Astrocytoma

Question 1

In WHO grading, please grading the following astrocytoma...
> Pilocytic astrocytoma
> Subependymal giant cell astrocytoma
> Pilomyxoid astrocytoma
> Fibrillary astrocytoma
> Anaplastic astrocytoma
> Glioblastoma multiforme
> Gliosarcoma
> Gliomatosis cerebri

Answer 1

1 > Pilocytic astrocytoma
1 > Subependymal giant cell astrocytoma
2 > Pilomyxoid astrocytoma
2 > Fibrillary astrocytoma
3 > Anaplastic astrocytoma
4 > Glioblastoma multiforme
4 > Gliosarcoma
3 > Gliomatosis cerebri

Question 2

What is the WHO grade of low-grade diffuse astrocytoma?

What is it synonym name of low grade diffuse astrocytoma?

Answer 2

2

It also call fibrillary astrocytoma.

Question 3

Which of lobe does the fibrillary or diffuse astrocytoma not involve?

Answer 3

Occipital lobe

Question 4

What is the incidence between supratentorial and infratentorial diffuse astrocytoma?

Answer 4

2/3 supratentorial

1/3 infratentorial

Question 5

What is the clinical significant about enhancing foci of low-grade diffuse astrocytoma?

Answer 5

It mentions about focal malignant degeneration should be suspected.

Question 6

What are the name of the subtype of low-grade diffuse astrocytoma?

Answer 6

1. Fibrillary astrocytoma
2. Gerministic astrocytoma
3. Protoplasmic astrocytoma (rare)

Question 7

What is the most common presentation of diffuse astrocytoma?

Answer 7

Seizure

Question 8

Are the following about Diffuse astrocytoma are true or false?
> May expand the adjacent cortex
> Ill-defined homo hypo/isodense mass
> 20% Ca++ but cyst are rare
> rare in cortical mass cause calvaria erosion
> Common in hemorrhage and brain edema

Answer 8

All are true except common in hemorrhage and cause adjacent brain edema

♪(´ε｀ )

Question 9

How much percentage of diffuse astrocytoma have calcification in NECT?

From
Osborn DI Neurology 2nd edition.

Answer 9

20%

Question 10

เราแบ่ง brain stem glioma ได้เป็นกี่แบบ

Answer 10

1. Diffuse pontine glioma (DPG)
   Poor prognosis
2. Focal gliomas, mostly pilocytic
   Favorable prognosis

Question 11

Please described classic imaging of pediatric brainstem tumors?

• Tectal
• Focal tegmental mesencephalic (FTM)
• Diffuse (intrinsic) pontine glioma (DPG)

And among these subgroup which are most poor prognosis and engulf basilar artery?

Answer 11

• Tectal
  » Hyper T2, variable enhancement
• Focal tegmental mesencephalic (FTM)
  » Cyst with mural nodule
• Diffuse (intrinsic) pontine glioma (DPG)
  » Hyper T2, expansile mass
  » engulf basilar artery and poorest prognosis.!

Question 12

Between tectal and diffuse pontine glioma which one is common in large size @ presentation and which one is common in early hydrocephalus?

Answer 12

Tectal usually early cause obstructive hydrocephalus and come early, so small size.

DPG usually large and cause late hydrocephalus.

Question 13

1. For diffuse pontine glioma with NF1, between adult and children which group is associated with poor prognosis?
2. For DPG without NF1 between adult and children which groups are poorer prognosis?

Answer 13

1. Adult

2. Children

Question 14

Please described the different clinical manifestation between pediatric brainstem tumors?

• Tectal
• Focal tegmental mesencephalic (FTM)
• Diffuse (intrinsic) pontine glioma (DPG)

Answer 14

• Tectal
  » Macrocrania, headache
• Focal tegmental mesencephalic (FTM)
  » Hemiparesis
• Diffuse (intrinsic) pontine glioma (DPG)
  » Cranial neuropathies, nausea/vomitting, headache and ataxia

Question 15

Between oligodendroglioma and astrocytoma which one is more common to have calcification?

Answer 15

Oligodendroglioma.

Question 16

What is the WHO grade of anaplastic astrocytoma?

What are more common in developed anaplastic astrocytoma between,
de novo and malignant degenration from low-grade diffuse astrocytoma?

Answer 16

WHO grade 3
____________________
75% of anaplastic astrocytoma developed from low-grade diffuse astrocytoma.

25% is De no vo

Question 17

When to considered malignant progression of anaplastic astrocytoma to GBM.?

Answer 17

Developed ring-enhancement.

Question 18

Which location of anaplastic astrocytoma likely to developed between gray and white matter?

Which lobes?

Answer 18

White matter.

Frontal and temporal lobes.
In children may involve pons and thalamus.

Question 19

In anaplastic astrocytoma (AA) which enhancement pattern are most common?

Does AA common to have calcification or hemorrhage?

Answer 19

Uncommon

Question 20

What is the other findings that may suggested malignant progression to GBM of anaplastic astrocytoma rather than ring enhanement?

Answer 20

Prominent flow void in T2W

From Osborn plate I, 6 , 15.

Question 21

What is the role of DTI in astrocytoma?

Answer 21

For surgical planning.

Question 22

In brain stem glioma which one is common to developed multiple cranial nerve palsy?

Answer 22

Diffuse pontine glioma

Question 23

The following sentence are the features of DPG, which one is/are not?

A) hyperdense and hypointense T2W
B) invade 4th ventricles
C) Engulf basilar artery
D) Variable enhancement

Answer 23

DPG imaging appearance…
» hypo T1
» hyper T2
» low density on CT
» uncommon to enhanced in CECT & MR when enhanced →suggested high grade
» Engulf basilar artery and common cause of multiple cranial nerve palsies.
» Not invaded 4th ventricle.

Question 24

What is MRS appearance of anaplastic astrocytoma?

Answer 24

in MRS of AA
Elevated Cho/Cr ratio, decreased NAA
Lower myoinositol (mI)/Cr ratio (0.33 ± 0.16) than low-grade (diffuse) astrocytoma