Pleomorphic xanthoastrocytoma. Non-contrast Head CT image of cortically-based tumor nodule with large cyst and H&E section of spindle-shaped tumor cells in fascicles.
Pleomorphic Xanthoastrocytoma
Pleomorphic Xanthoastrocytoma (PXA)
- Sporadic, grade 2, cerebral cortically-based tumor (predilection for the temporal lobes) with frequent leptomeningeal invasion.
- The cerebral cortical (superficial) temporal lobe localization makes them a prime trigger for seizures.
- Typically comprises a large cyst with a mural nodule
- Pathology:
- Spindle-shaped cells in fascicles, meaning the cells that are wide in the middle with tapered ends and bundle in small streaming patterns of cells.
- Pleomorphic giant cells with xanthomatous (foamy) cytoplasm.
- Being grade 2, they lack necroses or hemorrhage and have bland nuclei with rare mitoses.
- Intercellular reticulin deposition (a rich reticulin network) is commonly found; it surrounds the cells and cellular nests.
- Eosinophilic granular bodies are often found (as they are in pilocytic astrocytoma).
References
- Adesina, Adekunle M., Tarik Tihan, Christine E. Fuller, and Tina Young Poussaint. Atlas of Pediatric Brain Tumors. Springer, 2016.
- Louis, David N., Arie Perry, Guido Reifenberger, Andreas von Deimling, Dominique Figarella-Branger, Webster K. Cavenee, Hiroko Ohgaki, Otmar D. Wiestler, Paul Kleihues, and David W. Ellison. “The 2016 World Health Organization Classification of Tumors of the Central Nervous System: A Summary.” Acta Neuropathologica 131, no. 6 (June 1, 2016): 803–20. https://doi.org/10.1007/s00401-016-1545-1.
- Newton, Herbert B. Handbook of Brain Tumor Chemotherapy, Molecular Therapeutics, and Immunotherapy. Academic Press, 2018.
- Perry, Arie. “WHO’s Arrived in 2016! An Updated Weather Forecast for Integrated Brain Tumor Diagnosis.” Brain Tumor Pathology 33, no. 3 (July 1, 2016): 157–60. https://doi.org/10.1007/s10014-016-0266-4.
- Prayson, Richard A., and Mark L. Cohen. Practical Differential Diagnosis in Surgical Neuropathology. Springer Science & Business Media, 2000.
- Reni, Michele, Elena Mazza, Silvia Zanon, Gemma Gatta, and Charles J. Vecht. “Central Nervous System Gliomas.” Critical Reviews in Oncology/Hematology 113 (May 2017): 213–34. https://doi.org/10.1016/j.critrevonc.2017.03.021.
- Ryall, Scott, Uri Tabori, and Cynthia Hawkins. “A Comprehensive Review of Paediatric Low-Grade Diffuse Glioma: Pathology, Molecular Genetics and Treatment.” Brain Tumor Pathology 34, no. 2 (April 1, 2017): 51–61. https://doi.org/10.1007/s10014-017-0282-z.
- Samuels, Martin A., Allan H. Ropper, and Joshua Klein. Adams and Victor’s Principles of Neurology 10th Edition. McGraw-Hill Education, 2014.
- Sharma, Suash, and Prabal Deb. “Intraoperative Neurocytology of Primary Central Nervous System Neoplasia: A Simplified and Practical Diagnostic Approach.” Journal of Cytology / Indian Academy of Cytologists 28, no. 4 (2011): 147–58. https://doi.org/10.4103/0970-9371.86339.
- Wippold, F. J., A. Perry, and J. Lennerz. “Neuropathology for the Neuroradiologist: Rosenthal Fibers.” American Journal of Neuroradiology 27, no. 5 (May 1, 2006): 958–61.
Image References
- CT Image of PXA
- “File: 405663-PLEOMORPHIC XANTHOASTROCYTOMA.Jpg - Wikipedia.” Accessed June 18, 2018. https://it.m.wikipedia.org/wiki/File:405663-PLEOMORPHIC_XANTHOASTROCYTOMA.jpg.
- H&E slide of PXA
- Marvin 101. English: Histopathology of Pleomorphic Xanthoastrocytoma (PXA). H&E Stain. 400x. October 7, 2009. Own work. https://commons.wikimedia.org/wiki/File:PXA_HE_40x-2.jpg.