Persistence and late malignant transformation of childhood cerebellar astrocytoma

Case report

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✓ A 5-year-old girl with juvenile pilocytic astrocytoma subsequently had multiple episodes of symptomatic recurrence over the course of 21 years of follow-up review. This lesion underwent histological transformation to an anaplastic small-cell neoplasm 21 years after the initial resection and diagnosis. Late transformation of benign childhood cerebellar astrocytomas to malignant astrocytic tumors is very rare; transformation to an anaplastic small-cell neoplasm has not been reported previously. This case and other reported cases in which juvenile pilocytic astrocytoma recurred after a long interval indicate the requirement of long-term follow-up review of these patients before assuming either a cure or arrest of the tumor's growth.

Article Information

Address reprint requests to: Charles E. Alpers, M.D., Department of Pathology, M-576, University of California, San Francisco, California 94143.

© AANS, except where prohibited by US copyright law.

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Figures

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    Photomicrograph demonstrating compact and loose areas of tumor in the original biopsy specimen taken in 1960. H & E, × 16.

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    Left: Photomicrograph of the most recent (1981) biopsy specimen showing nuclear pleomorphism and dense fibrillary background. H & E, × 320. Right: Area comparable to that shown left demonstrating abundant astroglial processes. PTAH, × 320.

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    Left: Photomicrograph showing the most densely cellular portion of the latest (1981) recurrent tumor. Note presence of small, round to oval, dark-staining nuclei and scattered background cytoplasmic processes. H & E, × 320. Right: Area comparable to that shown left reveals occasional PTAH-positive processes. PTAH, × 320.

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