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Diffuse astrocytoma
- 1. Start with the Great name of ALLAH, the most merciful and the most Beneficent
- 2. A 44 year female present with new onset of seizures for last 5 months, Generalize tonic clonic in nature, associate with headache. KPS score 80 with intact neurology.
- 4. Left parietal Craino-tomy with inter-hemispheric microsurgical resection with stereotactic neuro- navigation were performed and biopsy came to be Diffuse Astrocytoma IDH mutant
- 6. Diffuse Astrocytoma IDH- mutant (WHO grade II)
- 7. General Information • IDH1 and IDH2 • Children and young adults • 5% of primary brain tumors, 15% of all glioma • Pediatric age < 20 year, IDH mutation (0.26) occur half that of adult (0.48); less malignant degeneration • Locations; temporal, posterior frontal, anterior parietal lobe (adults); thalamus (pediatric)
- 8. Pathology • Low degrees cellularity • Highly differentiated cells • Prevention of normal element • Calcification are rare • Anaplasia and mitosis absent • Blood vessels slightly inc • Stain positive for GFAP
- 10. Neuro-Radiology
- 11. Treatment • No treatment for static tumor • Radiation • Chemotherapy • Surgery • Radiation and chemotherapy together with or with out surgery
- 12. Surgery • Goals; Histological confirmation, neurological condition, reduce risk of tumor growth, to prevent malignant transformation • Pre- operative WHO grading; age > 50. KPS <80, eloquent brain, Max diameter >4cm • Intra-operative mapping and awake craniotomy
- 13. Adjuvant therapy • No affect on overall survival • Radically remove tumor doesn’t need radiotherapy • Incomplete resection can increase Progression free survival • Chemotherapy; for dedifferentiation, progressive tumor
- 14. Prognosis • Median survival 10.9 years • Worse prognosis variables; age >40, astrocytoma Histology, diameter>6 cm, tumor crossing midline, neurological deficit • Sum of score of WHO class(score, 5yr OS and PFS); 0-1, 97%, 76%; 2, 81%, 49%; 3-4, 56%, 18%.
- 15. Dedifferentiation • 75% adult tumor undergoes anaplastic or glioblastoma • More rapid if diagnosed after 45 years • Once occur; survival rate (2-3 years)
- 16. Gemistocytic Astrocytoma • >20% tumor cells and 10% of diffuse astrocytoma • Mean age 40 years • Histology; glassy, plump, angular eosinophilic cells and contain GFAP- Positive cell process • TP53 +ve >80% • No imaging difference • Dedifferentiate earlier and worse outcome
- 17. Diffuse Astrocytoma (wild Type) • Rare • Doesn’t have IDH mutation • Variety of tumor further classified with additional genetic testing • Doesn’t have WHO grade
- 19. Diffusion Astrocytoma, NOS • Histological resemblance with diffuse astrocytoma • IDH levels not satisfactorily identified • Diagnosis of exclusion • No WHO classification.