Astroblastoma – a rare and challenging tumor: a case report and review of the literature

Abstract

BackgroundAstroblastoma is a controversial and an extremely rare central nervous system neoplasm. Although its histogenesis has been clarified recently, controversies exist regarding its cellular origin and validity as a distinct entity. Because of its extreme rarity and because its common features are shared with other glial neoplasms, this tumor is prone to misdiagnosis and remains challenging not only in terms of diagnosis and classification but also in the subsequent management. This case report describes a new case of astroblastoma. It discusses clinical, radiologic, pathological, and therapeutic features and differential diagnosis of this rare neoplasm, with a review of the recent literature.Case presentationWe report the case of an 8-year-old Moroccan girl who presented with a 1-year history of epileptic seizure, headache, and decreased visual acuity. Cranial magnetic resonance imaging revealed a right occipito-temporal mass. A tumor resection was performed and histological examination combined with immunohistochemical study confirmed the diagnosis of low-grade astroblastoma.ConclusionsAstroblastoma is a very rare primary brain tumor. Its diagnosis is often challenging because of the astroblastic aspects that can be found in astrocytic tumors, in ependymomas, and in non-neuroepithelial tumors. Considerable confusion surrounds its histogenesis and classification. The low incidence rate makes it difficult to conduct studies to examine tumor characteristics.

A rare case of a high-grade astroblastoma with 5-year follow-up

“…[ 7 8 9 ] It is now classified under “other gliomas” in the “2016 WHO Classification of tumors in the Central Nervous system.” [ 9 ] Most of the cases fall within a bimodal distribution, with two peaks between the ages of 5–11 and 21–30; our patient falls within the second peak. [ 10 ] The tumor also shows a female predominance. [ 10 ] It usually shows up on an MRI as a solid–cystic lesion, as seen in our case.…”

“…[ 10 ] The tumor also shows a female predominance. [ 10 ] It usually shows up on an MRI as a solid–cystic lesion, as seen in our case.…”

“…Other features are the presence of perivascular pseudorosettes, spaces between the rosettes and hyalinization of vessels. [ 10 11 ] Some tumors show calcifications, but it is an uncommon finding. Many cases also show eosinophilic inclusions, such as eosinophilic granular bodies, hence boding similarity to oligodendrogliomas and astrocytomas.…”

A case report of high-grade astroblastoma in a young adult

“…However, based on bimodal age distribution, astroblastomas are common or at peak during infancy (5–10 years) and in young adults (21 and 30 years). Females are commonly diagnosed with astroblastoma with the male-to-female ratio reported at 1:11 [8].…”

“…The prognosis of low-grade astroblastoma is similar to that of low-grade gliomas. The prognosis of high-grade astroblastoma is similar to that of anaplastic astrocytomas considering the rate of progression and recurrence [15]. Unusual cases such as anaplastic astroblastoma and astroblastoma with bone invasion have also been reported in the literature [16,17].…”