title: In pursuit of prognostic factors in children with pilocytic astrocytomas.
abstract: 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.
authors.affiliation: Department of Pathology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Aline
authors.initials: A
authors.lastname: Paixão Becker
authors.forename: Ricardo Santos
authors.initials: RS
authors.lastname: de Oliveira
authors.forename: Fabiano Pinto
authors.initials: FP
authors.lastname: Saggioro
authors.forename: Luciano
authors.initials: L
authors.lastname: Neder
authors.forename: Leila Maria Cardão
authors.initials: LM
authors.lastname: Chimelli
authors.forename: Hélio Rubens
authors.initials: HR
authors.lastname: Machado
mesh_terms: 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
chemical_list: D037502:Galectin 3; D019394:Ki-67 Antigen