DIAGNOSIS: PILOCYTIC ASTROCYTOMA
DISCUSSION:
Pilocytic astrocytoma is a quite rare intramedullary neoplasm in the adult. In a well documented series of 177 resected tumors only four cases have been found (1). Since 1984 at the Department of Neurosurgery in Hamburg 226 patients harboring an intramedullary tumor underwent surgery, including ten cases with pilocytic astrocytoma (Table 1). The diagnosis of pilocytic astrocytoma required following criteria: bipolar cells, Rosenthal fibers, microcysts and a mixture of spongy and dense tissue architecture (2). The presented patient is the only one older than 60 years. During the same time span 117 patients affected by an intracranial pilocytic astrocytoma have been operated and again, only three of them were over 60 years old. The combination of spinal location and age over sixty is so far unique.
Table 1. Summary of patients harboring a pilocytic astrocytoma out of a series of 226 intramedullary tumors.
No |
Gender |
Age (yrs.) |
Location of Tumor |
1 |
M |
14 |
C0 – C4 |
2 |
M |
11 |
C1 – C2 |
3 |
F |
28 |
C2 – C4 |
4 |
M |
22 |
C2 – C7 |
5 |
F |
14 |
C3 – C7 |
6 |
F |
6 |
T2 – T9 |
7 |
M |
42 |
T3 – T5 |
8 |
M |
64 |
T5 – T7 |
9 |
M |
26 |
T8 – T9 |
10 |
F |
8 |
T10 – T11 |
The microscopic examination of samples taken from three distant areas of the exophytic tumor confirmed the typical histological pattern of pilocytic astrocytoma. Interestingly, the different pictures were almost identical so that the same cellular array has to be assumed for the intramedullary part of the tumor.
REFERENCES:
Contributed by Luca Papavero, Christian Hagel, Ulrich Grzyska, Eric Fritsche and Manfred Westphal