with
lower performance status, and for large unresectable lesions.