Pilocytic Astrocytoma in adults

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Epidemiology

Less common in adults (0.5 per million vs 8.3 per million in children) Mean age of 50. Median age of 45.

Anatomic location

Slight predilection for the supratentorial space (55% vs 67% in the cerebellum in children) Infratentorial lesions have a much shorter clinical history.

Clinical features

Associated with NF-1. Up to 90% of patients present with HAs; truncal ataxia (cerebellar lesions); rarely cranial nerve deficits.

Imaging findings

MRI: mixed intensities on T1/2, often cystic, marked enhancement, little edema, rarely hemorrhage.

Axial T1 weighted MRI in an adult with a pilocytic astrocytoma in the cerebellum.

Pathology

Biphasic pattern: compact bipolar cells with Rosenthal fibers and loosely textured multipolar cells with eosinophilic granular bodies and microcysts.

histopathology of pilocytic astrocytoma showing rosenthal fibers.


Treatment and prognosis

Total resection is treatment of choice. Radiation/chemotherapy for lesions of the optic pathway, thalamic, and brainstem lesions. Similar in clinical behavior to pediatric group with excellent prognosis (up to 100% at 5 yrs and 96% at 10 yrs). Very rarely undergo malignant degeneration.

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