A case of astroblastoma: Radiological and histopathological characteristics and a review of current treatment options

Abstract

Background:Astroblastoma is a rare neuroepithelial tumor that often originates in the cerebral hemisphere of children and young adults. Diagnosis of this obscure neoplasm can be difficult because these tumors are so infrequently encountered and share common radiological and neuropathological features of other glial neoplasms. As such, it should be included in the differential diagnosis of astrocytoma and ependymoma if the clinical and radiographic features suggest it. Standardized treatment of astroblastomas remains under dispute because of the lack of knowledge regarding the tumor and a paucity of studies in the literature.Case Description:We present a case of a low-grade astroblastoma diagnosed in a 30-year-old female with seizures, headache, and vision changes. She underwent gross total resection and, without evidence of high-grade features, adjuvant therapy was not planned postoperatively. Post-operative surveillance suggested early recurrence, warranting referral to radiation therapy. Patient ended up expiring despite adjuvant therapy secondary to extensive recurrence and tumor metastasis.Conclusions:Astroblastoma must be considered in the differential of supratentorial tumors in children and young adults. Treatment of such, as suggested by most recent literature, includes gross total resection and adjuvant radiotherapy for lesions exhibiting high-grade features.

Astroblastoma in a Young Female Patient: A Case Report and Literature Review of Clinicopathological, Radiological and Prognostic Characteristics and Current Treatment Strategies

“…Previously, characterization of astroblastoma tumors on cranial CT has been linked to radiological features such as isodense or slightly hyper-attenuated signal to the brain parenchyma and heterogeneous enhancement with contrast administration (particularly for the solid component of the tumor) [ 5 7 8 9 10 ]. Calcifications are typically described as punctate on CT [ 7 11 ].…”

“…In addition, astroblastoma typically arise in the supratentorial location, while ependymomas usually involve the posterior fossa. The calcifications found in astroblastoma may help distinguishing it from glioblastomas [ 9 ].…”

“…Specifically, low-grade tumors are characterized by their well-delineated shape, minimal proliferation index (Ki-67), no cellular atypia and no proliferation of vascular endothelium, as opposed to high-grade tumors that express higher proliferation rate, cellular atypia and hypertrophy of the vascular endothelium [ 2 6 ]. The extent of peritumoral T2WS signal on MRI and tumor necrosis may also help differentiating the tumor grade [ 9 ]. Interestingly, high-grade astroblastomas treated with GTR may offer relatively better prognosis, indicating that histological grade alone may not always be the best predictor of clinical outcome [ 31 ].…”

“…Moreover, the preoperative peritumoral edema has been considered an unfavorable prognostic feature, which has been correlated with early recurrence or progression, particularly in low-grade astroblastomas. Specifically, comparison of recurrence rate in high- vs. low-grade astroblastomas with peritumoral edema has been demonstrated at 60% vs. 23.5% [ 9 35 ].…”

“…The cystic component demonstrate rim enhancement. Tumor associated vasogenic edema may also be present [ 5 7 8 9 10 ]. The histopathological features of astroblastoma include perivascular arrangement of neoplastic cells having thick, stout and short cytoplasmic processes with peripheral nuclei, forming pseudorosettes giving the characteristic “cartwheel” appearance [ 4 5 6 11 12 13 14 ].…”