In pursuit of prognostic factors in children with pilocytic astrocytomas.
OBJECTIVE
This study described a 23-year experience in the treatment of children with pilocytic astrocytomas (piloA) with the aim of identifying putative clinical, histopathological, and/or immunohistochemical features that could be related to the outcome of these patients.


METHODS
Clinical data of 31 patients under 18 years of age with piloA were obtained from 1984 to 2006.


RESULTS
The mean age at the time of surgery was 7.8 +/- 4.2 years (1 to 17 years), and the mean follow-up was 5.7 +/- 5.4 years (1 to 20 years). The most common site of tumor formation was the cerebellum (17), followed by brainstem (4), optic chiasmatic hypothalamic region (4), cerebral hemisphere (3), cervical spinal cord (2), and optic nerve (1). Gross total resection (GTR) was achieved in 23 (74.1%), mainly in those with tumors located in the cerebellum and cerebral hemispheres (P = 0.02). The global mortality rate was 6.4%. Nine patients were reoperated. Rosenthal fibers, eosinophilic granular bodies, microvascular proliferation, and lymphocytic infiltration were observed in most cases. The mean Ki-67LI was 4.4 +/- 4.5%. In all cases, Gal-3 expression in tumor cells was observed with variable staining pattern.


CONCLUSIONS
Aside from GTR, no other clinical, histopathological, or immunohistochemical features were found to be related to the prognosis. We postulate that strict follow-up is recommended if piloA is associated with high mitotic activity/Ki67-LI, or if GTR cannot be achieved at surgery. Tumor recurrence or progression of the residual lesion should be strictly observed. In some aspects, childhood piloA remains an enigmatic tumor.
Paixão Becker
Aline
A
Department of Pathology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil.
de Oliveira
Ricardo Santos
RS
Saggioro
Fabiano Pinto
FP
Neder
Luciano
L
Chimelli
Leila Maria Cardão
LM
Machado
Hélio Rubens
HR
D000293:Adolescent; D001254:Astrocytoma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D037502:Galectin 3 / Q000378:metabolism; D006801:Humans; D007223:Infant; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D011379:Prognosis; D011859:Radiography; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013120:Spinal Cord Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome
D037502:Galectin 3; D019394:Ki-67 Antigen