Skip to main content

Advertisement

SpringerLink
Log in

Cerebral astroblastoma: analysis of six cases and critical review of treatment options

  • Clinical study - patient study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Astroblastoma is one of the rarest tumors of the central nervous system (CNS), and its classification, histogenesis, diagnosis and therapeutic management are still being debated. The typical histopathological appearance is the perivascular, astroblastic pseudorosette, which is however present in other CNS tumors. To clarify the clinical, radiological, histopathological, prognostic and therapeutic characteristics, which have been treated only recently and are not well established yet due to the rarity of this tumor, six cases of histologically proven astroblastoma were retrospectively analyzed in light of more pertinent literature and paying special attention to therapeutic remarks. Between 1996 and 2005, six patients with cerebral astroblastoma were surgically treated at the Department of Neurosciences—Neurosurgery of Sapienza University in Rome. In three cases the lesion was termed low-grade astroblastoma, and high grade in the other three, according to current standard parameters. Median age of the six patients was 36 years. The time to diagnosis ranged from 1 week to 18 months. The radiological and anatomopathological features of this lesion are described. Surgical removal was total in four cases and subtotal in two. All patients received radiotherapy: two also had chemotherapy with temozolomide (TMZ). The three patients with low-grade astroblastoma are still alive today after a follow-up of 2, 5 and 19 years, respectively. Of the three patients with high-grade lesions, one is still alive after a 7-year follow-up, while the other two survived for 17 months (progression time 15 months) and 35 months (progression-reoperation time 23 months), respectively. Conclusions radical surgical resection is the treatment of choice for astroblastomas. Radiotherapy may play an adjuvant role in the treatment of high-grade lesions. The role of chemotherapy is still very debatable. We propose an aggressive standardized treatment for those lesions that meet anaplastic criteria, owing to their postulated glial origin and the propensity to have aggressive courses, and we advocate the use of a safe adjuvant chemotherapeutic regimen with TMZ, used concomitantly and subsequently to radiotherapy, especially for the high-grade astroblastoma cases. Multicenter studies, taking into account molecular biological findings, are necessary to define a common therapeutic strategy for astroblastomas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Pizer BL, Moss T, Oakhill A, Webb D, Coakham HB (1995) Congenital astroblastoma: an immunohistochemical study. Case report. J Neurosurg 83:550–555

    PubMed  CAS  Google Scholar 

  2. Brat DJ, Hirose Y, Cohen KJ, Feuerstein BG, Burger PC (2000) Astroblastoma: clinicopathologic features and chromosomal abnormalities defined by comparative genomic hybridization. Brain Pathol 10:342–352

    PubMed  CAS  Google Scholar 

  3. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (eds) (2007) World Health Organization classification of tumours of the central nervous system. IARC Press, Lyon

    Google Scholar 

  4. Bonnin JM, Rubinstein LJ (1989) Astroblastomas: a pathological study of 23 tumors, with a postoperative follow-up in 13 patients. Neurosurgery 25:6–13. doi:10.1097/00006123-198907000-00002

    Article  PubMed  CAS  Google Scholar 

  5. De reuck J, Van de Velde E, Van der Eecken H (1975) The angioarchitecture of the astroblastoma. Clin Neurol Neurosurg 78:89–98. doi:10.1016/S0303-8467(75)80015-1

    Article  PubMed  CAS  Google Scholar 

  6. Elvidge AR, Penfield W, Cone W (1937) Gliomas of the central nervous system: study of 210 verified cases. Proc Assoc Res Nerv Ment Dis 16:107–181

    Google Scholar 

  7. Sharenberg K, Liss L (1969) Neuroectodermal tumors of the central and peripheral nervous system. Williams & Wilkins, Baltimore, pp 17–29

    Google Scholar 

  8. Rio-Hortega PD (1962) The macroscopic anatomy of tumors of the central and peripheral nervous system. III Charles C Thomas, Springfield

  9. Burger PC, Scheithauer BW (1994) Tumors of the central nervous system. Atlas of tumor pathology. 3rd series, fascicle 10. Armed ForcesInstitute of Pathology, Washington, DC, pp 146–148

  10. Port JD, Brat DJ, Burger P, Pomper M (2002) Astroblastoma: radiologic-pathologic correlation and distinct from ependymoma. AJNR Am J Neuroradiol 23:243–247

    PubMed  Google Scholar 

  11. Sener RN (2002) Astroblastoma: diffusion MRI, and proton MR spectroscopy. Comput Med Imaging Graph 26:187–191. doi:10.1016/S0895-6111(01)00042-8

    Article  PubMed  CAS  Google Scholar 

  12. Baka JJ, Patel SC, Roebuck JR, Hearshen DO (1993) Predominantly extraaxial astroblastoma: imaging and proton MR spectroscopy features. AJNR Am J Neuroradiol 14:946–950

    PubMed  CAS  Google Scholar 

  13. Bailey P, Cushing H (1924) Tumors of the glioma group. Lippincott, Philadelphia

    Google Scholar 

  14. Bailey P, Bucy PC (1930) Astroblastomas of the brain. Acta Psychiatr Neurol 5:439–461

    Google Scholar 

  15. Thiessen B, Finlay Y, Kulkarni R, Rosenblum MK (1998) Astroblastoma: does histology predict biologic behaviour? J Neurooncol 40:59–65. doi:10.1023/A:1006025000409

    Article  PubMed  CAS  Google Scholar 

  16. Kubota T, Hirano A, Sato K, Yamamoto S (1985) The fine structure of astroblastoma. Cancer 55:745–750. doi:10.1002/1097-0142(19850215)55:4<745::AID-CNCR2820550411>3.0.CO;2-L

    Article  PubMed  CAS  Google Scholar 

  17. Mierau GW, Tyson WR, McGavran L, Parker N, Partington MD (1999) Astroblastoma: ultrastructural observation on a case of high-grade type. Ultrastruct Pathol 23:325–332. doi:10.1080/019131299281473

    Article  PubMed  CAS  Google Scholar 

  18. Shuangshoti S, Mitphraphan W, Port JD, Kanvisersri S, Griffiths L, Navalitloha Y, Pornthanakasem W, Mutirangura A (2000) Astroblastoma: report of a case with microsatellite analysis. Neuropathology 20:228–232. doi:10.1046/j.1440-1789.2000.00335.x

    Article  PubMed  CAS  Google Scholar 

  19. Burger PC, Scheithauer BW, Vogel FS (2002) Surgical pathology of the nervous system and its coverings, 4th edn. Churchill, Livingstone, p 254

    Google Scholar 

  20. Schrock E, Blume C, Maffert MC, du Manoir S, Bersch W, Klessling M, Lozanowa T, Thiel G, Wickowski R, Reid T, Cremer T (1995) Recurrent gain of chromosome 7q in low-grade astrocytic tumors studied by comparative genomic hybridization. Genes Chromosomes Cancer 15:199–205. doi:10.1002/(SICI)1098-2264(199604)15:4<199::AID-GCC1>3.0.CO;2-X

    Article  Google Scholar 

  21. Kernohan JW, Sayre GP (1952) Tumors of the central nervous system. Atlas of tumor pathology, Sect. 10, fascicle 35. Armed Forces Institute of Pathology, Washington, DC

    Google Scholar 

  22. Zülch KJ (1965) Brain tumors. Their biology and pathology, 2nd edn. Springer-Verlag, New York

    Google Scholar 

  23. Rubinstein LJ, Herman MM (1989) The astroblastoma and its possible cytogenic relationship to the tanycyte: an electron microscopic, immunohistochemical, tissue and organ-culture study. Acta Neuropathol 78:472–483. doi:10.1007/BF00687708

    Article  PubMed  CAS  Google Scholar 

  24. Hoang G, Sima AAF, Rozdilsky B (1986) Astroblastoma revisited: a report of three cases. Acta Neuropathol 70:10–16. doi:10.1007/BF00689508

    Article  Google Scholar 

  25. Cabello A, Madero S, Castresana A, Diaz-Lobato R (1991) Astroblastoma: electron microscopy and immunohistochemical findings: case report. Surg Neurol 35:116–121. doi:10.1016/0090-3019(91)90261-7

    Article  PubMed  CAS  Google Scholar 

  26. Jay V, Edwards V, Squire J, Rutka J (1993) Astroblastoma: report of a case with ultrastructural, cell kinetic, and cytogenetic analysis. Pediatr Pathol 13:323–332. doi:10.3109/15513819309048220

    Article  PubMed  CAS  Google Scholar 

  27. Yunten N, Ersahin Y, Demirtas E, Yalman O, Sener RN (1996) Cerebral astroblastoma resembling an extraaxial neoplasm. J Neuroradiol 23:38–40

    PubMed  CAS  Google Scholar 

  28. Lau P, Thomas T, Lui P, Khin A (2006) ‘Low grade’ astroblastoma with rapid recurrence: a case report. Pathology 38(1):78–80. doi:10.1080/00313020500468871

    Article  PubMed  Google Scholar 

  29. Caroli E, Salvati M, Esposito V, Orlando ER, Giangaspero F (2004) Cerebral astroblastoma–case report. Acta Neurochir (Wien) 146:629–633. doi:10.1007/s00701-004-0230-7

    Article  CAS  Google Scholar 

  30. Cabrera Zubizarreta C, Caton B, Martinez De Guerenu B, Larena Iturbe JA, Ontanon JM (2002) Catalan Urribarrena. Low grade astroblastoma: pathological findings and on magnetic resonance. Rev Neurol 34:963–969

    Google Scholar 

  31. Russel DS, Rubiinsten LJ (1989) Tumors of neuroepithelial origin. In: Pathology of the tumors of the nervous system, edn 5. Edward Arnold, London, pp 161–169

  32. Husain AN, Leestma JE (1986) Cerebral astroblastoma: immunohistochemical and ultrastructural features. J Neurosurg 64:657–661

    Article  PubMed  CAS  Google Scholar 

  33. Yamashita J, Handa H, Yamagami T, Haebara H (1985) Astroblastoma of pure type. Surg Neurol 24:218–222. doi:10.1016/0090-3019(85)90188-0

    Article  PubMed  CAS  Google Scholar 

  34. Zülch KJ (1979) Histological typing of tumors of the central nervous system, international classification of tumors, number 21. World Health Organization, Geneva

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Sciences-Neurosurgery, University of Rome “Sapienza”, Via Cardinal Agliardi, 15, 00165, Rome, Italy

    Maurizio Salvati, Alessandro D’Elia, Christian Brogna, Alessandro Frati, Manila Antonelli, Felice Giangaspero, Antonino Raco, Antonio Santoro & Roberto Delfini

  2. Department of Neurosurgery, INM Neuromed IRCCS, Pozzilli, IS, Italy

    Maurizio Salvati & Felice Giangaspero

Authors
  1. Maurizio Salvati
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandro D’Elia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christian Brogna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alessandro Frati
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Manila Antonelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Felice Giangaspero
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Antonino Raco
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Antonio Santoro
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Roberto Delfini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maurizio Salvati.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Salvati, M., D’Elia, A., Brogna, C. et al. Cerebral astroblastoma: analysis of six cases and critical review of treatment options. J Neurooncol 93, 369–378 (2009). https://doi.org/10.1007/s11060-008-9789-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-008-9789-9

Keywords

Search

Navigation