Anaplastic Astrocytoma

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Contents 1 Introduction 2 Pathology 3 Genetics 4 Radiology 5 Complications 6 Management 7 More General Terms 8 References

Introduction

• Astrocytoma with anaplasia (Grade 3).

Pathology

• increased cellularity
• nuclear atypia
• mitoses
• tend to progress to glioblastoma

Genetics

• chromosome 9p loss in 50% of anaplastic astrocytomas & GBMs primarily affecting CDKN2A gene
• chromosome 13q loss in 1/3 - 1/2 of high grade astrocytomas RB gene inactivated in 20% of anaplastic astrocytomas, 35% GBMs
• chromosome 12q13-14 amplification in 15% malignant gliomas including gene for CDK4
• allelic loss on chromosome 19q in up to 40% of anaplastic astrocytomas and GBMs
• diminished or absent expression of PHF3

Radiology

• magnetic resonance imaging ( MRI)
• computed tomography ( CT)
• in general, higher grade astrocytic tumors show contrast enhancement

Complications

• 
  
• disease interaction(s) of cancer with Alzheimer's disease

Management

• radiation

• prolongs survival
• 5000-6500 cGy
• administered in multiple fractions to an area around the tumor
• radiation necrosis may produce clinical picture indistinguishable from recurrent high-grade tumor

• dexamethasone

• administered with radiation therapy
• tapered to lowest dose after radiation

• chemotherapy ( BCNU, CCNU) combined with radiation

• treatment of choice [1] (marginally effective [2])

• surgery

• surgical excision is not possible because anaplastic astrocytomas infiltrate adjacent brain tissue
• may be useful to reduce mass effect
• stereotaxic radiosurgery with gamma knife

• potential for tumor abalation
• useful for tumors < 3 cm in diameter

• prognosis: 50% survival of 12 months (with radiation)

More General Terms

• malignant neoplasm (cancer)
• astrocytoma (astrocytic neoplasm)

References

1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
2. Harrison's Online, Chapter 370, McGraw-Hill, 2002

anaplastic astrocytoma (grade 3)