Astrocytoma - Erler Zimmer

Astrocytoma - Erler Zimmer

Clinical History

Admitted for new-onset left-sided hemiplegia, a 73-year-old woman disclosed a three-month history of headaches, nausea, and deteriorating balance. A CT brain scan revealed an inoperable brain tumor, leading to her demise one week after admission.

Pathology

This brain specimen, in coronal section, displays a poorly demarcated tumor in the right temporal lobe. Hemispheric enlargement and gyral pattern flattening are evident. Subfalcine herniation* is noted from the posterior aspect, and the tumor appears less differentiated with hemorrhagic and necrotic foci. Histology identified the tumor as an astrocytoma, Grade III/IV.
*Subfalcine herniation, the most common brain herniation type, involves the frontal lobe's innermost part being pushed beneath the falx cerebri, between the brain's two hemispheres.

Further Information

Gliomas, the second most prevalent central nervous system cancer after meningiomas, are tumors histologically resembling normal glial cells—astrocytes, oligodendrocytes, and ependymal cells. Originating from a progenitor cell that differentiates along cell lines, astrocytomas emerge from the astrocyte lineage. Tumors are staged by histological differentiation, ranging from diffuse astrocytoma (Grade II/IV) to anaplastic astrocytoma (Grade III/IV) to glioblastoma (Grade IV). Histological features include prominent eosinophilic cytoplasm in some astrocytic tumor cells (gemistocytes) and a fibrillary background.
Astrocytomas typically occur between the fourth and sixth decades of life, primarily in cerebral hemispheres but potentially in the cerebellum, brainstem, or spinal cord. Common presentations include seizures, headaches, nausea, and focal neurological deficits based on the affected area. Without treatment, Grade III median survival is 18 months. Treatment options encompass surgical resection, radiotherapy, chemotherapy, or a combination, tailored to the clinical context.