Astroblastoma is a rare glial
tumor
A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
derived from the astroblast, a type of cell that closely resembles
spongioblastoma and
astrocytes
Astrocytes (from Ancient Greek , , "star" + , , "cavity", "cell"), also known collectively as astroglia, are characteristic star-shaped glial cells in the brain and spinal cord. They perform many functions, including biochemical control of endo ...
.
Astroblastoma cells are most likely found in the supratentorial region of the brain that houses the
cerebrum
The cerebrum, telencephalon or endbrain is the largest part of the brain containing the cerebral cortex (of the two cerebral hemispheres), as well as several subcortical structures, including the hippocampus, basal ganglia, and olfactory bulb. In ...
, an area responsible for all voluntary movements in the body.
It also occurs significantly in the
frontal lobe
The frontal lobe is the largest of the four major lobes of the brain in mammals, and is located at the front of each cerebral hemisphere (in front of the parietal lobe and the temporal lobe). It is parted from the parietal lobe by a groove betwe ...
,
parietal lobe
The parietal lobe is one of the four major lobes of the cerebral cortex in the brain of mammals. The parietal lobe is positioned above the temporal lobe and behind the frontal lobe and central sulcus.
The parietal lobe integrates sensory informa ...
, and
temporal lobe
The temporal lobe is one of the four Lobes of the brain, major lobes of the cerebral cortex in the brain of mammals. The temporal lobe is located beneath the lateral fissure on both cerebral hemispheres of the mammalian brain.
The temporal lobe ...
, areas where movement, language creation, memory perception, and environmental surroundings are expressed. These tumors can be present in major brain areas not associated with the main cerebral hemispheres, including the
cerebellum
The cerebellum (Latin for "little brain") is a major feature of the hindbrain of all vertebrates. Although usually smaller than the cerebrum, in some animals such as the mormyrid fishes it may be as large as or even larger. In humans, the cerebel ...
,
optic nerve
In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual system, visual information from the retina to the brain. In humans, the optic nerve i ...
,
cauda equina
The cauda equina () is a bundle of spinal nerves and spinal nerve rootlets, consisting of the second through fifth lumbar nerve pairs, the first through fifth sacral nerve pairs, and the coccygeal nerve, all of which arise from the lumbar enlargeme ...
,
hypothalamus
The hypothalamus () is a part of the brain that contains a number of small nuclei with a variety of functions. One of the most important functions is to link the nervous system to the endocrine system via the pituitary gland. The hypothalamu ...
, and
brain stem
The brainstem (or brain stem) is the posterior stalk-like part of the brain that connects the cerebrum with the spinal cord. In the human brain the brainstem is composed of the midbrain, the pons, and the medulla oblongata. The midbrain is conti ...
.
The most defining physical symptom of astroblastoma, regardless of location, is elevated intracranial pressure, occurring when
cerebrospinal fluid
Cerebrospinal fluid (CSF) is a clear, colorless body fluid found within the tissue that surrounds the brain and spinal cord of all vertebrates.
CSF is produced by specialised ependymal cells in the choroid plexus of the ventricles of the bra ...
in the
subarachnoid space
In anatomy, the meninges (, ''singular:'' meninx ( or ), ) are the three membranes that envelop the brain and spinal cord. In mammals, the meninges are the dura mater, the arachnoid mater, and the pia mater. Cerebrospinal fluid is located in th ...
exhibits heavy pressure and decreased blood flow, resulting in throbbing headache or nausea for the patient.
Despite widespread localization in the brain, astroblastoma is rarely reported in oncological studies, accounting for only 0.45–2.8% of all brain gliomas since its discovery in 1926.
Without a doubt, astroblastoma remains one of the most challenging and problematic tumors to diagnose and treat among all nervous system cancers.
Subtypes
Astroblastoma can be divided into low-grade, well-differentiated tumors and high-grade, anaplastic subtypes.
The majority of tumors exhibit a spherical perimeter with either a solid or cystic interior, comprising peripheral vasculature and
epithelioid Epithelioid may refer to:
* Epithelioid cell, a cell that resembles epithelial cells
* Epithelioid sarcoma, a soft tissue tumour
* Epithelioid hemangioendothelioma, a vascular tumour occurring in the lining of blood vessels
* Epithelioid blue nevus ...
neoplasms.
General Pathology
Since the early 1890s, astroblastoma has established a stable set of pathological qualities that truly distinguishes itself as a separate and significant entity. Compilations from various case reports reveal the following common characteristics:
* Appears "bubbly" in nature
* Polarized, unipolar in structure
* Peripheral vasculature
* Radial arrangement as a
pseudorosette
In histopathology, a palisade is a single layer of relatively long cells, arranged loosely perpendicular to a surface and parallel to each other. A rosette is a palisade in a halo or spoke-and-wheel arrangement, surrounding a central core or hub. ...
* Immunoreactive for
GFAP and
vimentin
Vimentin is a structural protein that in humans is encoded by the ''VIM'' gene. Its name comes from the Latin ''vimentum'' which refers to an array of flexible rods.
Vimentin is a type III intermediate filament (IF) protein that is expressed ...
(supports astrocytic origin)
* Lacks "true
rosette" architecture
* Lacks structural cohesiveness
* Prominent
pseudopapillae formation
* Localization mostly in
cerebral hemispheres
The vertebrate cerebrum (brain) is formed by two cerebral hemispheres that are separated by a groove, the longitudinal fissure. The brain can thus be described as being divided into left and right cerebral hemispheres. Each of these hemispheres ...
* Nodular, non-invasive growth
* Strong, associative vasculature in other parts of the body
*
Tissue fibrosis prominence
* High likelihood of vascular
hyalinization
* Low likelihood to metastasize toward other regions of the brain
Abnormal Pathology
Beyond normal pathologies, scientists have discovered some abnormal characteristics of astroblastoma in a variety of patients. The presence of a bulky
calcification
Calcification is the accumulation of calcium salts in a body tissue. It normally occurs in the formation of bone, but calcium can be deposited abnormally in soft tissue,Miller, J. D. Cardiovascular calcification: Orbicular origins. ''Nature Mat ...
with punctate (pointed) and globular features was noted in a 2009 study of a 12-year-old girl.
Computerized tomography
A computed tomography scan (CT scan; formerly called computed axial tomography scan or CAT scan) is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers ...
confirmed these calcified masses in the
posteroinferior region to the
fourth ventricle
The fourth ventricle is one of the four connected fluid-filled cavities within the human brain. These cavities, known collectively as the ventricular system, consist of the left and right lateral ventricles, the third ventricle, and the fourth ve ...
just above the
midline
In typography, the mean line is the imaginary line at the top of the x-height.
upright 2.0, alt=A diagram showing the line terms used in typography
Round glyphs will tend to break ( overshoot) the mean line slightly in many typefaces, since thi ...
. The mass began at the
brainstem
The brainstem (or brain stem) is the posterior stalk-like part of the brain that connects the cerebrum with the spinal cord. In the human brain the brainstem is composed of the midbrain, the pons, and the medulla oblongata. The midbrain is cont ...
, extended along the
inferior cerebellar peduncle
The upper part of the posterior district of the medulla oblongata is occupied by the inferior cerebellar peduncle, a thick rope-like strand situated between the lower part of the fourth ventricle and the roots of the glossopharyngeal and vagus ner ...
to roof areas against the ventricles through the
nodule of vermis
The nodule (nodular lobe), or anterior end of the inferior vermis, abuts against the roof of the fourth ventricle, and can only be distinctly seen after the cerebellum has been separated from the medulla oblongata and pons
The pons (from Latin ...
, easily detected against normal grey matter surrounding it.
Calcification deriving from nervous system tumors is a rare quality in astroblastoma patients, but it is nonetheless easy to identify. Lumbar pain and lower body weakness is also a rarity in astroblastoma patients, even though it is entirely possible for lesions to proliferate toward the spinal cord.
Associations with Other Tumors
An enormous difficulty lies in classifying an astroblastoma tumor due to its overlapping features with other brain tumors. Certain neuroradiologic features finally distinguish astroblastoma from the common
ependymoma
An ependymoma is a tumor that arises from the ependyma, a tissue of the central nervous system. Usually, in pediatric cases the location is intracranial, while in adults it is spinal. The common location of intracranial ependymomas is the fourth ...
, another frequent tumor occurring in the fourth ventricle. In general, when brain lesions are smaller than Grade I, demarcating between these features is near impossible, often mistaking astroblastoma with glial
neoplasms
A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
, high-grade
astrocytes
Astrocytes (from Ancient Greek , , "star" + , , "cavity", "cell"), also known collectively as astroglia, are characteristic star-shaped glial cells in the brain and spinal cord. They perform many functions, including biochemical control of endo ...
, and embryonal
neoplasms
A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
. However, the “bubbly” appearance in astroblastoma is entirely exclusive.
Researchers have also confirmed astroblastoma distinct from
oligodendroglioma
Oligodendrogliomas are a type of glioma that are believed to originate from the oligodendrocytes of the brain or from a glial precursor cell. They occur primarily in adults (9.4% of all primary brain and central nervous system tumors) but are also ...
, which are invasive nodular cysts that may resemble a "bubbly" interior.
Pleomorphic xanthoastrocytoma
Pleomorphic xanthoastrocytoma (PXA) is a brain tumor that occurs most frequently in children and teenagers. At Boston Children's Hospital, the average age at diagnosis is 12 years.
Pleomorphic xanthoastrocytoma usually develops within the suprat ...
,
dysembryoplastic neuroepithelial tumors, juvenile
pilocytic astrocytoma
Pilocytic astrocytoma (and its variant pilomyxoid astrocytoma) is a brain tumor that occurs most commonly in children and young adults (in the first 20 years of life). They usually arise in the cerebellum, near the brainstem, in the hypothalamic r ...
, and
hemangioblastoma
Hemangioblastomas, or haemangioblastomas, are vascular tumors of the central nervous system that originate from the vascular system, usually during middle age. Sometimes, these tumors occur in other sites such as the spinal cord and retina. They ma ...
are well-established, pediatric brain cancer tumors that are often confused with astroblastoma patients. However, further histology has confirmed that special structures and characteristics are unique to astroblastoma. Advances in the 21st century of histology have justified proper diagnosis, eliminating inconsistency that plagued this tumor for several decades.
Research going back to early 2000 marks the first complications for satisfying requirements in radiographic and histopathologic studies. Seven astroblastoma cases of
comparative genomic hybridization Comparative genomic hybridization (CGH) is a molecular cytogenetic method for analysing copy number variations (CNVs) relative to ploidy level in the DNA of a test sample compared to a reference sample, without the need for culturing cells. The ai ...
, a molecular technique analyzing chromosomal changes in DNA content of brain cancer cells, suggested that chromosome 19 and chromosome 20q were amplified in astroblastoma cells throughout the brain.
These genomic features are responsible for widespread proliferation,
tumorigenesis
Carcinogenesis, also called oncogenesis or tumorigenesis, is the formation of a cancer, whereby normal cells are transformed into cancer cells. The process is characterized by changes at the cellular, genetic, and epigenetic levels and abno ...
, and deregulation of pathways associated with normal housekeeping. Furthermore, the absence of chromosome function in 9q, 10, and X were not observed in other types of neoplasms, such as an ependymoma.
Specific neuronal markers further distinguish astroblastoma.
Neuron-specific enolase
Gamma-enolase, also known as enolase 2 (ENO2) or neuron specific enolase (NSE), is an enzyme that in humans is encoded by the ''ENO2'' gene. Gamma-enolase is a phosphopyruvate hydratase.
Gamma-enolase is one of the three enolase isoenzymes found i ...
(NSE) positive, NSE negative,
synaptophysin
Synaptophysin, also known as the major synaptic vesicle protein p38, is a protein that in humans is encoded by the ''SYP'' gene.
Genomics
The gene is located on the short arm of X chromosome (Xp11.23-p11.22). It is 12,406 bases in length and ...
negative, neurofilament negative, TUJ1 positive, and
nestin positive have been expressed in astroblastoma cell populations, showing significant promise in neuronal stem cell treatment for the tumor.
Symptoms and signs
The majority of patients with astroblastoma display a limited set of physical and physiological symptoms. Rare cases in literature reveal atypical conditions, but these are often exclusive to the individual and do not suggest a widespread trend. As research continues, a larger set of symptoms can be properly assessed in the clinic.
Intracranial pressure
Most patients experience a series of intermittent headaches over a few weeks or sustained, powerful pressure in a matter of days.
The time-frame for this pressure varies from patient to patient and fluctuate based on the stage of the tumor. Both low-grade and high-grade astroblastoma can exhibit significant discomfort from headaches, although literature supports that higher-grade astroblastoma affect a patient with day-to-day activities, forcing individuals to stay at home away from their jobs and family. Malignant astroblastoma distorts the function of surrounding brain regions, and pressure is the primary result.
Enhanced drowsiness
Along with cranial pressure, patients exhibit noticeable lethargy, increasing in severity as the tumor progresses.
In the first few months, morning activities are usually unaffected; over time, these effects become more pronounced, especially late at night.
Lethargy can disrupt vital signs, depleting energy and desire to perform simple cognitive tasks.
Frequent nausea
The desire to eat normally becomes worse over time, leading to weight loss from vomiting.
Nausea is seen in almost all cases of astroblastoma, especially in low-grade tumors.
Impaired vision
Vision deficit usually occurs when lesions grow in the occipital lobe of the brain,
causing a blurred daze for patients, especially in sensitivity to light. Focusing upon finer objects becomes a challenge, along with edge and border detection.
Driving behind the wheel is dangerous when astroblastoma grows in residual tissue size, since peripheral vision can be insufficient. Horizontal
nystagmus
Nystagmus is a condition of involuntary (or voluntary, in some cases) eye movement. Infants can be born with it but more commonly acquire it in infancy or later in life. In many cases it may result in reduced or limited vision. Due to the invol ...
and other involuntary eye disorders can occur.
Motor system imbalance and weakness
Frequent reports show that adolescents and adults with grade III and IV astroblastoma fall frequently before they even reach a doctor's office.
Alertness is diminished when walking normally, forcing patients to exhibit awkward gait patterns to avoid imbalance.
Decreased sensation
Since the motor system can be impaired with severe cases, the malignant spread of astroblastoma throughout the body may press against or paralyze the spinal cord, diminishing sensation in upper and lower extremities.
Seizures
Convulsions
A convulsion is a medical condition where the body muscles contract and relax rapidly and repeatedly, resulting in uncontrolled shaking. Because epileptic seizures typically include convulsions, the term ''convulsion'' is sometimes used as a s ...
are observed in older patients with astroblastoma.
Psychotic episodes
Grade III and IV astroblastoma have been shown gradually change the mental stability of a patient.
Hallucinations impair cognition to the point where patients experience a loss of identity, although this is not commonly seen in clinic.
Cognitive dysregulation
Irritability, aggression, memory loss, neurological deficits, and inattentiveness on everyday tasks are the most common forms of deregulation in the mental capabilities of a patient.
Verbal communication is affected, but usually not to the point where close friends can detect that the individual is cognitively impaired.
Diagnosis
Classification
The
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
, a specialized agency that classifies abnormal tumors affecting the central nervous system and assesses potential risk to life, has difficulty in assigning a proper grade for astroblastoma.
The organization’s most recent grade in 2007 assigned astroblastoma as a high-grade III and grade IV
neoplasm
A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
, signifying that the glial tumor is dangerous for patients, causing fatal problems even after surgery.
However, recent data compilation from 2011, one that compiled nearly 30 years of clinical information, confirms opposite results from patients: a 95% survival rate exists after astroblastoma is completely removed (gross total resection).
The most important factor for any patient when cancer is concerned – the likelihood of surviving – is still controversial for astroblastoma, but recent advances in the last decade have improved prognosis.
Treatment
Like most tumors in the brain, astroblastoma can be treated through surgery and various forms of therapy. Many publications within the last decade have suggested a noticeable improvement in success rate of patients. With the advancement of cutting-edge technology and novel approaches in stem cells, patients are hopeful that they be happy and healthy through old age.
The following factors influence an oncologist's specific treatment plan:
# Patient's overall medical history
# Localization and grade severity of the tumor
# Age and tolerance to certain medications, procedures, and treatment
# Predicted progress of recovery
# Final anticipated outcome of treatment
Gross-total resection
Complete surgical removal, known as gross-total resection or
craniotomy
A craniotomy is a surgical operation in which a bone flap is temporarily removed from the skull to access the brain. Craniotomies are often critical operations, performed on patients who are suffering from brain lesions, such as tumors, blood clots ...
, remains the standard for treating astroblastoma, despite high recurrence rate for high-grade tumors.
Since there are so few cases reported around the world each year, the standard for surgery varies from physician to physician and is often difficult to rightfully diagnose. Low-grade astroblastomas exhibit low recurrence rates following resection, but varying reports prove that some patients, despite the severity of the lesion, will unpredictably witness recurrence.
In a recent study of a 17-year-old male, a low-grade astroblastoma was resected and recurred within 5 months of the therapy, forcing the oncologist to administer further chemotherapy, radiotherapy, and a second resection to completely put the tumor in remission.
Radiotherapy
Radiation therapy
Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radia ...
selectively kills astroblastoma cells while leaving surrounding normal brain tissue unharmed. The use of radiation therapy after an astroblastoma excision has variable results.
Conventional external beam radiation has both positive and negative effects on patients, but it is not recommended at this point to treat all types.
All in all, the radiosensitivity of astroblastoma to therapy remains unclear, since some research advocate its effectiveness while others diminish the effects. Future studies must be done on patients with both total excision and sub-excision of the tumor to accurately assess whether radiation benefits patients under different circumstances.
Chemotherapy
Chemotherapy
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemotherap ...
is the preferred secondary treatment after resection. The treatment kills astroblastoma cells left behind after surgery and induces a non-dividing, benign state for remaining tumor cells. Normally, chemotherapy is not recommended until the second required resection, implying that the astroblastoma is a high-grade tumor continuing to recur every few months.
A standard chemotherapy protocol starts with two rounds of
nimustine hydrochoride (ACNU),
etoposide
Etoposide, sold under the brand name Vepesid among others, is a chemotherapy medication used for the treatments of a number of types of cancer including testicular cancer, lung cancer, lymphoma, leukemia, neuroblastoma, and ovarian cancer. It is ...
,
vincristine
Vincristine, also known as leurocristine and marketed under the brand name Oncovin among others, is a chemotherapy medication used to treat a number of types of cancer. This includes acute lymphocytic leukemia, acute myeloid leukemia, Hodgkin's ...
, and
interferon-beta
The type-I interferons (IFN) are cytokines which play essential roles in inflammation, immunoregulation, tumor cells recognition, and T-cell responses. In the human genome, a cluster of thirteen functional IFN genes is located at the 9p21.3 cyto ...
.
The patient undergoes a strict drug regimen until another surgery is required. By the third surgery, should recurrence in the astroblastoma occur, a six-round program of
ifosfamide
Ifosfamide (IFO), sold under the brand name Ifex among others, is a chemotherapy medication used to treat a number of types of cancer. This includes testicular cancer, soft tissue sarcoma, osteosarcoma, bladder cancer, small cell lung cancer, cer ...
,
cisplatin
Cisplatin is a chemotherapy medication used to treat a number of cancers. These include testicular cancer, ovarian cancer, cervical cancer, breast cancer, bladder cancer, head and neck cancer, esophageal cancer, lung cancer, mesothelioma, br ...
, and
etoposide
Etoposide, sold under the brand name Vepesid among others, is a chemotherapy medication used for the treatments of a number of types of cancer including testicular cancer, lung cancer, lymphoma, leukemia, neuroblastoma, and ovarian cancer. It is ...
will "shock" the patient's system to the point where recurrence halts.
Unfortunately, chemotherapy may not always be successful with patients requiring further resection of the tumor, since the tumor cell begins to show superior vasculature and a strong likelihood of compromising a patient's well-being. Oral ingestion of
temozolomide
Temozolomide (TMZ), sold under the brand name Temodar among others, is a medication used to treat brain tumors such as glioblastoma and anaplastic astrocytoma. Text was copied from this source which is © European Medicines Agency. Reproduction i ...
for at-home bedside use may be preferred by the patient.
Future advances
A popular form of surgery involves
CyberKnife radiotherapy and
Gamma Knife
Radiosurgery is surgery using radiation, that is, the destruction of precisely selected areas of tissue (biology), tissue using ionizing radiation rather than excision with a blade. Like other forms of radiation therapy (also called radiotherapy) ...
radiosurgery. Their success-rate on cranial lesion is fairly effective, but recurrence is still a problem for severe patients.
One of the more exciting and promising routes for treatment involves stem cell use to combat astroblastoma. A study in 2005 profiled cell surface markers of astroblastoma cells removed from an 11-year-old patient.
Fluorescence
Fluorescence is the emission of light by a substance that has absorbed light or other electromagnetic radiation. It is a form of luminescence. In most cases, the emitted light has a longer wavelength, and therefore a lower photon energy, tha ...
activation suggested that about 1/4 of these cells were
CD133
CD133 antigen, also known as prominin-1, is a glycoprotein that in humans is encoded by the ''PROM1'' gene. It is a member of pentaspan transmembrane glycoproteins, which specifically localize to cellular protrusions. When embedded in the cell m ...
positive
CD24
Signal transducer CD24 also known as cluster of differentiation 24 or heat stable antigen CD24 (HSA) is a protein that in humans is encoded by the ''CD24'' gene. CD24 is a cell adhesion molecule.
Function
CD24 is a sialoglycoprotein expressed ...
,
CD34
CD34 is a transmembrane phosphoglycoprotein protein encoded by the CD34 gene in humans, mice, rats and other species.
CD34 derives its name from the cluster of differentiation protocol that identifies cell surface antigens. CD34 was first descri ...
, and
CD45
Protein tyrosine phosphatase, receptor type, C also known as PTPRC is an enzyme that, in humans, is encoded by the ''PTPRC'' gene. PTPRC is also known as CD45 antigen (CD stands for cluster of differentiation), which was originally called leukocy ...
negative. This specific genetic makeup lends to self-renewal, differentiation, and propagation of neural stem cells in the brain.
However, the work remains a preliminary insight into the role of neuronal stemlike cells on astroblastoma development.
Prognosis
More than other brain tumors, astroblastoma is frequently a recurring tumor; its rate remains high, even after resection as treatment. Currently, an unfavorable prognosis exists for patients with high-grade, anaplastic astroblastoma: they tend to recur almost indefinitely, forcing the patient to invest in more invasive surgeries. In contrast, a favorable prognosis exists for patients with well-differentiated, low-grade astroblastoma, since patients usually never require such a treatment.
The strict black-and-white diagnosis of an astroblastoma based on grade does not determine all tumor behaviors, but it can be used as a benchmark for patients with varying degrees of severity.
Low-grade
The likelihood of low-grade astroblastoma returning after surgery is highly improbable, but some patients have exhibited recurrence.
Patients with low-grade lesions can remain asymptomatic after surgery and show recurrence 1–2 years in follow-up sessions.
However, since residual tissue size is a large determinant for profiling recurrence, it is almost never the case that a low-grade astroblastoma continues to appear in size and strength after the second resection.
Usually, patients are not recommended for resection at all and are simply directed towards other therapeutic techniques. Most children can continue to lead productive, healthy lives after a low-grade astroblastoma is treated.
High-grade
Surviving the symptoms of high-grade astroblastoma is not life-threatening, but a significant portion of patients die due to repeated recurrence of tumors as they continue to grow and spread. Unlike conventional low-grade tumors, high-grade tumors associate a plethora of factors when they metastasize to other areas of the body. Therefore, complications frequently occur after surgery is performed since an oncologist cannot efficiently control the tumor in a suitable time-frame.
Cases in literature confirm that high-grade patients face up to five or six resection surgeries and ''still'' experience symptoms post-operatively.
The dual-action of chemotherapy and radiotherapy can slow down recurrence when gross total resection is performed multiple times, but there is no guarantee that the tumor will ever be in remission.
onsiderations for specialized astroblastoma therapies, but they are not mentioned in current literature.
Epidemiology
Astroblastoma predominantly affects children, but young adults are also susceptible to the tumor .
Although the tumor is widely considered a pediatric disease, elderly patients are documented throughout literature.
Age incidence
The age distribution of astroblastoma is largely
bimodal
In statistics, a multimodal distribution is a probability distribution with more than one mode (statistics), mode. These appear as distinct peaks (local maxima) in the probability density function, as shown in Figures 1 and 2. Categorical, ...
, suggesting that two distinct diagnosis peaks occur from ages 5–10 and ages 21–30.
A likely explanation for this discrepancy is that parents of children are more likely to report symptoms of nausea and constant headaches than young adults, who may, at first, disregard these symptoms for a lesser condition. Nevertheless, a combination of age, anatomic location, and image assessment can efficiently evaluate astroblastoma. Furthermore, the age of a patient can aid an oncologist in recommending appropriate treatment plans, along with other factors.
Gender incidence
In reported cases of the tumor over the last 25 years, the number of affected females with astroblastoma is significantly higher than the number of affected males.
Sughrue et al. confirmed this trend, stating that 70% of the cases with clearly stated gender were female (100 cases total).
While several publications support a genetic predisposition to females, the underlying reasons are still unknown.
Environmental incidence
At this point, no literature has indicated whether environmental factors increase the likelihood of astroblastoma. Although
cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
in general is caused by a variety of external factors, including carcinogens, dangerous chemicals, and viral infections, astroblastoma research has not even attempted to classify incidence in this regard. The next few decades will aid in this understanding.
See also
*
Neoplasm
A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
*
Neuroepithelial cell Neuroepithelial cells, or neuroectodermal cells, form the wall of the closed neural tube in early embryonic development. The neuroepithelial cells span the thickness of the tube's wall, connecting with the pial surface and with the ventricular or l ...
*
Astrocytes
Astrocytes (from Ancient Greek , , "star" + , , "cavity", "cell"), also known collectively as astroglia, are characteristic star-shaped glial cells in the brain and spinal cord. They perform many functions, including biochemical control of endo ...
*
Glial cells
Glia, also called glial cells (gliocytes) or neuroglia, are non-neuronal cells in the central nervous system (brain and spinal cord) and the peripheral nervous system that do not produce electrical impulses. They maintain homeostasis, form mye ...
*
Brain cancer
A brain tumor occurs when abnormal cells form within the brain. There are two main types of tumors: malignant tumors and benign (non-cancerous) tumors. These can be further classified as primary tumors, which start within the brain, and secondar ...
References
External links
{{Nervous tissue tumors
Nervous system neoplasia