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.

Feature Protoplasmic Astrocytoma Gemistocytic Astrocytoma
Cell Size Small tumor cells Large rounded neoplastic astrocytes
Cytoplasm Scant Copious amount of glassy eosinophilic cytoplasm
GFAP Expression Weakly expressed Strongly positive
Nuclear Location Not specifically mentioned Eccentrically located nucleus
Background Frequently associated with a myxoid or microcystic background Not specifically mentioned
Cell Shape Not specifically mentioned Predominantly gemistocytic
Behavior Not specified Despite benign appearance, intrinsic tendency to progress
Morphological Appearance Composed of well-differentiated, spindle- to stellate-shaped astrocytes Composed of a predominant population of neoplastic astrocytes

Gemistocytic Astrocytoma

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