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Anaplastic Astrocytoma
Karen L. Salzman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Anaplastic astrocytoma (AA)
            • Synonyms

              • Grade III astrocytoma, malignant astrocytoma, high-grade astrocytoma
            • Definitions

              • Diffusely infiltrating malignant astrocytoma with focal or diffuse anaplasia & marked proliferative potential

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Bahrami N et al: Molecular classification of patients with grade II/III glioma using quantitative MRI characteristics. J Neurooncol. 139(3):633-42, 2018
                                            2. Louis DN et al: cIMPACT-NOW update 2: diagnostic clarifications for diffuse midline glioma, H3 K27M-mutant and diffuse astrocytoma/anaplastic astrocytoma, IDH-mutant. Acta Neuropathol. 135(4):639-42, 2018
                                            3. Thust SC et al: Apparent diffusion coefficient for molecular subtyping of non-gadolinium-enhancing WHO grade II/III glioma: volumetric segmentation versus two-dimensional region of interest analysis. Eur Radiol. 28(9):3779-88, 2018
                                            4. Delfanti RL et al: Imaging correlates for the 2016 update on WHO classification of grade II/III gliomas: implications for IDH, 1p/19q and ATRX status. J Neurooncol. 135(3):601-9, 2017
                                            5. Gupta A et al: Pediatric thalamic gliomas: an updated review. Arch Pathol Lab Med. 141(10):1316-23, 2017
                                            6. Louis DN et al: The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 131(6):803-20, 2016
                                            7. Shin JY et al: Anaplastic astrocytoma: prognostic factors and survival in 4807 patients with emphasis on receipt and impact of adjuvant therapy. J Neurooncol. 129(3):557-565, 2016
                                            8. McCrea HJ et al: Sex, age, anatomic location, and extent of resection influence outcomes in children with high-grade glioma. Neurosurgery. 77(3):443-52, 2015
                                            9. Nayak L et al: Radiotherapy and temozolomide for anaplastic astrocytic gliomas. J Neurooncol. 123(1):129-34, 2015
                                            10. Ogura R et al: Immunohistochemical profiles of IDH1, MGMT and P53: Practical significance for prognostication of patients with diffuse gliomas. Neuropathology. 35(4):324-35, 2015
                                            11. Reuss DE et al: Adult IDH wild type astrocytomas biologically and clinically resolve into other tumor entities. Acta Neuropathol. 130(3):407-17, 2015
                                            12. Speirs CK et al: Impact of 1p/19q codeletion and histology on outcomes of anaplastic gliomas treated with radiation therapy and temozolomide. Int J Radiat Oncol Biol Phys. 91(2):268-76, 2015
                                            13. Gempt J et al: Multimodal imaging in cerebral gliomas and its neuropathological correlation. Eur J Radiol. 83(5):829-34, 2014
                                            14. Minniti G et al: IDH1 mutation and MGMT methylation status predict survival in patients with anaplastic astrocytoma treated with temozolomide-based chemoradiotherapy. J Neurooncol. 118(2):377-83, 2014
                                            15. Rusthoven CG et al: The impact of adjuvant radiation therapy for high-grade gliomas by histology in the United States population. Int J Radiat Oncol Biol Phys. 90(4):894-902, 2014
                                            16. Koukourakis GV et al: Temozolomide with radiation therapy in high grade brain gliomas: pharmaceuticals considerations and efficacy; a review article. Molecules. 14(4):1561-77, 2009
                                            17. Attenello FJ et al: Use of Gliadel (BCNU) wafer in the surgical treatment of malignant glioma: a 10-year institutional experience. Ann Surg Oncol. 15(10):2887-93, 2008
                                            18. Hirai T et al: Prognostic value of perfusion MR imaging of high-grade astrocytomas: long-term follow-up study. AJNR Am J Neuroradiol. 29(8):1505-10, 2008
                                            19. Iwamoto FM et al: Clinical relevance of 1p and 19q deletion for patients with WHO grade 2 and 3 gliomas. J Neurooncol. 88(3):293-8, 2008
                                            20. Moulding HD et al: Revisiting anaplastic astrocytomas I: an expansive growth pattern is associated with a better prognosis. J Magn Reson Imaging. 28(6):1311-21, 2008
                                            21. Paulino AC et al: Radiation-induced malignant gliomas: is there a role for reirradiation? Int J Radiat Oncol Biol Phys. 71(5):1381-7, 2008
                                            22. Walid MS et al: Cerebellar anaplastic astrocytoma in a teenager with Ollier Disease. J Neurooncol. 89(1):59-62, 2008
                                            23. Louis DN et al (eds): WHO classification of tumours of the central nervous system: anaplastic astrocytoma. Lyon, France: IARC Press. 30-2, 2007
                                            24. Louis DN et al: The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 114(2):97-109, 2007; Erratum in: Acta Neuropathol. 114(5):547, 2007
                                            25. Jellison BJ et al: Diffusion tensor imaging of cerebral white matter: a pictorial review of physics, fiber tract anatomy, and tumor imaging patterns. AJNR Am J Neuroradiol. 25(3):356-69, 2004
                                            26. Tortosa A et al: Prognostic implication of clinical, radiologic, and pathologic features in patients with anaplastic gliomas. Cancer. 97(4):1063-71, 2003
                                            27. Burger PC et al: Surgical pathology of the nervous system and its coverings: the brain: tumors. 4th ed. Philadelphia: Churchill Livingstone. 177-80, 2002
                                            28. Ironside JW et al: Diagnostic pathology of nervous system tumours: astrocytic tumors. 1st ed. Edinburgh: Churchill Livingstone. 53-120, 2002
                                            29. Mori S et al: Brain white matter anatomy of tumor patients evaluated with diffusion tensor imaging. Ann Neurol. 51(3):377-80, 2002
                                            30. Nelson SJ et al: Characterization of untreated gliomas by magnetic resonance spectroscopic imaging. Neuroimaging Clin N Am. 12(4):599-613, 2002
                                            31. Provenzale JM et al: Comparison of permeability in high-grade and low-grade brain tumors using dynamic susceptibility contrast MR imaging. AJR Am J Roentgenol. 178(3):711-6, 2002
                                            32. Wong TZ et al: Positron emission tomography imaging of brain tumors. Neuroimaging Clin N Am. 12(4):615-26, 2002
                                            33. Wild-Bode C et al: Molecular determinants of glioma cell migration and invasion. J Neurosurg. 94(6):978-84, 2001
                                            34. Castillo M et al: Correlation of myo-inositol levels and grading of cerebral astrocytomas. AJNR Am J Neuroradiol. 21(9):1645-9, 2000
                                            35. Kleihues P et al: Pathology and genetics of tumours of the nervous system: Anaplastic astrocytoma. Lyon: IARC Press. 27-8, 2000
                                            36. Rutherford GS et al: Contrast enhanced imaging is critical to glioma nosology and grading. IJNR 1:28-38, 1995
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Anaplastic astrocytoma (AA)
                                                      • Synonyms

                                                        • Grade III astrocytoma, malignant astrocytoma, high-grade astrocytoma
                                                      • Definitions

                                                        • Diffusely infiltrating malignant astrocytoma with focal or diffuse anaplasia & marked proliferative potential

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Bahrami N et al: Molecular classification of patients with grade II/III glioma using quantitative MRI characteristics. J Neurooncol. 139(3):633-42, 2018
                                                                                      2. Louis DN et al: cIMPACT-NOW update 2: diagnostic clarifications for diffuse midline glioma, H3 K27M-mutant and diffuse astrocytoma/anaplastic astrocytoma, IDH-mutant. Acta Neuropathol. 135(4):639-42, 2018
                                                                                      3. Thust SC et al: Apparent diffusion coefficient for molecular subtyping of non-gadolinium-enhancing WHO grade II/III glioma: volumetric segmentation versus two-dimensional region of interest analysis. Eur Radiol. 28(9):3779-88, 2018
                                                                                      4. Delfanti RL et al: Imaging correlates for the 2016 update on WHO classification of grade II/III gliomas: implications for IDH, 1p/19q and ATRX status. J Neurooncol. 135(3):601-9, 2017
                                                                                      5. Gupta A et al: Pediatric thalamic gliomas: an updated review. Arch Pathol Lab Med. 141(10):1316-23, 2017
                                                                                      6. Louis DN et al: The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 131(6):803-20, 2016
                                                                                      7. Shin JY et al: Anaplastic astrocytoma: prognostic factors and survival in 4807 patients with emphasis on receipt and impact of adjuvant therapy. J Neurooncol. 129(3):557-565, 2016
                                                                                      8. McCrea HJ et al: Sex, age, anatomic location, and extent of resection influence outcomes in children with high-grade glioma. Neurosurgery. 77(3):443-52, 2015
                                                                                      9. Nayak L et al: Radiotherapy and temozolomide for anaplastic astrocytic gliomas. J Neurooncol. 123(1):129-34, 2015
                                                                                      10. Ogura R et al: Immunohistochemical profiles of IDH1, MGMT and P53: Practical significance for prognostication of patients with diffuse gliomas. Neuropathology. 35(4):324-35, 2015
                                                                                      11. Reuss DE et al: Adult IDH wild type astrocytomas biologically and clinically resolve into other tumor entities. Acta Neuropathol. 130(3):407-17, 2015
                                                                                      12. Speirs CK et al: Impact of 1p/19q codeletion and histology on outcomes of anaplastic gliomas treated with radiation therapy and temozolomide. Int J Radiat Oncol Biol Phys. 91(2):268-76, 2015
                                                                                      13. Gempt J et al: Multimodal imaging in cerebral gliomas and its neuropathological correlation. Eur J Radiol. 83(5):829-34, 2014
                                                                                      14. Minniti G et al: IDH1 mutation and MGMT methylation status predict survival in patients with anaplastic astrocytoma treated with temozolomide-based chemoradiotherapy. J Neurooncol. 118(2):377-83, 2014
                                                                                      15. Rusthoven CG et al: The impact of adjuvant radiation therapy for high-grade gliomas by histology in the United States population. Int J Radiat Oncol Biol Phys. 90(4):894-902, 2014
                                                                                      16. Koukourakis GV et al: Temozolomide with radiation therapy in high grade brain gliomas: pharmaceuticals considerations and efficacy; a review article. Molecules. 14(4):1561-77, 2009
                                                                                      17. Attenello FJ et al: Use of Gliadel (BCNU) wafer in the surgical treatment of malignant glioma: a 10-year institutional experience. Ann Surg Oncol. 15(10):2887-93, 2008
                                                                                      18. Hirai T et al: Prognostic value of perfusion MR imaging of high-grade astrocytomas: long-term follow-up study. AJNR Am J Neuroradiol. 29(8):1505-10, 2008
                                                                                      19. Iwamoto FM et al: Clinical relevance of 1p and 19q deletion for patients with WHO grade 2 and 3 gliomas. J Neurooncol. 88(3):293-8, 2008
                                                                                      20. Moulding HD et al: Revisiting anaplastic astrocytomas I: an expansive growth pattern is associated with a better prognosis. J Magn Reson Imaging. 28(6):1311-21, 2008
                                                                                      21. Paulino AC et al: Radiation-induced malignant gliomas: is there a role for reirradiation? Int J Radiat Oncol Biol Phys. 71(5):1381-7, 2008
                                                                                      22. Walid MS et al: Cerebellar anaplastic astrocytoma in a teenager with Ollier Disease. J Neurooncol. 89(1):59-62, 2008
                                                                                      23. Louis DN et al (eds): WHO classification of tumours of the central nervous system: anaplastic astrocytoma. Lyon, France: IARC Press. 30-2, 2007
                                                                                      24. Louis DN et al: The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 114(2):97-109, 2007; Erratum in: Acta Neuropathol. 114(5):547, 2007
                                                                                      25. Jellison BJ et al: Diffusion tensor imaging of cerebral white matter: a pictorial review of physics, fiber tract anatomy, and tumor imaging patterns. AJNR Am J Neuroradiol. 25(3):356-69, 2004
                                                                                      26. Tortosa A et al: Prognostic implication of clinical, radiologic, and pathologic features in patients with anaplastic gliomas. Cancer. 97(4):1063-71, 2003
                                                                                      27. Burger PC et al: Surgical pathology of the nervous system and its coverings: the brain: tumors. 4th ed. Philadelphia: Churchill Livingstone. 177-80, 2002
                                                                                      28. Ironside JW et al: Diagnostic pathology of nervous system tumours: astrocytic tumors. 1st ed. Edinburgh: Churchill Livingstone. 53-120, 2002
                                                                                      29. Mori S et al: Brain white matter anatomy of tumor patients evaluated with diffusion tensor imaging. Ann Neurol. 51(3):377-80, 2002
                                                                                      30. Nelson SJ et al: Characterization of untreated gliomas by magnetic resonance spectroscopic imaging. Neuroimaging Clin N Am. 12(4):599-613, 2002
                                                                                      31. Provenzale JM et al: Comparison of permeability in high-grade and low-grade brain tumors using dynamic susceptibility contrast MR imaging. AJR Am J Roentgenol. 178(3):711-6, 2002
                                                                                      32. Wong TZ et al: Positron emission tomography imaging of brain tumors. Neuroimaging Clin N Am. 12(4):615-26, 2002
                                                                                      33. Wild-Bode C et al: Molecular determinants of glioma cell migration and invasion. J Neurosurg. 94(6):978-84, 2001
                                                                                      34. Castillo M et al: Correlation of myo-inositol levels and grading of cerebral astrocytomas. AJNR Am J Neuroradiol. 21(9):1645-9, 2000
                                                                                      35. Kleihues P et al: Pathology and genetics of tumours of the nervous system: Anaplastic astrocytoma. Lyon: IARC Press. 27-8, 2000
                                                                                      36. Rutherford GS et al: Contrast enhanced imaging is critical to glioma nosology and grading. IJNR 1:28-38, 1995