Astrocytic Tumours

GRADING AND CLASSIFICATION

Tumor grade refers to a scale, generally ranging from I to IV, that reflects the potential
aggressiveness of the tumor type.

Grade I-II tumors may be classified as low grade and less aggressive, whereas Grade III-IV tumors
may be classified as high grade and more aggressive

Pilocytic astrocytoma (WHO grade I)

A relatively circumscribed, slowly growing, often cystic astrocytoma occurring in children
and young adults, histologically characterized by a biphasic pattern with varying proportions
of compacted bipolar cells associated with Rosenthal fibers and loose-textured multipolar
cells associated with microcysts and eosinophilic granular bodies/hyaline droplets.
Subependymal giant cell astrocytoma (WHO grade I)
A benign, slowly growing tumour typically arising in the wall of the lateral ventricles and
composed of large ganglioid astrocytes (See Chapter 13, Tuberous sclerosis complex and
subependymal giant cell astrocytoma).
Pleomorphic xanthoastrocytoma (WHO grade II)
An astrocytic neoplasm with a relatively favourable prognosis, typically encountered in
children and young adults, with superficial location in the cerebral hemispheres and involvement
of the meninges; characteristic histological features include pleomorphic and lipidized cells
expressing GFAP and often surrounded by a reticulin network as well as eosinophilic
granular bodies.
Diffuse astrocytoma (WHO grade II)
A diffusely infiltrating astrocytoma that typically affects young adults and is characterized
by a high degree of cellular differentiation and slow growth; the tumour occurs throughout
the CNS but is preferentially located supratentorially and has an intrinsic tendency for malignant
progression to anaplastic astrocytoma and, ultimately, glioblastoma.
Anaplastic astrocytoma (WHO grade III)
A diffusely infiltrating malignant astrocytoma that primarily affects adults, is preferentially
located in the cerebral hemispheres, and is histologically characterized by nuclear atypia,
increased cellularity and significant proliferative activity. The tumour may arise from diffuse
astrocytoma WHO grade II or de novo, i.e. without evidence of a less malignant precursor
lesion, and has an inherent tendency to undergo progression to glioblastoma.
Glioblastoma (WHO grade IV)
The most frequent primary brain tumour and the most malignant neoplasm with predominant
astrocytic differentiation; histopathological features include nuclear atypia, cellular pleomorphism,
mitotic activity, vascular thrombosis, microvascular proliferation and necrosis. It typically
affects adults and is preferentially located in the cerebral hemispheres. Most glioblastomas
manifest rapidly de novo, without recognizable precursor lesions (primary glioblastoma).
Secondary glioblastomas develop slowly from diffuse astrocytoma WHO grade II or anaplastic
astrocytoma (WHO grade III). Due to their invasive nature, glioblastomas cannot be completely
resected, and despite progress in radio/chemotherapy, less than half of patients survive more
than a year, with older age as the most significant adverse prognostic factor.
Gliomatosis cerebri
A diffuse glioma (usually astrocytic) growth pattern consisting of exceptionally extensive
infiltration of a large region of the central nervous system, with involvement of at least three
cerebral lobes, usually with bilateral involvement of the cerebral hemispheres and/or deep
gray matter, and frequent extension to the brain stem, cerebellum, and even the spinal cord.
Gliomatosis cerebri most commonly displays an astrocytic phenotype, although oligodendrogliomas
and mixed oligoastrocytomas can also present with the gliomatosis cerebri
growth pattern.