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Hemorrhagic Recurrence in Diffuse Astrocytoma without Malignant Transformation.

Baek HJ, Kim SM, Chung SY, Park MS - Brain Tumor Res Treat (2014)

Bottom Line: Annual follow-up MRIs had shown evidence of slow tumor recurrence.Histopathology confirmed diffuse astrocytoma without malignant changes.As the patient's postoperative condition was excellent, we plan to withhold chemotherapy and radiation therapy for use as a later treatment option.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Daejeon, Korea.

ABSTRACT
Although uncommon, hemorrhage can be a complication of low grade glioma with an unfavorable prognosis such as transformation to higher grade glioma. To our knowledge, hemorrhagic recurrence of World Health Organization Grade II, diffuse astrocytoma without malignant transformation has not been reported. Thus, we report a case of diffuse astrocytoma with hemorrhagic recurrence without malignant transformation. The patient had undergone craniotomy and tumor removal 7 years previously. Annual follow-up MRIs had shown evidence of slow tumor recurrence. With the sudden onset of seizure, the patient was diagnosed as hemorrhagic recurrence and underwent second tumor removal highly suspecting malignant change into higher grade glioma. Histopathology confirmed diffuse astrocytoma without malignant changes. As the patient's postoperative condition was excellent, we plan to withhold chemotherapy and radiation therapy for use as a later treatment option.

No MeSH data available.


Related in: MedlinePlus

Histopathology. A: Histology of 1st operation (hematoxylin-eosin stain, ×200).Tumor cells with mild nuclear atypia are present in fibrillary background, diagnosed as diffuse astrocytoma. B: Histology of main lesion of 2nd operation (hematoxylin-eosin stain, ×200). The neoplastic astrocytes with occasional nuclear atypia and glomeruloid vessels are present in the background of a loosely structured or microcystic tumor matrix, diagnosed as astrocytoma. C: Main lesion 2nd operation (hematoxylin-eosin stain, ×100). Evidence of hemorrhage and vascular proliferation of the main lesion is present. D: Main lesion 2nd operation (hematoxylin-eosin stain, ×200). Neovascularization is identified along the edge of tumor periphery. E: There is 1-2% stain of tumor cells in Ki-67 immunohistochemical staining (×200).
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Figure 3: Histopathology. A: Histology of 1st operation (hematoxylin-eosin stain, ×200).Tumor cells with mild nuclear atypia are present in fibrillary background, diagnosed as diffuse astrocytoma. B: Histology of main lesion of 2nd operation (hematoxylin-eosin stain, ×200). The neoplastic astrocytes with occasional nuclear atypia and glomeruloid vessels are present in the background of a loosely structured or microcystic tumor matrix, diagnosed as astrocytoma. C: Main lesion 2nd operation (hematoxylin-eosin stain, ×100). Evidence of hemorrhage and vascular proliferation of the main lesion is present. D: Main lesion 2nd operation (hematoxylin-eosin stain, ×200). Neovascularization is identified along the edge of tumor periphery. E: There is 1-2% stain of tumor cells in Ki-67 immunohistochemical staining (×200).

Mentions: The frozen biopsy showed vascular proliferation with necrosis, which was highly suspicious of high grade giloma, with the final histopathology results revealing WHO grade II diffuse astrocytoma with red blood cells and no evidence of malignant tumor cells. The pathologist remarked that the pleomorphism of the tumor was rare and the necrotic portions were mostly hemorrhagic necrosis rather than tumor necrosis. Ki-67 showed 1-2% staining with well-differentiated astrocytoma and minimal nuclear atypia. There was no definite hypercellularity (Fig. 3). In addition, because this was her second operation, neovascularization with granular tissues along the tumor margin can be considered as postoperative changes from initial operation.


Hemorrhagic Recurrence in Diffuse Astrocytoma without Malignant Transformation.

Baek HJ, Kim SM, Chung SY, Park MS - Brain Tumor Res Treat (2014)

Histopathology. A: Histology of 1st operation (hematoxylin-eosin stain, ×200).Tumor cells with mild nuclear atypia are present in fibrillary background, diagnosed as diffuse astrocytoma. B: Histology of main lesion of 2nd operation (hematoxylin-eosin stain, ×200). The neoplastic astrocytes with occasional nuclear atypia and glomeruloid vessels are present in the background of a loosely structured or microcystic tumor matrix, diagnosed as astrocytoma. C: Main lesion 2nd operation (hematoxylin-eosin stain, ×100). Evidence of hemorrhage and vascular proliferation of the main lesion is present. D: Main lesion 2nd operation (hematoxylin-eosin stain, ×200). Neovascularization is identified along the edge of tumor periphery. E: There is 1-2% stain of tumor cells in Ki-67 immunohistochemical staining (×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231623&req=5

Figure 3: Histopathology. A: Histology of 1st operation (hematoxylin-eosin stain, ×200).Tumor cells with mild nuclear atypia are present in fibrillary background, diagnosed as diffuse astrocytoma. B: Histology of main lesion of 2nd operation (hematoxylin-eosin stain, ×200). The neoplastic astrocytes with occasional nuclear atypia and glomeruloid vessels are present in the background of a loosely structured or microcystic tumor matrix, diagnosed as astrocytoma. C: Main lesion 2nd operation (hematoxylin-eosin stain, ×100). Evidence of hemorrhage and vascular proliferation of the main lesion is present. D: Main lesion 2nd operation (hematoxylin-eosin stain, ×200). Neovascularization is identified along the edge of tumor periphery. E: There is 1-2% stain of tumor cells in Ki-67 immunohistochemical staining (×200).
Mentions: The frozen biopsy showed vascular proliferation with necrosis, which was highly suspicious of high grade giloma, with the final histopathology results revealing WHO grade II diffuse astrocytoma with red blood cells and no evidence of malignant tumor cells. The pathologist remarked that the pleomorphism of the tumor was rare and the necrotic portions were mostly hemorrhagic necrosis rather than tumor necrosis. Ki-67 showed 1-2% staining with well-differentiated astrocytoma and minimal nuclear atypia. There was no definite hypercellularity (Fig. 3). In addition, because this was her second operation, neovascularization with granular tissues along the tumor margin can be considered as postoperative changes from initial operation.

Bottom Line: Annual follow-up MRIs had shown evidence of slow tumor recurrence.Histopathology confirmed diffuse astrocytoma without malignant changes.As the patient's postoperative condition was excellent, we plan to withhold chemotherapy and radiation therapy for use as a later treatment option.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Daejeon, Korea.

ABSTRACT
Although uncommon, hemorrhage can be a complication of low grade glioma with an unfavorable prognosis such as transformation to higher grade glioma. To our knowledge, hemorrhagic recurrence of World Health Organization Grade II, diffuse astrocytoma without malignant transformation has not been reported. Thus, we report a case of diffuse astrocytoma with hemorrhagic recurrence without malignant transformation. The patient had undergone craniotomy and tumor removal 7 years previously. Annual follow-up MRIs had shown evidence of slow tumor recurrence. With the sudden onset of seizure, the patient was diagnosed as hemorrhagic recurrence and underwent second tumor removal highly suspecting malignant change into higher grade glioma. Histopathology confirmed diffuse astrocytoma without malignant changes. As the patient's postoperative condition was excellent, we plan to withhold chemotherapy and radiation therapy for use as a later treatment option.

No MeSH data available.


Related in: MedlinePlus