Download scientific diagram | Astrocitoma pilocítico parenquimatoso. Resonancia magnética: en el Astrocitoma pilocítico cerebeloso (recidiva posquirúrgica). Más de 80 % de los astrocitomas ubicados en el cerebelo son de grado bajo ( pilocíticos La activación de BRAF en el astrocitoma pilocítico sucede, con mayor. O astrocitoma pilocítico (AP) é uma neoplasia glial grau I encontrada principalmente no cerebelo de crianças. Os autores relatam um caso de.
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Pilocytic astrocytoma PA is a grade I glial neoplasm arising mainly in the cerebellum of children. Herein, the authors report a case of PA in a 21 pilocituco male patient, who presented headache, vomiting and delayed pubertal development.
Pilocytic astrocytoma of sellar/suprasellar region determining endocrine manifestations
Serum level of cortisol and testosterone corresponded to The patient underwent resection of the process. Astrrocitoma evaluation revealed a glial neoplasm constituted by loose glial tissue, small microcysts, areas of dense piloid tissue and Rosenthal fibers. The neoplastic cells were immunoreactive for glial fibrillary acidic protein GFAP and negative for chromogranin and synaptophysin.
The diagnosis of PA was then established. The tumor is most common during the first two decades of life without any gender preference. It is the most common brain tumor within the ages of astrocjtoma to In adults, these tumors tend to appear one decade earlier than low grade diffusely infiltrating astrocytomas 2, 5, The clinical presentation of PA generally consists of a slowly evolving lesion, given their slow growth rate.
The tumor may produce focal neurologic deficits or non-localizing signs, including macrocephaly, headache, endocrinopathy, or increased intracranial pressure due to mass effect or ventricular obstruction 2, 3, 8, 14, PA are pilocltico a well-circumscribed, often cystic astrocytoma composed of variable proportions of loose and compact tissue World Health Organization [WHO] grade I. Having the capacity asttrocitoma form Rosenthal fibers, the hair-like, piloid cells of PA are remarkably similar to reactive astrocytes surrounding various chronic lesions of the hypothalamus, cerebellum and spinal cord.
Their histological and cytological resemblance makes such astrocytes prime candidates as precursors 2, 14, 16, Pillcitico, they review pathological and clinical findings of this tumor. A 21 year-old male Caucasian patient was taken to hospital service referring nausea, headache and vomiting in the last 24 hours.
Associated with these symptoms, the patient had decreased pubertal development astrocotoma On physical examination, there were no focal neurological deficits.
Ophthalmologic examination demonstrated bilateral edema of the optic nerve papilla. At lumbar puncture, an increase in cerebrospinal fluid CSF pressure was observed. At laboratory investigation, serum level of cortisol and testosterone corresponded to The relevant laboratory tests are described in the Table.
The patient underwent resection of the process and ventriculoperitoneal shunt. On gross examination, the sample comprised some gray, irregular fragments, weighting 1 g, with the largest fragment measuring 0.
On histological evaluation, a primary central nervous system neoplasm demonstrating a biphasic pattern was evaluated, which was constituted by loose glial tissue Figure 2 and dense piloid tissue.
The loose glial tissue was composed of small microcysts with multipolar cells, round to oval nuclei and short, afibrillar processes.
Globular aggregates compatible with eosinophilic granular bodies were identified between astrocytic processes. Some tumor areas consisted of sheets of compact, elongated, bipolar piloid cells, with hair-like processes and Rosenthal fibers Figure 3. Their nuclei were elongated to oval and bland.
There were no significant cytological atypia and areas of necrosis. A low mitotic index was observed. There was negative immunoexpression for cytokeratin, chromogranin and synaptophysin. The diagnosis of PA was then established. Since any given hypothalamic hormone is commonly produced in more than one nucleus, and, in many cases, a single nucleus may express several hormones, different clinical signs may be found in this group of patients.
Structure-function correlations are complex wstrocitoma of the functional heterogeneity of many hypothalamic nuclei. Alterations in the suprachiasmatic nucleus of the hypothalamus may be associated with decrease in gonadotropin release. Lesions of cerebelosk supraoptic nuclei may decrease the synthesis of oxytocin and vasopressin.
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Destruction of the ventromedial nucleus results in obesity; conversely, destruction of the ventrolateral nucleus causes anorexia and cachexia.
The arcuate infundibular nucleus plays a major role in the modulation of anterior pituitary function. The paired medial and lateral nuclei are linked with autonomic function, particularly temperature control and olfaction. The posterior nucleus astroccitoma been implicated in temperature regulation and its large neurons are thought to be the source of hypothalamic efferents, which descend to cerebellso reticular formation of the brainstem 1, The consequences of hypothalamic tumors result from lesions of the hypothalamic nuclei, pituitary dysfunction, and impairment of adjacent nervous structures.
Functional astrocitomaa determined by PA arising in the hypothalamus include syndromes of hyperfunction or hypofunction. The hyperfunction syndromes include early puberty, ectopic production of hypothalamic hormones, and inappropriate secretion of antidiuretic hormone.
The hypofunction syndromes may determine hypothalamic dwarfism, the so called diencephalic syndrome, obesity, hypothalamic hypogonadism, amenorrhea, diabetes insipidus and hypopituitarism. Other functional disorders include changes in appetite and thirst, hypothermia, hyperthermia, disorders in the pattern of sleep and wakefulness, behavioral disorders, visual disturbances, spasticity, hyperreflexia, ataxia and uncoordinated pilocitido 1, 2, 9, In the present case, the authors describe a PA originated in the hypothalamus that determined hypofunction syndrome hypogonadism.
Clinically, this deficiency determined the alterations related to the secondary sexual characteristics no beard, delayed genital development, and thinning of pubic hair. The increase astorcitoma prolactin serum levels Hypothalamic hypogonadism HH occurs by decreased secretion of gonadotropin-releasing hormone GnRH or non-pulsatile secretion of this hormone, which may result in lack of sexual maturation, or pituitary hormone deficiency due to hypothalamic dysfunction.
In post-pubertal males, symptoms related to HH may include impotence and reduction in libido. Patients with primary hypogonadism testicular have low serum levels of testosterone and high levels of LH and FSH. In severe cases of HH, the basal levels of estradiol and serum gonadotropin response to GnRH are reduced, which indicate a defect in the tonic and cyclic secretion of GnRH.
The isolated GnRH deficiency characterizes Kallmann syndrome. Hyperprolactinemia in some cases of hypothalamic PA exerts an inhibitory activity on the positive feedback effect of estradiol on GnRH secretion The increase in prolactin in cases of PA seems to depend on the decrease in factors that inhibit prolactin secretion, namely dopamine produced by the arcuate nucleus of the hypothalamus, which is probably damaged by PA 4.
In males, hyperprolactinemia causes hypogonadism, and may be manifested as reduction in libido and impotence, occasionally followed by gynecomastia.
In hypothalamic dwarfism, patients have more often thyrotroph and growth hormone deficiency, which determine a shorter height owing to premature fusion of the epiphyseal cartilage. These patients have normal proportions between the limbs, trunk, abdomen, and head. The presence of hypopituitarism associated with hypothalamic PA may pipocitico accountable for the compressive effect of the neoplasm 4,15, 18, Herein, the authors presented a case axtrocitoma PA related to an astroctioma clinical presentation: An excellent follow-up is expected in the present case, although a risk for recurrence has been described in the literature in cases of hypothalamic PA.
Astrocytoma in the third ventricle and hypothalamus presenting with parkinsonism. J Korean Neurosurg Socv. Childhood diencephalic pilocytic astrocytoma. A review of seven observations. A population-based study of the incidence and survival rates in patients with pilocytic astrocytoma. J Neurosurgv. Stereotactic radiation therapy for progressive residual pilocytic astrocytomas.
J Neurooncolv. Rare primary tumours of the hypothalamus in adults: Neurol Neurochir Polv.
An Esp Pediatrv. Hypogonadism cereeloso to hyperprolactinaemia: Exp Clin Endocrinol Diabetesv. Guanabara Koogan,p. Pathogenesis, evaluation and treatment of hypogonadism in men. Endokrynol Polv. Pilocytic astrocytoma of neurohypophysis.
IARC Press,p. Hypothalamic-pituitary lesions in pediatric patients: J Pediatrv. Pilocytic astrocytoma of the optic pathway: Pathologic characteristics of pediatric intracranial pilocytic astrocytomas and their impact on outcome in 3 countries: Am J Surg Patholv. Hypogonadism due to hyperprolactinemia and subsequent first episode of psychosis. Gend Medv. Etiology and treatment of hypogonadism in adolescents. Pediatr Clin North Amv. All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License.
astrocitoma_pilocitico [Neurocirugía Contemporánea]
Services on Demand Journal. Case report A 21 year-old male Caucasian patient was taken to hospital service referring nausea, headache and vomiting in the last 24 hours. How to cite this article.