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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 PA (JPA)
            • Definitions

              • PA: Well-circumscribed, slow-growing tumor, often with cyst and mural nodule
              • Characterized by hair-like cytoplasmic (Rosenthal) fibers and multipolar cells with microcysts; BRAF fusion

            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. Payabvash S et al: Machine learning decision tree models for differentiation of posterior fossa tumors using diffusion histogram analysis and structural MRI findings. Front Oncol. 10:71, 2020
                                                2. Takeishi Y et al: Advantage of high b value diffusion-weighted imaging for differentiation of common pediatric brain tumors in posterior fossa. Eur J Radiol. 128:108983, 2020
                                                3. McAuley E et al: The benefit of surveillance imaging for paediatric cerebellar pilocytic astrocytoma. Childs Nerv Syst. 35(5):801-5, 2019
                                                4. Tabash MA: Characteristics, survival and incidence rates and trends of pilocytic astrocytoma in children in the United States; SEER-based analysis. J Neurol Sci. 400:148-52, 2019
                                                5. Kikuchi K et al: Usefulness of perfusion- and diffusion-weighted imaging to differentiate between pilocytic astrocytomas and high-grade gliomas: a multicenter study in Japan. Neuroradiology. 60(4):391-401, 2018
                                                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. Pilocytic astrocytoma. In Louis DN et al: WHO Classification of Tumours of the Central Nervous System. IARC Press. 80-9, 2016
                                                8. Alkonyi B et al: Differential imaging characteristics and dissemination potential of pilomyxoid astrocytomas versus pilocytic astrocytomas. Neuroradiology. 57(6):625-38, 2015
                                                9. Collins VP et al: Pilocytic astrocytoma: pathology, molecular mechanisms and markers. Acta Neuropathol. 129(6):775-88, 2015
                                                10. Kapoor A et al: Spontaneous hemorrhages in pediatric supratentorial pilocytic astrocytomas. Malignant presentation of a benign entity. Childs Nerv Syst. 31(9):1617-20, 2015
                                                11. Kleinschmidt-DeMasters BK et al: Pilomyxoid sstrocytoma (PMA) shows significant differences in gene expression vs. pilocytic astrocytoma (PA) and variable tendency toward maturation to PA. Brain Pathol. 25(4):429-40, 2015
                                                12. 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
                                                13. Nakano Y et al: Pilocytic astrocytoma presenting with atypical features on magnetic resonance imaging. J Neuroradiol. 42(5):278-82, 2015
                                                14. Bian SX et al: Pilocytic astrocytoma with leptomeningeal dissemination. Childs Nerv Syst. 29(3):441-50, 2013
                                                15. Rodriguez FJ et al: Pathological and molecular advances in pediatric low-grade astrocytoma. Annu Rev Pathol. 8:361-79, 2013
                                                16. Sadighi Z et al: Pilocytic astrocytoma: a disease with evolving molecular heterogeneity. J Child Neurol. 28(5):625-32, 2013
                                                17. 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
                                                18. 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
                                                19. Mazloom A et al: Outcome of patients with pilocytic astrocytoma and leptomeningeal dissemination. Int J Radiat Oncol Biol Phys. 84(2):350-4, 2012
                                                20. 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
                                                21. 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
                                                22. Fisher PG et al: Outcome analysis of childhood low-grade astrocytomas. Pediatr Blood Cancer. 51(2):245-50, 2008
                                                23. Linscott LL et al: Pilomyxoid astrocytoma: expanding the imaging spectrum. AJNR Am J Neuroradiol. 29(10):1861-6, 2008
                                                24. 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
                                                25. Rozen WM et al: Spontaneous regression of low-grade gliomas in pediatric patients without neurofibromatosis. Pediatr Neurosurg. 44(4):324-8, 2008
                                                26. Burger PC et al: Pilocytic astrocytoma. In Louis DN et al: Tumours of the Central Nervous System. IARC Press. 14-21, 2007
                                                27. Stüer C et al: Frequent recurrence and progression in pilocytic astrocytoma in adults. Cancer. 110(12):2799-808, 2007
                                                28. 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
                                                29. 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
                                                30. Hwang JH et al: Proton MR spectroscopic characteristics of pediatric pilocytic astrocytomas. AJNR Am J Neuroradiol. 19(3):535-40, 1998
                                                31. 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 PA (JPA)
                                                          • Definitions

                                                            • PA: Well-circumscribed, slow-growing tumor, often with cyst and mural nodule
                                                            • Characterized by hair-like cytoplasmic (Rosenthal) fibers and multipolar cells with microcysts; BRAF fusion

                                                          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. Payabvash S et al: Machine learning decision tree models for differentiation of posterior fossa tumors using diffusion histogram analysis and structural MRI findings. Front Oncol. 10:71, 2020
                                                                                              2. Takeishi Y et al: Advantage of high b value diffusion-weighted imaging for differentiation of common pediatric brain tumors in posterior fossa. Eur J Radiol. 128:108983, 2020
                                                                                              3. McAuley E et al: The benefit of surveillance imaging for paediatric cerebellar pilocytic astrocytoma. Childs Nerv Syst. 35(5):801-5, 2019
                                                                                              4. Tabash MA: Characteristics, survival and incidence rates and trends of pilocytic astrocytoma in children in the United States; SEER-based analysis. J Neurol Sci. 400:148-52, 2019
                                                                                              5. Kikuchi K et al: Usefulness of perfusion- and diffusion-weighted imaging to differentiate between pilocytic astrocytomas and high-grade gliomas: a multicenter study in Japan. Neuroradiology. 60(4):391-401, 2018
                                                                                              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. Pilocytic astrocytoma. In Louis DN et al: WHO Classification of Tumours of the Central Nervous System. IARC Press. 80-9, 2016
                                                                                              8. Alkonyi B et al: Differential imaging characteristics and dissemination potential of pilomyxoid astrocytomas versus pilocytic astrocytomas. Neuroradiology. 57(6):625-38, 2015
                                                                                              9. Collins VP et al: Pilocytic astrocytoma: pathology, molecular mechanisms and markers. Acta Neuropathol. 129(6):775-88, 2015
                                                                                              10. Kapoor A et al: Spontaneous hemorrhages in pediatric supratentorial pilocytic astrocytomas. Malignant presentation of a benign entity. Childs Nerv Syst. 31(9):1617-20, 2015
                                                                                              11. Kleinschmidt-DeMasters BK et al: Pilomyxoid sstrocytoma (PMA) shows significant differences in gene expression vs. pilocytic astrocytoma (PA) and variable tendency toward maturation to PA. Brain Pathol. 25(4):429-40, 2015
                                                                                              12. 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
                                                                                              13. Nakano Y et al: Pilocytic astrocytoma presenting with atypical features on magnetic resonance imaging. J Neuroradiol. 42(5):278-82, 2015
                                                                                              14. Bian SX et al: Pilocytic astrocytoma with leptomeningeal dissemination. Childs Nerv Syst. 29(3):441-50, 2013
                                                                                              15. Rodriguez FJ et al: Pathological and molecular advances in pediatric low-grade astrocytoma. Annu Rev Pathol. 8:361-79, 2013
                                                                                              16. Sadighi Z et al: Pilocytic astrocytoma: a disease with evolving molecular heterogeneity. J Child Neurol. 28(5):625-32, 2013
                                                                                              17. 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
                                                                                              18. 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
                                                                                              19. Mazloom A et al: Outcome of patients with pilocytic astrocytoma and leptomeningeal dissemination. Int J Radiat Oncol Biol Phys. 84(2):350-4, 2012
                                                                                              20. 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
                                                                                              21. 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
                                                                                              22. Fisher PG et al: Outcome analysis of childhood low-grade astrocytomas. Pediatr Blood Cancer. 51(2):245-50, 2008
                                                                                              23. Linscott LL et al: Pilomyxoid astrocytoma: expanding the imaging spectrum. AJNR Am J Neuroradiol. 29(10):1861-6, 2008
                                                                                              24. 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
                                                                                              25. Rozen WM et al: Spontaneous regression of low-grade gliomas in pediatric patients without neurofibromatosis. Pediatr Neurosurg. 44(4):324-8, 2008
                                                                                              26. Burger PC et al: Pilocytic astrocytoma. In Louis DN et al: Tumours of the Central Nervous System. IARC Press. 14-21, 2007
                                                                                              27. Stüer C et al: Frequent recurrence and progression in pilocytic astrocytoma in adults. Cancer. 110(12):2799-808, 2007
                                                                                              28. 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
                                                                                              29. 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
                                                                                              30. Hwang JH et al: Proton MR spectroscopic characteristics of pediatric pilocytic astrocytomas. AJNR Am J Neuroradiol. 19(3):535-40, 1998
                                                                                              31. Lee YY et al: Juvenile pilocytic astrocytomas: CT and MR characteristics. AJR Am J Roentgenol. 152(6):1263-70, 1989