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Differential imaging characteristics and dissemination potential of pilomyxoid astrocytomas versus pilocytic astrocytomas

  • Paediatric Neuroradiology
  • Published:
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Abstract

Introduction

Pilomyxoid astrocytoma (PMA) is a rare WHO grade II tumor occurring most often in young children. PMA is associated with worse outcome as compared to the pathologically related pilocytic astrocytoma (PA). The radiological differentiation of PMAs from PAs is challenging. Furthermore, it is not completely clarified whether PMA is associated with a higher rate of cerebrospinal fluid (CSF) dissemination in the youngest pediatric population as compared to PA. The aim of our study was firstly to compare imaging features of these tumors and, secondly, to evaluate the occurrence of CSF dissemination.

Methods

The study population included 15 children with PMA and 32 children with PA. The initial MRI and CT scans from the time of the diagnosis were retrospectively analyzed according to standardized criteria and the findings compared between the two tumor types. Furthermore, we also compared the occurrence of imaging evidences of CSF dissemination.

Results

PMAs showed less frequently cystic components (p = 0.03) and never had large tumor cysts. Gadolinium enhancement of PMAs was more frequently homogeneous (p = 0.006). PMAs appeared to show more often intratumoral hemorrhages (p = 0.047). Within the subgroup of children <6 years of age, the PMA histology tended to have a larger effect on the occurrence of CSF dissemination than the age (p = 0.05 vs. 0.12).

Conclusion

Some imaging features like enhancement pattern or presence of cysts or hemorrhage may help differentiating these low-grade gliomas. Our results confirm previous scarce data suggesting a higher rate of CSF dissemination in PMAs, even in the youngest patient population.

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References

  1. Janisch W, Schreiber D, Martin H, Gerlach H (1985) Diencephalic pilocytic astrocytoma with clinical onset in infancy. Biological behavior and pathomorphological findings in 11 children. Zentralbl Allg Pathol 130:31–43

    CAS  PubMed  Google Scholar 

  2. Tihan T, Burger PC (1998) A variant of pilocytic astrocytoma: a possible distinct clinicopathological entity with a less favorable outcome. (abstract). J Neuropathol Exp Neurol 57:500

    Article  Google Scholar 

  3. Cottingham SL, Boesel CP, Yates AJ (1996) Pilocytic astrocytoma in infants: a distinctive histological pattern. (abstract). J Neuropathol Exp Neurol 55:654

    Article  Google Scholar 

  4. Tihan T, Fisher PG, Kepner JL, Godfraind C, McComb RD, Goldthwaite PT et al (1999) Pediatric astrocytomas with monomorphous pilomyxoid features and a less favorable outcome. J Neuropathol Exp Neurol 58:1061–1068

    Article  CAS  PubMed  Google Scholar 

  5. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A et al (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114:97–109

    Article  PubMed Central  PubMed  Google Scholar 

  6. Komotar RJ, Burger PC, Carson BS, Brem H, Olivi A, Goldthwaite PT et al (2004) Pilocytic and pilomyxoid hypothalamic/chiasmatic astrocytomas. Neurosurgery 54:72–79, discussion 79-80

    Article  PubMed  Google Scholar 

  7. Arslanoglu A, Cirak B, Horska A, Okoh J, Tihan T, Aronson L et al (2003) MR imaging characteristics of pilomyxoid astrocytomas. AJNR Am J Neuroradiol 24:1906–1908

    PubMed  Google Scholar 

  8. Komotar RJ, Zacharia BE, Sughrue ME, Mocco J, Carson BS, Tihan T et al (2008) Magnetic resonance imaging characteristics of pilomyxoid astrocytoma. Neurol Res 30:945–951

    Article  PubMed  Google Scholar 

  9. Lee IH, Kim JH, Suh YL, Eo H, Shin HJ, Yoo SY et al (2011) Imaging characteristics of pilomyxoid astrocytomas in comparison with pilocytic astrocytomas. Eur J Radiol 79:311–316

    Article  PubMed  Google Scholar 

  10. Gnekow AK, Falkenstein F, von Hornstein S, Zwiener I, Berkefeld S, Bison B et al (2012) Long-term follow-up of the multicenter, multidisciplinary treatment study HIT-LGG-1996 for low-grade glioma in children and adolescents of the German Speaking Society of Pediatric Oncology and Hematology. Neuro Oncol 14:1265–1284

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Chang CH, Housepian EM, Herbert C Jr (1969) An operative staging system and a megavoltage radiotherapeutic technic for cerebellar medulloblastomas. Radiology 93:1351–1359

    Article  CAS  PubMed  Google Scholar 

  12. Phi JH, Lee J, Wang KC, Cho BK, Kim IO, Park CK et al (2011) Cerebrospinal fluid M staging for medulloblastoma: reappraisal of Chang's M staging based on the CSF flow. Neuro Oncol 13:334–344

    Article  PubMed Central  PubMed  Google Scholar 

  13. Bhargava D, Sinha P, Chumas P, Al-Tamimi Y, Shivane A, Chakrabarty A et al (2013) Occurrence and distribution of pilomyxoid astrocytoma. Br J Neurosurg 27:413–418

    Article  CAS  PubMed  Google Scholar 

  14. Linscott LL, Osborn AG, Blaser S, Castillo M, Hewlett RH, Wieselthaler N et al (2008) Pilomyxoid astrocytoma: expanding the imaging spectrum. AJNR Am J Neuroradiol 29:1861–1866

    Article  CAS  PubMed  Google Scholar 

  15. Komotar RJ, Carson BS, Rao C, Chaffee S, Goldthwaite PT, Tihan T (2005) Pilomyxoid astrocytoma of the spinal cord: report of three cases. Neurosurgery 56:191

    PubMed  Google Scholar 

  16. Fernandez C, Figarella-Branger D, Girard N, Bouvier-Labit C, Gouvernet J, Paz Paredes A et al (2003) Pilocytic astrocytomas in children: prognostic factors—a retrospective study of 80 cases. Neurosurgery 53:544–553, discussion 554-555

    Article  PubMed  Google Scholar 

  17. Gottfried ON, Fults DW, Townsend JJ, Couldwell WT (2003) Spontaneous hemorrhage associated with a pilomyxoid astrocytoma. Case report. J Neurosurg 99:416–420

    Article  PubMed  Google Scholar 

  18. Komotar RJ, Mocco J, Zacharia BE, Wilson DA, Kim PY, Canoll PD et al (2006) Astrocytoma with pilomyxoid features presenting in an adult. Neuropathology 26:89–93

    Article  PubMed  Google Scholar 

  19. Mendiratta-Lala M, Kader Ellika S, Gutierrez JA, Patel SC, Jain R (2007) Spinal cord pilomyxoid astrocytoma: an unusual tumor. J Neuroimaging 17:371–374

    Article  PubMed  Google Scholar 

  20. Poretti A, Meoded A, Huisman TA (2012) Neuroimaging of pediatric posterior fossa tumors including review of the literature. J Magn Reson Imaging 35:32–47

    Article  PubMed  Google Scholar 

  21. Mulvihill JJ, Parry DM, Sherman JL, Pikus A, Kaiser-Kupfer MI, Eldridge R (1990) NIH conference. Neurofibromatosis 1 (Recklinghausen disease) and neurofibromatosis 2 (bilateral acoustic neurofibromatosis). An update. Ann Intern Med 113:39–52

    Article  CAS  PubMed  Google Scholar 

  22. Williams VC, Lucas J, Babcock MA, Gutmann DH, Korf B, Maria BL (2009) Neurofibromatosis type 1 revisited. Pediatrics 123:124–133

    Article  PubMed  Google Scholar 

  23. Rodriguez FJ, Perry A, Gutmann DH, O'Neill BP, Leonard J, Bryant S et al (2008) Gliomas in neurofibromatosis type 1: a clinicopathologic study of 100 patients. J Neuropathol Exp Neurol 67:240–249

    Article  PubMed Central  PubMed  Google Scholar 

  24. Khanani MF, Hawkins C, Shroff M, Dirks P, Capra M, Burger PC et al (2006) Pilomyxoid astrocytoma in a patient with neurofibromatosis. Pediatr Blood Cancer 46:377–380

    Article  PubMed  Google Scholar 

  25. Komotar RJ, Mocco J, Carson BS, Sughrue ME, Zacharia BE, Sisti AC et al (2004) Pilomyxoid astrocytoma: a review. Med Gen Med 6:42

    Google Scholar 

  26. Komakula ST, Fenton LZ, Kleinschmidt-DeMasters BK, Foreman NK (2007) Pilomyxoid astrocytoma: neuroimaging with clinicopathologic correlates in 4 cases followed over time. J Pediatr Hematol Oncol 29:465–470

    Article  PubMed  Google Scholar 

  27. Morales H, Kwock L, Castillo M (2007) Magnetic resonance imaging and spectroscopy of pilomyxoid astrocytomas: case reports and comparison with pilocytic astrocytomas. J Comput Assist Tomogr 31:682–687

    Article  PubMed  Google Scholar 

  28. Cirak B, Horska A, Barker PB, Burger PC, Carson BS, Avellino AM (2005) Proton magnetic resonance spectroscopic imaging in pediatric pilomyxoid astrocytoma. Childs Nerv Syst 21:404–409

    Article  PubMed  Google Scholar 

  29. Horger M, Vogel MN, Beschorner R, Ernemann U, Worner J, Fenchel M et al (2012) T2 and DWI in pilocytic and pilomyxoid astrocytoma with pathologic correlation. Can J Neurol Sci 39:491–498

    Article  CAS  PubMed  Google Scholar 

  30. Shibahara I, Kanamori M, Kumabe T, Endo H, Sonoda Y, Ogawa Y et al (2009) Hemorrhagic onset of pilocytic astrocytoma and pilomyxoid astrocytoma. Brain Tumor Pathol 26:1–5

    Article  PubMed  Google Scholar 

  31. Rumboldt Z, Camacho DL, Lake D, Welsh CT, Castillo M (2006) Apparent diffusion coefficients for differentiation of cerebellar tumors in children. AJNR Am J Neuroradiol 27:1362–1369

    CAS  PubMed  Google Scholar 

  32. Stokland T, Liu JF, Ironside JW, Ellison DW, Taylor R, Robinson KJ et al (2010) A multivariate analysis of factors determining tumor progression in childhood low-grade glioma: a population-based cohort study (CCLG CNS9702). Neuro Oncol 12:1257–1268

    PubMed Central  PubMed  Google Scholar 

  33. Mirow C, Pietsch T, Berkefeld S, Kwiecien R, Warmuth-Metz M, Falkenstein F et al (2014) Children <1 year show an inferior outcome when treated according to the traditional LGG treatment strategy: a report from the German multicenter trial HIT-LGG 1996 for children with low grade glioma (LGG). Pediatr Blood Cancer 61:457–463

    Article  PubMed  Google Scholar 

  34. Forbes JA, Mobley BC, O'Lynnger TM, Cooper CM, Ghiassi M, Hanif R et al (2011) Pediatric cerebellar pilomyxoid-spectrum astrocytomas. J Neurosurg Pediatr 8:90–96

    Article  PubMed Central  PubMed  Google Scholar 

  35. Fuller CE, Frankel B, Smith M, Rodziewitz G, Landas SK, Caruso R et al (2001) Suprasellar monomorphous pilomyxoid neoplasm: an ultastructural analysis. Clin Neuropathol 20:256–262

    CAS  PubMed  Google Scholar 

  36. Chikai K, Ohnishi A, Kato T, Ikeda J, Sawamura Y, Iwasaki Y et al (2004) Clinico-pathological features of pilomyxoid astrocytoma of the optic pathway. Acta Neuropathol 108:109–114

    Article  PubMed  Google Scholar 

  37. Jeon YK, Cheon JE, Kim SK, Wang KC, Cho BK, Park SH (2008) Clinicopathological features and global genomic copy number alterations of pilomyxoid astrocytoma in the hypothalamus/optic pathway: comparative analysis with pilocytic astrocytoma using array-based comparative genomic hybridization. Mod Pathol 21:1345–1356

    Article  CAS  PubMed  Google Scholar 

  38. Ceppa EP, Bouffet E, Griebel R, Robinson C, Tihan T (2007) The pilomyxoid astrocytoma and its relationship to pilocytic astrocytoma: report of a case and a critical review of the entity. J Neurooncol 81:191–196

    Article  PubMed  Google Scholar 

  39. Kleinschmidt-DeMasters BK, Foreman N, Handler M (2008) Pilomyxoid tumors with a chronic relapsing course may become more cystic and mature to pilocystic histology: abstract from the International Symposium on Pediatric Neuro-oncology. J Neurooncol 10:460–461

    Google Scholar 

  40. Johnson MW, Eberhart CG, Perry A, Tihan T, Cohen KJ, Rosenblum MK et al (2010) Spectrum of pilomyxoid astrocytomas: intermediate pilomyxoid tumors. Am J Surg Pathol 34:1783–1791

    Article  PubMed  Google Scholar 

  41. Wisoff JH, Sanford RA, Heier LA, Sposto R, Burger PC, Yates AJ et al (2011) Primary neurosurgery for pediatric low-grade gliomas: a prospective multi-institutional study from the Children's Oncology Group. Neurosurgery 68:1548–1554, discussion 1554-1545

    Article  PubMed  Google Scholar 

  42. Goodden J, Pizer B, Pettorini B, Williams D, Blair J, Didi M et al (2014) The role of surgery in optic pathway/hypothalamic gliomas in children. J Neurosurg Pediatr 13:1–12

    Article  PubMed  Google Scholar 

  43. Tsugu H, Oshiro S, Yanai F, Komatsu F, Abe H, Fukushima T et al (2009) Management of pilomyxoid astrocytomas: our experience. Anticancer Res 29:919–926

    PubMed  Google Scholar 

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Acknowledgments

This work was supported by the German Childhood Cancer Foundation.

Ethical standards and patient consent

We declare that all human studies have been approved by the local and central Ethics Commitee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that patient consent was waived for this retrospective, anonymous study.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neuroradiology, Universitätsklinikum Würzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany

    Bálint Alkonyi, Johannes Nowak & Monika Warmuth-Metz

  2. Department of Diagnostic and Interventional Radiology, Universitätsklinikum Würzburg, 97080, Würzburg, Germany

    Johannes Nowak

  3. Children’s Hospital of Augsburg, Augsburg, Germany

    Astrid K. Gnekow

  4. German Brain Tumor Reference Center of the DGNN, Institute of Neuropathology, University of Bonn, Bonn, Germany

    Torsten Pietsch

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  1. Bálint Alkonyi
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Correspondence to Bálint Alkonyi.

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Alkonyi, B., Nowak, J., Gnekow, A.K. et al. Differential imaging characteristics and dissemination potential of pilomyxoid astrocytomas versus pilocytic astrocytomas. Neuroradiology 57, 625–638 (2015). https://doi.org/10.1007/s00234-015-1498-4

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  • DOI: https://doi.org/10.1007/s00234-015-1498-4

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