Definition and Diagnostic Implications of Gemistocytic Astrocytomas: A Pathological Perspective

Tihan, Tarık; Vohra, Poonam; Berger, Mitchel S.; Keles, G. Evren

doi:10.1007/s11060-005-4897-2

Cited by 39 publications

(18 citation statements)

References 29 publications

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“…Therefore, the pathologist who did not obtain accurate clinical information misdiagnosed the infection as a gemistocytic astrocytoma and mistakenly performed postoperative radiation therapy of the remnant mass. Gemistocytes typically accompany a variety of CNS tumors and tumor-like lesions, including gemistocytic astrocytoma, oligodendroglioma with minigemistocytes, subependymal giant cell astrocytoma, astroblastoma, ependymoma, toxic/metabolic leukoencephalopathy, and reactive gliosis in demyelinating disease (Tihan et al 2006). Gemistocytes also can be found in reactive gliosis due to the infection/inflammation, as observed in our patient.…”

Section: Introductionsupporting

confidence: 78%

Migration of cerebral sparganosis to the ipsilateral cerebellar hemisphere

Eom

Kim

2009

Acta Parasitologica

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We report the case of a 52-year-old man in whom multiple conglomerated ring-enhanced lesions in the left frontal lobe were revealed on magnetic resonance imaging (MRI); further, he presented with headache. Subtotal resection of the mass was performed and the histopathological diagnosis of gemistocytic astrocytoma was made. He received postoperative radiotherapy of remnant mass. Six months post-surgery, new multiple lesions were developed on the left cerebellum and the lesion yielded radiological findings that were quite similar to those of the lesion previously observed in the left frontal lobe. Total resection was performed with the aid of neuronavigation and a live yellow 10-cm-long worm with an active scolex was found. A pathologist identified the worm as a sparganum of Spirometra mansoni. This suggests that the live worm may have moved to the ipsilateral cerebellum due to the stimulus from the surgery and radiation on the frontal lobe. Although this case presented characteristic MRI findings of sparganosis, we did not conduct a serological test; therefore, we misdiagnosed sparganosis as gemistocytic astrocytoma. To the best of our knowledge, this is the first report of the ipsilateral transtentorial migration of cerebral sparganosis.

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Section: Introductionsupporting

confidence: 78%

Migration of cerebral sparganosis to the ipsilateral cerebellar hemisphere

Eom

Kim

2009

Acta Parasitologica

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“…This variant has been shown to be more prone to malignant transformation and is associated with a shorter overall survival. 12,17,21,31,35 A study by Krouwer et al…”

Section: Discussionmentioning

confidence: 99%

Low-grade astrocytomas: the prognostic value of fibrillary, gemistocytic, and protoplasmic tumor histology

Babu

Bagley

Park

et al. 2013

JNS

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Object Low-grade astrocytomas are slow-growing, infiltrative gliomas that over time may progress into more malignant tumors. Various factors have been shown to affect the time to progression and overall survival including age, performance status, tumor size, and the extent of resection. However, more recently it has been suggested that histological subtypes (fibrillary, protoplasmic, and gemistocytic) may impact patient outcome. In this study the authors have performed a large comparative population-based analysis to examine the characteristics and survival of patients with the various subtypes of WHO Grade II astrocytomas. Methods Patients diagnosed with fibrillary, protoplasmic, and gemistocytic astrocytomas were identified through the Surveillance, Epidemiology, and End Results (SEER) database. The chi-square test and Student t-test were used to evaluate differences in patient and treatment characteristics between astrocytoma subtypes. Kaplan-Meier analysis was used to assess overall survival, and the log-rank test was used to evaluate the differences between survival curves. Univariate and multivariate analyses were also performed to determine the effect of various patient, tumor, and treatment variables on overall survival. Results A total of 500 cases were included in the analysis, consisting of 326 fibrillary (65.2%), 29 protoplasmic (5.8%), and 145 gemistocytic (29%) variants. Gemistocytic astrocytomas presented at a significantly older age than the fibrillary variant (46.8 vs 37.7 years, p < 0.0001), with protoplasmic and fibrillary subtypes having a similar age. Although protoplasmic and fibrillary variants underwent radiotherapy at similar rates, gemistocytic tumors more frequently received radiotherapy (p = 0.0001). Univariate analysis revealed older age, larger tumor size, and the use of radiotherapy to be poor prognostic factors, with resection being associated with improved survival. The gemistocytic subtype (hazard ratio [HR] 1.62 [95% CI 1.27–2.07], p = 0.0001) also resulted in significantly worse survival than fibrillary tumors. Bivariate analyses demonstrated that older age, the use of radiotherapy, and resection significantly influenced median survival. Tumor subtype also affected median survival; patients who harbored gemistocytic tumors experienced less than half the median survival of fibrillary and protoplasmic tumors (38 vs 82 months, p = 0.0003). Multivariate analysis revealed increasing age (HR 1.05 [95% CI 1.04–1.05], p < 0.0001), larger tumor size (HR 1.02 [95% CI 1.01–1.03], p = 0.0002), and the use of resection (HR 0.70 [95% CI 0.52–0.94], p = 0.018) to be independent predictors of survival. Examination of tumor subtype revealed that the gemistocytic variant (HR 1.30 [95% CI 0.98–1.74], p = 0.074) was associated with worse patient survival than fibrillary tumors, although this only approached significance. The protoplasmic subtype did not affect overall survival (p = 0.33). Conclusions Gemistocytic tumor histology was associated with worse survival than fibrillary and protoplasmic astrocytomas. As protoplasmic astrocytomas have a survival similar to fibrillary tumors, there may be limited utility to the identification of this rare variant. However, increased attention should be paid to the presence of gemistocytes in low-grade gliomas as this is associated with shorter time to progression, increased malignant transformation, and reduced overall survival.

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“…Gemistocytic astrocytoma (GA), characterized by gemistocytes with glassy, non-fibrillary cytoplasm and peripherally displaced nuclei, is delineated as a WHO grade II tumour (ICD-O 9411/3) however these tumours often behave more aggressively than other lower grade astrocytomas [89,164]. While a tumour sample containing 20% of gemistocytes is defined for a diagnosis of diffuse astrocytoma, the amount of tumour containing gemistocytic components suggesting an aggressive tumour is debatable [85,164].…”

Section: Gemistocytic Astrocytomamentioning

confidence: 99%

“…While a tumour sample containing 20% of gemistocytes is defined for a diagnosis of diffuse astrocytoma, the amount of tumour containing gemistocytic components suggesting an aggressive tumour is debatable [85,164]. In fact, this threshold of gemistocytic cells in astrocytomas has been shown to significantly impact overall and progression-free survival [85].…”

Section: Gemistocytic Astrocytomamentioning

confidence: 99%

Established and emerging variants of glioblastoma multiforme: review of morphological and molecular features

Karsy¹,

Gelbman²,

Shah³

et al. 2012

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A b s t r a c t Since the recent publication of the World Health Organization brain tumour classification guidelines in 2007, a significant expansion in the molecular understanding of glioblastoma multiforme (GBM) and its pathological as well as genomic variants has been evident. The purpose of this review article is to evaluate the histopathological, molecular and clinical features surrounding emerging and currently established GBM variants. The tumours discussed include classic glioblastoma multiforme and its four genomic variants, proneural, neural, mesenchymal, classical, as well as gliosarcoma (GS), and giant cell GBM (gcGBM). Furthermore, the emerging variants include fibrillary/epithelial GBM, small cell astrocytoma (SCA), GBM with oligodendroglial component (GBMO), GBM with primitive neuroectodermal features (GBM-PNET), gemistocytic astrocytoma (GA), granular cell astrocytoma (GCA), and paediatric high-grade glioma (HGG) as well as diffuse intrinsic pontine glioma (DIPG

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Definition and Diagnostic Implications of Gemistocytic Astrocytomas: A Pathological Perspective

Cited by 39 publications

References 29 publications

Migration of cerebral sparganosis to the ipsilateral cerebellar hemisphere

Migration of cerebral sparganosis to the ipsilateral cerebellar hemisphere

Low-grade astrocytomas: the prognostic value of fibrillary, gemistocytic, and protoplasmic tumor histology

Established and emerging variants of glioblastoma multiforme: review of morphological and molecular features

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