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Pilocytic Astrocytoma
Karen L. Salzman, MD; Chang Yueh Ho, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Pilocytic astrocytoma (PA), juvenile pilocytic astrocytoma (JPA)
            • Definitions

              • Pilocytic astrocytoma: Well-circumscribed, slow-growing tumor, often with cyst and mural nodule
              • Characterized by hair-like cytoplasmic (Rosenthal) fibers &/or eosinophilic granular bodies in stacked bipolar cells

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Angiographic 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. Alkonyi B et al: Differential imaging characteristics and dissemination potential of pilomyxoid astrocytomas versus pilocytic astrocytomas. Neuroradiology. 57(6):625-38, 2015
                                                2. Collins VP et al: Pilocytic astrocytoma: pathology, molecular mechanisms and markers. Acta Neuropathol. 129(6):775-88, 2015
                                                3. Kapoor A et al: Spontaneous hemorrhages in pediatric supratentorial pilocytic astrocytomas. Malignant presentation of a benign entity. Childs Nerv Syst. ePub, 2015
                                                4. Nabavizadeh SA et al: High accuracy of arterial spin labeling perfusion imaging in differentiation of pilomyxoid from pilocytic astrocytoma. Neuroradiology. 57(5):527-33, 2015
                                                5. Kleinschmidt-DeMasters BK et al: Pilomyxoid Astrocytoma (PMA) Shows Significant Differences in Gene Expression vs. Pilocytic Astrocytoma (PA) and Variable Tendency Toward Maturation to PA. Brain Pathol. ePub, 2014
                                                6. Nakano Y et al: Pilocytic astrocytoma presenting with atypical features on magnetic resonance imaging. J Neuroradiol. ePub, 2014
                                                7. Bian SX et al: Pilocytic astrocytoma with leptomeningeal dissemination. Childs Nerv Syst. 29(3):441-50, 2013
                                                8. Rodriguez FJ et al: Pathological and molecular advances in pediatric low-grade astrocytoma. Annu Rev Pathol. 8:361-79, 2013
                                                9. Sadighi Z et al: Pilocytic astrocytoma: a disease with evolving molecular heterogeneity. J Child Neurol. 28(5):625-32, 2013
                                                10. Avery RA et al: Visual acuity in children with low grade gliomas of the visual pathway: implications for patient care and clinical research. J Neurooncol. 110(1):1-7, 2012
                                                11. Edwards JR et al: Temporal and optic pathway pilomyxoid astrocytoma mimicking dural-based lesion: case report and review of the literature. Pediatr Neurosurg. 48(4):253-7, 2012
                                                12. Mazloom A et al: Outcome of patients with pilocytic astrocytoma and leptomeningeal dissemination. Int J Radiat Oncol Biol Phys. 84(2):350-4, 2012
                                                13. Amatya VJ et al: Clinicopathological and immunohistochemical features of three pilomyxoid astrocytomas: comparative study with 11 pilocytic astrocytomas. Pathol Int. 59(2):80-5, 2009
                                                14. Qaddoumi I et al: Pediatric low-grade gliomas and the need for new options for therapy: Why and how? Cancer Biol Ther. 8(1), 2009
                                                15. Fisher PG et al: Outcome analysis of childhood low-grade astrocytomas. Pediatr Blood Cancer. 51(2):245-50, 2008
                                                16. Linscott LL et al: Pilomyxoid astrocytoma: expanding the imaging spectrum. AJNR Am J Neuroradiol. 29(10):1861-6, 2008
                                                17. Parsa CF et al: Juvenile pilocytic astrocytomas do not undergo spontaneous malignant transformation: grounds for designation as hamartomas. Br J Ophthalmol. 92(1):40-6, 2008
                                                18. Rozen WM et al: Spontaneous regression of low-grade gliomas in pediatric patients without neurofibromatosis. Pediatr Neurosurg. 44(4):324-8, 2008
                                                19. Burger PC et al: Pilocytic astrocytoma. In Louis DN et al: Tumours of the Central Nervous System. Lyon: IARC Press. 14-21, 2007
                                                20. Stüer C et al: Frequent recurrence and progression in pilocytic astrocytoma in adults. Cancer. 110(12):2799-808, 2007
                                                21. Brown PD et al: Adult patients with supratentorial pilocytic astrocytomas: a prospective multicenter clinical trial. Int J Radiat Oncol Biol Phys. 58(4):1153-60, 2004
                                                22. Fernandez C et al: Pilocytic astrocytomas in children: prognostic factors--a retrospective study of 80 cases. Neurosurgery. 53(3):544-53; discussion 554-5, 2003
                                                23. Hwang JH et al: Proton MR spectroscopic characteristics of pediatric pilocytic astrocytomas. AJNR Am J Neuroradiol. 19(3):535-40, 1998
                                                24. Lee YY et al: Juvenile pilocytic astrocytomas: CT and MR characteristics. AJR Am J Roentgenol. 152(6):1263-70, 1989
                                                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

                                                            • Pilocytic astrocytoma (PA), juvenile pilocytic astrocytoma (JPA)
                                                          • Definitions

                                                            • Pilocytic astrocytoma: Well-circumscribed, slow-growing tumor, often with cyst and mural nodule
                                                            • Characterized by hair-like cytoplasmic (Rosenthal) fibers &/or eosinophilic granular bodies in stacked bipolar cells

                                                          IMAGING

                                                          • General Features

                                                            • CT Findings

                                                              • MR Findings

                                                                • Ultrasonographic Findings

                                                                  • Angiographic 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. Alkonyi B et al: Differential imaging characteristics and dissemination potential of pilomyxoid astrocytomas versus pilocytic astrocytomas. Neuroradiology. 57(6):625-38, 2015
                                                                                              2. Collins VP et al: Pilocytic astrocytoma: pathology, molecular mechanisms and markers. Acta Neuropathol. 129(6):775-88, 2015
                                                                                              3. Kapoor A et al: Spontaneous hemorrhages in pediatric supratentorial pilocytic astrocytomas. Malignant presentation of a benign entity. Childs Nerv Syst. ePub, 2015
                                                                                              4. Nabavizadeh SA et al: High accuracy of arterial spin labeling perfusion imaging in differentiation of pilomyxoid from pilocytic astrocytoma. Neuroradiology. 57(5):527-33, 2015
                                                                                              5. Kleinschmidt-DeMasters BK et al: Pilomyxoid Astrocytoma (PMA) Shows Significant Differences in Gene Expression vs. Pilocytic Astrocytoma (PA) and Variable Tendency Toward Maturation to PA. Brain Pathol. ePub, 2014
                                                                                              6. Nakano Y et al: Pilocytic astrocytoma presenting with atypical features on magnetic resonance imaging. J Neuroradiol. ePub, 2014
                                                                                              7. Bian SX et al: Pilocytic astrocytoma with leptomeningeal dissemination. Childs Nerv Syst. 29(3):441-50, 2013
                                                                                              8. Rodriguez FJ et al: Pathological and molecular advances in pediatric low-grade astrocytoma. Annu Rev Pathol. 8:361-79, 2013
                                                                                              9. Sadighi Z et al: Pilocytic astrocytoma: a disease with evolving molecular heterogeneity. J Child Neurol. 28(5):625-32, 2013
                                                                                              10. Avery RA et al: Visual acuity in children with low grade gliomas of the visual pathway: implications for patient care and clinical research. J Neurooncol. 110(1):1-7, 2012
                                                                                              11. Edwards JR et al: Temporal and optic pathway pilomyxoid astrocytoma mimicking dural-based lesion: case report and review of the literature. Pediatr Neurosurg. 48(4):253-7, 2012
                                                                                              12. Mazloom A et al: Outcome of patients with pilocytic astrocytoma and leptomeningeal dissemination. Int J Radiat Oncol Biol Phys. 84(2):350-4, 2012
                                                                                              13. Amatya VJ et al: Clinicopathological and immunohistochemical features of three pilomyxoid astrocytomas: comparative study with 11 pilocytic astrocytomas. Pathol Int. 59(2):80-5, 2009
                                                                                              14. Qaddoumi I et al: Pediatric low-grade gliomas and the need for new options for therapy: Why and how? Cancer Biol Ther. 8(1), 2009
                                                                                              15. Fisher PG et al: Outcome analysis of childhood low-grade astrocytomas. Pediatr Blood Cancer. 51(2):245-50, 2008
                                                                                              16. Linscott LL et al: Pilomyxoid astrocytoma: expanding the imaging spectrum. AJNR Am J Neuroradiol. 29(10):1861-6, 2008
                                                                                              17. Parsa CF et al: Juvenile pilocytic astrocytomas do not undergo spontaneous malignant transformation: grounds for designation as hamartomas. Br J Ophthalmol. 92(1):40-6, 2008
                                                                                              18. Rozen WM et al: Spontaneous regression of low-grade gliomas in pediatric patients without neurofibromatosis. Pediatr Neurosurg. 44(4):324-8, 2008
                                                                                              19. Burger PC et al: Pilocytic astrocytoma. In Louis DN et al: Tumours of the Central Nervous System. Lyon: IARC Press. 14-21, 2007
                                                                                              20. Stüer C et al: Frequent recurrence and progression in pilocytic astrocytoma in adults. Cancer. 110(12):2799-808, 2007
                                                                                              21. Brown PD et al: Adult patients with supratentorial pilocytic astrocytomas: a prospective multicenter clinical trial. Int J Radiat Oncol Biol Phys. 58(4):1153-60, 2004
                                                                                              22. Fernandez C et al: Pilocytic astrocytomas in children: prognostic factors--a retrospective study of 80 cases. Neurosurgery. 53(3):544-53; discussion 554-5, 2003
                                                                                              23. Hwang JH et al: Proton MR spectroscopic characteristics of pediatric pilocytic astrocytomas. AJNR Am J Neuroradiol. 19(3):535-40, 1998
                                                                                              24. Lee YY et al: Juvenile pilocytic astrocytomas: CT and MR characteristics. AJR Am J Roentgenol. 152(6):1263-70, 1989