Brain Tumor Res Treat.  2017 Oct;5(2):120-126. 10.14791/btrt.2017.5.2.120.

Astroblastoma in a Young Female Patient: A Case Report and Literature Review of Clinicopathological, Radiological and Prognostic Characteristics and Current Treatment Strategies

• Sadiq M
• Ahmad I
• Shuja J
• Ahmad Z
• Ahmed R
• Ahmad K

• KMID: 2396458
• DOI: http://doi.org/10.14791/btrt.2017.5.2.120

Abstract

Astroblastoma is an uncommon glial tumor with predominant manifestation in the young age. Herein, we report a case of 18-year-old astroblastoma female patient who presented with history of two months headache. Magnetic resonance imaging (MRI) of the brain demonstrated well circumscribed, intra-axial abnormal signal intensity lesion (size=5×4 cm²) in the right parieto-occipital region of the brain. The patient underwent complete surgical resection of the gross tumor, as confirmed by an early post-surgical MRI (i.e., within 24 hours of surgery). Histopathological examination revealed neoplastic lesion exhibiting perivascular pseudo-rosettes with centrally hyalinized blood vessel and focal nuclear pleomorphism. Immunohistochemistry staining illustrated reactivity for glial fibrillary acidic protein and integrase interactor 1 (INI-1). These features rendered the diagnosis of astroblastoma. A comprehensive review of the current literature to summarize the clinicopathological and radiological characteristics, prognostic factors and current treatment strategies of astroblastomas is also presented. Our study would expand the pool of this uncommon tumor towards its better understanding and optimal treatment.

Keyword

Astroblastoma; Brain tumors; Craniotomy; Magnetic resonance imaging

MeSH Terms

Adolescent
Blood Vessels
Brain
Brain Neoplasms
Craniotomy
Diagnosis
Female*
Glial Fibrillary Acidic Protein
Headache
Humans
Hyalin
Immunohistochemistry
Integrases
Magnetic Resonance Imaging
Neoplasms, Neuroepithelial*
Glial Fibrillary Acidic Protein
Integrases

Figure

• 

  Fig. 1 MR imaging study of the brain. First row, pre-surgery MR images illustrating a well-circumscribed tumor in the right parieto-occipital region of the brain measuring 5×4 cm2; the lesion appeared heterogeneously hypointense to brain parenchyma on T1WS (A) while heterogeneously hyperintense on T2WS (B) and FLAIR (C). Second row, post-surgery MR images illustrating no definite residual mass and abnormal signal intensity area in tumor region, appearing predominantly hypointense on T1WS and hyperintense on T2WS and FLAIR signifying edema. MR, magnetic resonance; T1WS, T1 weighting sequence; T2WS, T2 weighting sequence; FLAIR, fluid-attenuated inversion recovery.

• 

  Fig. 2 Illustrative histopathology (hematoxylin and eosin) and immunohistochemical images of the resected astroblastoma specimen. A and B: Pseudo-papillary configuration at low magnification (×10). The arrow is pointing towards central blood vessel. C and D: arrow marking vascular hyalinization which is a conspicuous feature of astroblastomas and ranges from mild to severe (×20). E and F: tumor cells arranged in perivascular pseudo-rosette like fashion at higher magnification (×40). Arrow pointing towards central blood vessel wall, G: Ribbon like appearance of astroblastic rosettes on tangential section. It shows classic morphology of tumor displaying columnar to elongated tumor cells with tapering cytoplasmic process pointed by arrow at higher magnification (×40). H: Low proliferative index on Ki-67 (×10). I: glial fibrillary acidic protein immunostain positivity (×20).

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