FEU FEU- -NRMF nstitute of Medicine NRMF nstitute of Medicine A8TROCYTOMA A Lype of neoplasm of Lhe braln CrlglnaLe ln a parLlcular klnd of gllalcells sLarshaped braln cells ln Lhe cerebrum called asLrocyLes usually found ln Lhe cerebral hemlspheres MosL ofLen ln Lhe 46 Lh decades Introduct|on Lt|o|ogy Grad|ng scheme Morpho|ogy C||n|ca| course athogenes|s Etiology: Etiology: All All grades have been assoclaLed grades have been assoclaLed wlLh cranlal LherapeuLlc lrradlaLlon wlLh cranlal LherapeuLlc lrradlaLlon exposure Lo pesLlcldes exposure Lo pesLlcldes nn nlLroso nlLroso compounds compounds Lndogenous Lndogenous muLaLlons caused by muLaLlons caused by Lhese agenLs or oLher causes acL Lo Lhese agenLs or oLher causes acL Lo produce produce asLrocyLomas asLrocyLomas Introduct|on Lt|o|ogy Grad|ng scheme Morpho|ogy C||n|ca| course athogenes|s JC gradlng scheme W W Crade l Crade l llocyLlc asLrocyLoma W W Crade ll Crade ll Lowgrade (dlffuse) asLrocyLoma W W CCrade lll rade lll AnaplasLlc asLrocyLoma W W Crade lv Crade lv ClloblasLoma mulLlforme (C8M) Introduct|on Lt|o|ogy Grad|ng scheme Morpho|ogy C||n|ca| course athogenes|s GRADE I: GRADE I: W lowgrowlng benlgn wlLh longLerm survlval W Macro exam CfLen cysLlc lf solld ls a well clrcumscrlbed or less lnfllLraLlve W M|cro exam JlLh blpolar cells wlLh long Lhln halrllke" processes LhaL are ClA poslLlve form dense flbrlllary meshworks 8osenLhal flbers and eoslnophlllc granular bodles are ofLen presenL W (+) surglcal removal radlaLlon GRADE I: GRADE I: W lowgrowlng benlgn wlLh longLerm survlval W Macro exam CfLen cysLlc lf solld ls a well clrcumscrlbed or less lnfllLraLlve W M|cro exam JlLh blpolar cells wlLh long Lhln halrllke" processes LhaL are ClA poslLlve form dense flbrlllary meshworks 8osenLhal flbers and eoslnophlllc granular bodles are ofLen presenL W (+) surglcal removal radlaLlon GRADE II: GRADE II: W lowgrowlng usually benlgn someLlmes evolve lnLo more mallgnanL or hlghergrade Lumors W 1umor cells peneLraLe lnLo Lhe surroundlng normal braln W Mlld Lo moderaLe lncrease ln gllal cellularlLy varlable nuclear pleomorphlsm an lnLervenlng felLwork of flne ClAposlLlve asLrocyLlc processes LhaL glve Lhe background a flbrlllary appearance GRADE II: GRADE II: W lowgrowlng usually benlgn someLlmes evolve lnLo more mallgnanL or hlghergrade Lumors W 1umor cells peneLraLe lnLo Lhe surroundlng normal braln W Mlld Lo moderaLe lncrease ln gllal cellularlLy varlable nuclear pleomorphlsm an lnLervenlng felLwork of flne ClAposlLlve asLrocyLlc processes LhaL glve Lhe background a flbrlllary appearance Introduct|on Lt|o|ogy Grad|ng scheme Morpho|ogy C||n|ca| course athogenes|s GRADE III: GRADE III: W More densely cellular have greaLer nuclear pleomorphlsm marked mlLoLlc flgures W CfLen relaLed Lo selzures neurologlc deflclLs headaches or changes ln menLal sLaLus W Landard lnlLlal LreaLmenL 8emove as much of Lhe Lumor as posslble wlLhouL worsenlng neurologlc deflclLs GRADE III: GRADE III: W More densely cellular have greaLer nuclear pleomorphlsm marked mlLoLlc flgures W CfLen relaLed Lo selzures neurologlc deflclLs headaches or changes ln menLal sLaLus W Landard lnlLlal LreaLmenL 8emove as much of Lhe Lumor as posslble wlLhouL worsenlng neurologlc deflclLs GRADE IV: GRADE IV: W lmllar Lo anaplasLlc asLrocyLoma wlLh Lhe addlLlonal feaLures of necros|s vascu|ar or endothe||a| ce|| pro||ferat|on W necrosls ln glloblasLoma ofLen occurs ln a serpenLlne paLLern ln areas of hypercellularlLy W 1umor cells collecL along Lhe edges of Lhe necroLlc reglons produclng a hlsLologlc paLLern referred Lo as pseudo pa||sad|ng GRADE IV: GRADE IV: W lmllar Lo anaplasLlc asLrocyLoma wlLh Lhe addlLlonal feaLures of necros|s vascu|ar or endothe||a| ce|| pro||ferat|on W necrosls ln glloblasLoma ofLen occurs ln a serpenLlne paLLern ln areas of hypercellularlLy W 1umor cells collecL along Lhe edges of Lhe necroLlc reglons produclng a hlsLologlc paLLern referred Lo as pseudo pa||sad|ng Introduct|on Lt|o|ogy Grad|ng scheme Morpho|ogy C||n|ca| course athogenes|s Introduct|on Lt|o|ogy Grad|ng scheme Morpho|ogy C||n|ca| course athogenes|s Introduct|on Lt|o|ogy Grad|ng scheme Morpho|ogy C||n|ca| course athogenes|s Molecular Molecular Pathogenesis: Pathogenesis: MuLaLlons ln p33 overexpresslon of uClA mosL common alLeraLlons ln Lhe lowgrade asLrocyLoma 1umor suppressor genes (k8 p16/cukNoA) Lumor suppressor on chromosome 19q are assoclaLed wlLh Lhe hlgher grade asLrocyLoma Introduct|on Lt|o|ogy Grad|ng scheme Morpho|ogy C||n|ca| course athogenes|s Molecular Pathogenesis: Molecular Pathogenesis: ClloblasLoma occur ln one of Lwo cllnlcal seLLlngs r|mary g||ob|astoma Secondary g||ob|astoma MosL commonly as new onseL dlsease 1yplcally ln older lndlvlduals ave ampllflcaLlon of MuM2 (gene LhaL encodes an lnhlblLor of p33) ave ampllfled (LCl8) genes JlLh a pasL hlsLory of lower grade asLrocyLoma ln younger paLlenLs ave p33 muLaLlons ave lncreased slgnallng Lhrough Lhe uClA recepLor Introduct|on Lt|o|ogy Grad|ng scheme Morpho|ogy C||n|ca| course athogenes|s Clinical course: Clinical course: W MosL common presenLlng slgns and sympLoms selzures headaches focal neurologlc deflclLs relaLed Lo Lhe anaLomlc slLe of lnvolvemenL W Crade ll Lhe mean survlval ls 3 years W 34 wlLhouL LreaLmenL W 70 wlLh radlaLlon Lherapy W Crade lll 18 monLhs wlLh LreaLmenL (radlaLlon and chemoLherapy) W oor prognosls for glloblasLoma W 17wks wlLhouL LreaLmenL W 37wks wlLh LreaLmenL Introduct|on Lt|o|ogy Grad|ng scheme Morpho|ogy C||n|ca| course athogenes|s