Clinicoradiological and histopathological characteristics and treatment outcomes of cerebral astroblastoma in children: a single-institution experience

Chiman Jeon MD1, Binnari Kim MD, PhD2, and Jung Won Choi MD, PhD1
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  • 1 Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
  • | 2 Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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OBJECTIVE

Astroblastoma (AB) is a rare glial tumor. The optimal treatment and prognosis of this tumor remain unclear. The authors retrospectively analyzed the clinical characteristics, neuroimaging findings, histopathological results, and treatment outcomes of 7 patients with AB.

METHODS

The study comprised 7 patients with pathologically proven AB who were surgically treated at Samsung Medical Center from November 1994 to January 2019. Clinicoradiological, histopathological, and surgical records were reviewed.

RESULTS

The patients included 5 girls (71.4%) and 2 boys (28.6%), with a median age of 13 years. All patients showed contrast enhancement on preoperative MRI: 5 ABs (71.4%) showed a concomitant solid and cystic appearance, and 2 (28.6%) demonstrated a solid appearance. ABs in 6 patients (85.7%) showed a well-circumscribed, characteristic "bubbly" appearance on T2-weighted MRI. Gross-total resection (GTR) was achieved in all cases (100%). Six patients (85.7%) were diagnosed with high-grade AB and 1 (14.3%) with low-grade AB. Six (85.7%) of the 7 patients received adjuvant treatment after resection, including 5 (83.3%) with AB who received chemotherapy and radiotherapy and 1 (16.7%) who received proton therapy alone. The median clinical follow-up duration was 96 months (range 48–189 months). Two patients experienced recurrence, and all patients in this series were alive at the last follow-up.

CONCLUSIONS

In this study, the clinicoradiological and histopathological features of AB were described. Based on the authors’ limited experience with 7 cases, resection with the goal of GTR is currently the mainstream treatment for AB, and adjuvant radiation treatment should be considered after surgery.

ABBREVIATIONS

AB = astroblastoma; AG = angiocentric glioma; AT/RT = atypical teratoid/rhabdoid tumor; EMA = epithelial membrane antigen; GFAP = glial fibrillary acidic protein; GTR = gross-total resection; OS = overall survival; PFS = progression-free survival; RT = radiation treatment; STR = subtotal resection.

Diagram from Behbahani et al. (pp 488–496).

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  • 1

    Bailey P, Bucy PC. Astroblastomas of the brain. Acta Psychiatr Neurol Scand. 1930;5:439461.

  • 2

    Bailey P, Cushing H. A Classification of the Tumours of the Glioma Group on a Histogenetic Basis with a Correlated Study of Prognosis. J B Lippincott Co; 1926:133136.

    • Search Google Scholar
    • Export Citation
  • 3

    Navarro R, Reitman AJ, de León GA, Goldman S, Marymont M, Tomita T. Astroblastoma in childhood: pathological and clinical analysis. Childs Nerv Syst. 2005;21(3):211220.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Bell JW, Osborn AG, Salzman KL, Blaser SI, Jones BV, Chin SS. Neuroradiologic characteristics of astroblastoma. Neuroradiology. 2007;49(3):203209.

  • 5

    Port JD, Brat DJ, Burger PC, Pomper MG. Astroblastoma: radiologic-pathologic correlation and distinction from ependymoma. AJNR Am J Neuroradiol. 2002;23(2):243247.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Eom KS, Kim JM, Kim TY. A cerebral astroblastoma mimicking an extra-axial neoplasm. J Korean Neurosurg Soc. 2008;43(4):205208.

  • 7

    Sughrue ME, Choi J, Rutkowski MJ, et al. Clinical features and post-surgical outcome of patients with astroblastoma. J Clin Neurosci. 2011;18(6):750754.

  • 8

    Shen F, Chen LC, Yao Y, Zhou LF. Astroblastoma: rare incidence and challenges in the pattern of care. World Neurosurg. 2014;82(1-2):e125e127.

  • 9

    Ahmed KA, Allen PK, Mahajan A, Brown PD, Ghia AJ. Astroblastomas: a Surveillance, Epidemiology, and End Results (SEER)-based patterns of care analysis. World Neurosurg. 2014;82(1-2):e291e297.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016;131(6):803820.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Louis DN, Ohgaki H, Wiestler OD, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114(2):97109.

  • 12

    Fuller GN, Scheithauer BW. The 2007 Revised World Health Organization (WHO) Classification of Tumours of the Central Nervous System: newly codified entities. Brain Pathol. 2007;17(3):304307.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Janz C, Buhl R. Astroblastoma: report of two cases with unexpected clinical behavior and review of the literature. Clin Neurol Neurosurg. 2014;125:114124.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Kim BS, Kothbauer K, Jallo G. Brainstem astroblastoma. Pediatr Neurosurg. 2004;40(3):145146.

  • 15

    Notarianni C, Akin M, Fowler M, Nanda A. Brainstem astroblastoma: a case report and review of the literature. Surg Neurol. 2008;69(2):201205.

  • 16

    Shin SA, Ahn B, Kim SK, et al. Brainstem astroblastoma with MN1 translocation. Neuropathology. 2018;38(6):631637.

  • 17

    Yamada SM, Tomita Y, Shibui S, et al. Primary spinal cord astroblastoma: case report. J Neurosurg Spine. 2018;28(6):642646.

  • 18

    Yamasaki K, Nakano Y, Nobusawa S, et al. Spinal cord astroblastoma with an EWSR1-BEND2 fusion classified as a high-grade neuroepithelial tumour with MN1 alteration. Neuropathol Appl Neurobiol. 2020;46(2):190193.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Hirano H, Yunoue S, Kaji M, Tsuchiya M, Arita K. Consecutive histological changes in an astroblastoma that disseminated to the spinal cord after repeated intracranial recurrences: a case report. Brain Tumor Pathol. 2008;25(1):2531.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Yapıcıer Ö, Demir MK, Özdamarlar U, Kılıç D, Akakın A, Kılıç T. Posterior fossa astroblastoma in a child: a case report and a review of the literature. Childs Nerv Syst. 2019;35(7):12511255.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Ganapathy S, Kleiner LI, Mirkin DL, Broxson E. Unusual manifestations of astroblastoma: a radiologic-pathologic analysis. Pediatr Radiol. 2009;39(2):168171.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Cunningham DA, Lowe LH, Shao L, Acosta NR. Neuroradiologic characteristics of astroblastoma and systematic review of the literature: 2 new cases and 125 cases reported in 59 publications. Pediatr Radiol. 2016;46(9):13011308.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Kurokawa R, Baba A, Kurokawa M, et al. Neuroimaging of astroblastomas: a case series and systematic review. J Neuroimaging. Published online November 23, 2021. doi: 10.1111/jon.12948

    • Search Google Scholar
    • Export Citation
  • 24

    de la Garma VH, Arcipreste AA, Vázquez FP, Aguilar RR, Castruita UO, Guerra RM. High-grade astroblastoma in a child: Report of one case and review of literature. Surg Neurol Int. 2014;5:111.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Hammas N, Senhaji N, Alaoui Lamrani MY, et al. Astroblastoma - a rare and challenging tumor: a case report and review of the literature. J Med Case Rep. 2018;12(1):102.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Bonnin JM, Rubinstein LJ. Astroblastomas: a pathological study of 23 tumors, with a postoperative follow-up in 13 patients. Neurosurgery. 1989;25(1):613.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Hirose T, Nobusawa S, Sugiyama K, et al. Astroblastoma: a distinct tumor entity characterized by alterations of the X chromosome and MN1 rearrangement. Brain Pathol. 2018;28(5):684694.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Singh DK, Singh N, Singh R, Husain N. Cerebral astroblastoma: a radiopathological diagnosis. J Pediatr Neurosci. 2014;9(1):4547.

  • 29

    Kubota T, Sato K, Arishima H, Takeuchi H, Kitai R, Nakagawa T. Astroblastoma: immunohistochemical and ultrastructural study of distinctive epithelial and probable tanycytic differentiation. Neuropathology. 2006;26(1):7281.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Brat DJ, Hirose Y, Cohen KJ, Feuerstein BG, Burger PC. Astroblastoma: clinicopathologic features and chromosomal abnormalities defined by comparative genomic hybridization. Brain Pathol. 2000;10(3):342352.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Yuzawa S, Nishihara H, Tanino M, et al. A case of cerebral astroblastoma with rhabdoid features: a cytological, histological, and immunohistochemical study. Brain Tumor Pathol. 2016;33(1):6370.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Lehman NL, Hattab EM, Mobley BC, et al. Morphological and molecular features of astroblastoma, including BRAFV600E mutations, suggest an ontological relationship to other cortical-based gliomas of children and young adults. Neuro Oncol. 2017;19(1):3142.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33

    Boisseau W, Euskirchen P, Mokhtari K, et al. Molecular profiling reclassifies adult astroblastoma into known and clinically distinct tumor entities with frequent mitogen-activated protein kinase pathway alterations. Oncologist. 2019;24(12):15841592.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Chen W, Soon YY, Pratiseyo PD, et al. Central nervous system neuroepithelial tumors with MN1-alteration: an individual patient data meta-analysis of 73 cases. Brain Tumor Pathol. 2020;37(4):145153.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Lehman NL, Usubalieva A, Lin T, et al. Genomic analysis demonstrates that histologically-defined astroblastomas are molecularly heterogeneous and that tumors with MN1 rearrangement exhibit the most favorable prognosis. Acta Neuropathol Commun. 2019;7(1):42.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Wood MD, Tihan T, Perry A, et al. Multimodal molecular analysis of astroblastoma enables reclassification of most cases into more specific molecular entities. Brain Pathol. 2018;28(2):192202.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Sturm D, Orr BA, Toprak UH, et al. New brain tumor entities emerge from molecular classification of CNS-PNETs. Cell. 2016;164(5):10601072.

  • 38

    Salvati M, D’Elia A, Brogna C, et al. Cerebral astroblastoma: analysis of six cases and critical review of treatment options. J Neurooncol. 2009;93(3):369378.

  • 39

    Lehman NL. Central nervous system tumors with ependymal features: a broadened spectrum of primarily ependymal differentiation?. J Neuropathol Exp Neurol. 2008;67(3):177188.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Kaji M, Takeshima H, Nakazato Y, Kuratsu J. Low-grade astroblastoma recurring with extensive invasion. Neurol Med Chir (Tokyo). 2006;46(9):450454.

  • 41

    Miranda P, Lobato RD, Cabello A, Gómez PA, Martínez de Aragón A. Complete surgical resection of high-grade astroblastoma with long time survival: case report and review of the literature. Neurocirugia (Astur). 2006;17(1):6063.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42

    Nasit JG, Trivedi P. Recurrent low-grade astroblastoma with signet ring-like cells and high proliferative index. Fetal Pediatr Pathol. 2013;32(4):284292.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Asha U, Mahadevan A, Sathiyabama D, et al. Lack of IDH1 mutation in astroblastomas suggests putative origin from ependymoglial cells?. Neuropathology. 2015;35(4):303311.

  • 44

    Mangano FT, Bradford AC, Mittler MA, Valderrama E, Schneider SJ. Astroblastoma. Case report, review of the literature, and analysis of treatment strategies. J Neurosurg Sci. 2007;51(1):2127.

    • PubMed
    • Search Google Scholar
    • Export Citation

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