Anaplasia in pilocytic astrocytoma predicts aggressive behavior

Fausto J Rodriguez, Bernd W. Scheithauer, Peter C. Burger, Sarah Jenkins, Caterina Giannini

Research output: Contribution to journalArticle

Abstract

The clinical significance of anaplastic features, a rare event in pilocytic astrocytoma (PA), is not fully established. We reviewed 34 PA with anaplastic features (Male=21, Female=13; median age 35 y, 5 to 75) among approximately 2200 PA cases (1.7%). Tumors were included which demonstrated brisk mitotic activity [at least 4 mitoses/10 high power fields (400×)], in addition to hypercellularity and moderate-to-severe cytologic atypia, with or without necrosis. The tumors either had a PA precursor, coexistent (n=14) (41%) or documented by previous biopsy (n=10) (29%), or exhibited typical pilocytic features in an otherwise anaplastic astrocytoma (n=10) (29%). Clinical features of neurofibromatosis type-1 were present in 24% and a history of radiation for PA precursor in 12%. Histologically, the anaplastic component was classified as pilocytic like (41%), small cell (32%), epithelioid (15%), or fibrillary (12%). Median MIB1 labeling index was 24.7% in the anaplastic component and 2.6% in the precursor, although overlapping values were present. Strong p53 staining (3+) was limited to areas with anaplasia (19%), with overlapping values for 1 and 2+ in areas without anaplasia. Median overall and progression-free survivals after diagnosis for the entire study group were 24 and 14 months, respectively. Overall and progression-free survivals were shorter in the setting of prior radiation for a PA precursor (P=0.007, 0.028), increasing mitotic activity (P=0.03, 0.02), and presence of necrosis (P=0.02, 0.02), after adjusting for age and site. The biologic behavior of PAs with high-mitotic rates and those with necrosis paralleled that of St Anne-Mayo grades 2 and 3 diffuse astrocytomas, respectively. In summary, PA with anaplastic features exhibits a spectrum of morphologies and is associated with decreased survival when compared with typical PA.

Original languageEnglish (US)
Pages (from-to)147-160
Number of pages14
JournalAmerican Journal of Surgical Pathology
Volume34
Issue number2
DOIs
StatePublished - Feb 2010
Externally publishedYes

Fingerprint

Anaplasia
Astrocytoma
Necrosis
Disease-Free Survival
Radiation
Epithelioid Cells
Neurofibromatosis 1
Mitosis
Neoplasms

Keywords

  • Anaplasia
  • Glioma
  • Grading
  • Neurofibromatosis
  • Pilocytic astrocytoma
  • Prognosis

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery

Cite this

Anaplasia in pilocytic astrocytoma predicts aggressive behavior. / Rodriguez, Fausto J; Scheithauer, Bernd W.; Burger, Peter C.; Jenkins, Sarah; Giannini, Caterina.

In: American Journal of Surgical Pathology, Vol. 34, No. 2, 02.2010, p. 147-160.

Research output: Contribution to journalArticle

Rodriguez, Fausto J ; Scheithauer, Bernd W. ; Burger, Peter C. ; Jenkins, Sarah ; Giannini, Caterina. / Anaplasia in pilocytic astrocytoma predicts aggressive behavior. In: American Journal of Surgical Pathology. 2010 ; Vol. 34, No. 2. pp. 147-160.
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abstract = "The clinical significance of anaplastic features, a rare event in pilocytic astrocytoma (PA), is not fully established. We reviewed 34 PA with anaplastic features (Male=21, Female=13; median age 35 y, 5 to 75) among approximately 2200 PA cases (1.7{\%}). Tumors were included which demonstrated brisk mitotic activity [at least 4 mitoses/10 high power fields (400×)], in addition to hypercellularity and moderate-to-severe cytologic atypia, with or without necrosis. The tumors either had a PA precursor, coexistent (n=14) (41{\%}) or documented by previous biopsy (n=10) (29{\%}), or exhibited typical pilocytic features in an otherwise anaplastic astrocytoma (n=10) (29{\%}). Clinical features of neurofibromatosis type-1 were present in 24{\%} and a history of radiation for PA precursor in 12{\%}. Histologically, the anaplastic component was classified as pilocytic like (41{\%}), small cell (32{\%}), epithelioid (15{\%}), or fibrillary (12{\%}). Median MIB1 labeling index was 24.7{\%} in the anaplastic component and 2.6{\%} in the precursor, although overlapping values were present. Strong p53 staining (3+) was limited to areas with anaplasia (19{\%}), with overlapping values for 1 and 2+ in areas without anaplasia. Median overall and progression-free survivals after diagnosis for the entire study group were 24 and 14 months, respectively. Overall and progression-free survivals were shorter in the setting of prior radiation for a PA precursor (P=0.007, 0.028), increasing mitotic activity (P=0.03, 0.02), and presence of necrosis (P=0.02, 0.02), after adjusting for age and site. The biologic behavior of PAs with high-mitotic rates and those with necrosis paralleled that of St Anne-Mayo grades 2 and 3 diffuse astrocytomas, respectively. In summary, PA with anaplastic features exhibits a spectrum of morphologies and is associated with decreased survival when compared with typical PA.",
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