Astrocytoma

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Definition

  • SOL that exhibit purely astrocytic differentiation can be separated into two major categories: diffuse (or infiltrating) and circumscribed.
  • Complete surgical resection is rarely attained with diffuse astrocytoma because of the inherently infiltrative nature of the neoplastic cells, which extend well beyond the apparent gross margin of the tumor.

Diffuse astrocytoma (WHO II)

Pathology

  • Mildly hypercellular, infiltrative
  • well-differentiated, spindle- to stellate-shaped astrocytes w/ minimal nuclear atypia
  • separated by a loosely fibrillary (± microcystic) background.
  • Nuclei are characteristically irregular, angulated, and hyperchromatic.
  • Mitotic figures are either absent or rare,
  • no vascular proliferation or necrosis.
  • Glial fibrillary acidic protein (GFAP) may be highly or weakly expressed.

Morphologic subtypes

Two morphologic subtypes are recognized: protoplasmic and gemistocytic.

FeatureProtoplasmic AstrocytomaGemistocytic Astrocytoma
Cell SizeSmall tumor cellsLarge rounded neoplastic astrocytes
CytoplasmScantCopious amount of glassy eosinophilic cytoplasm
GFAP ExpressionWeakly expressedStrongly positive
Nuclear LocationNot specifically mentionedEccentrically located nucleus
BackgroundFrequently associated with a myxoid or microcystic backgroundNot specifically mentioned
Cell ShapeNot specifically mentionedPredominantly gemistocytic
BehaviorNot specifiedDespite benign appearance, intrinsic tendency to progress
Morphological AppearanceComposed of well-differentiated, spindle- to stellate-shaped astrocytesComposed of a predominant population of neoplastic astrocytes