Astroblastoma. Case report, review of the literature, and analysis of treatment strategies.
Astroblastoma, a unique glial tumor, has been described in the literature in case reports and small series. Its rarity has prevented evidenced-based treatment stratification. An 8-year-old boy presented with signs and symptoms of raised intracranial pressure. Imaging studies of the brain demonstrated a large heterogeneously enhancing solid mass in the left frontal lobe with punctate calcifications and cystic components that created subfalcine and uncal herniation. After tumor resection, histological diagnosis revealed a high-grade cerebral astroblastoma. The child's postoperative recovery was complicated by hydrocephalus that necessitated placement of a ventriculoperitoneal shunt. Fifty-four months after undergoing gross total resection and adjuvant radiation therapy, the patient, now 12-years-old, remains tumor free and neurologically stable. Chemotherapy was reserved in the event of tumor recurrence. Since the first description of astroblastoma, its histopathological and clinical features have been debated. We review the histology, immunohistochemistry, and cytogenetics of astroblastoma as well as examine the current literature and treatment strategies for the management of both low and high-grade tumors. Continued clinical studies and longer patient follow-up with a tumor based registry would further clarify optimal treatment for this rare tumor.
Mangano
F T
FT
Department of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45267-0515, USA. editor@mayfieldclinic.com
Bradford
A C
AC
Mittler
M A
MA
Valderrama
E
E
Schneider
S J
SJ
D000367:Age Factors; D014408:Biomarkers, Tumor / Q000032:analysis / Q000378:metabolism; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology; D001932:Brain Neoplasms / Q000473:pathology* / Q000503:physiopathology* / Q000628:therapy; D002648:Child; D002869:Chromosome Aberrations; D004252:DNA Mutational Analysis; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D019586:Intracranial Hypertension / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D018302:Neoplasms, Neuroepithelial / Q000473:pathology* / Q000503:physiopathology* / Q000628:therapy; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011878:Radiotherapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt
D014408:Biomarkers, Tumor