Circumscribed astrocytic tumors (pleomorphic xanthoastrocytoma, subependymal giant cell astrocytoma, pilocytic astrocytoma) have well-defined margins, are benign, and are typically managed with surgery alone.
Diffuse astrocytomas (grade II to IV) represent a spectrum of the same highly infiltrative disease, with lower grades inevitably progressing to higher grade lesions. They share common molecular genetic abnormalities.
Low-grade astrocytomas (grade I and II) tend to be present in younger patients and have a better prognosis.
High-grade astrocytomas (grade III and IV) typically present in older patients and the prognosis is poor.
There are no known predisposing factors except rare familial syndromes and prior cranial radiation therapy.
Treatments vary depending on tumor grade and molecular characteristics, and include maximal surgical resection alone or in conjunction with radiation therapy and/or chemotherapy.
Astrocytic brain tumors are primary tumors of the brain arising from astrocytes. Astrocytes provide structural and metabolic support to the brain and neurons, regulate ion concentrations in the extracellular space, modulate synaptic transmissions, and take up and release neurotransmitters. They are an integral component of the blood-brain barrier.
History and exam
Other diagnostic factors
- altered mental status
- nausea and/or vomiting
- gait abnormality
- visual disturbances
- speech deficit
- sensory deficit
- motor weakness
- visual change
- cranial nerve palsy
- personality change/emotional lability
- cognitive decline
- ipsilateral dysmetria
- finger agnosia
- left-right confusion
- alexia (without agraphia)
- hypothalamic syndrome
- white ancestry
- male sex
- neurofibromatosis type 1
- tuberous sclerosis
- Li-Fraumeni syndrome
- Turcot syndrome
- ionizing radiation
1st investigations to order
- MRI head
- ophthalmologic evaluation; visual field testing
- CT head
- spectroscopy MRI head
- perfusion MRI head
Investigations to consider
- pituitary hormones tests
- diffusion tensor imaging (DTI)
- 2-hydroxyglutarate-targeted magnetic resonance spectroscopy
elevated intracranial pressure or vasogenic edema
grade I: pilocytic astrocytoma
grade I: subependymal giant cell astrocytoma
grade II (excluding diffuse pontine glioma): pleomorphic xanthoastrocytoma
grade II (excluding diffuse pontine glioma): pilomyxoid astrocytoma
grade II (excluding diffuse pontine glioma): diffuse astrocytoma
grade III (excluding diffuse pontine glioma)
grade IV (excluding diffuse pontine glioma)
diffuse pontine glioma
grade I: recurrent pilocytic astrocytoma
grade I: recurrent subependymal giant cell astrocytoma
grade II (excluding diffuse pontine glioma): recurrent pleomorphic xanthoastrocytoma
grade II (excluding diffuse pontine glioma): recurrent pilomyxoid astrocytoma
grade II (excluding diffuse pontine glioma): recurrent diffuse astrocytomas
recurrent grade III (excluding diffuse pontine glioma)
recurrent grade IV (excluding diffuse pontine glioma)
recurrent diffuse pontine glioma
Timothy C. Ryken, MD, MS
Chief of Neurosurgery
Dartmouth-Hitchcock Medical Center
TCR is an author of a number of references cited in this topic.
Linton T. Evans, MD
Assistant Professor of Neurosurgery
Dartmouth-Hitchcock Medical Center
LTE declares that he has no competing interests.
Dr Timothy C. Ryken and Dr Linton T. Evans would like to gratefully acknowledge Dr Manmeet S. Ahluwalia, Dr Susan Chang, and Dr Karine Michaud, previous contributors to this topic.
MSA has acted as a consultant for Elekta, Incyte, AstraZeneca, Novocure, Caris Life Sciences, Bristol-Myers Squibb, Monteris Medical, AbbVie, MRI Solutions, Elsevier, and Prime oncology. MSA has received clinical trial investigations grants from Tracon, Bristol-Myers Squibb, AstraZeneca, Novartis, and Novocure. SC has received research support from Agios, Novartis, Quest, Roche, and Schering Plough. KM declares that she has no competing interests.
David A. Reardon, MD
The Preston Robert Tisch Brain Tumor Center
Duke University Medical Center
DAR declares that he has no competing interests.
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