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 year-old male patient, who presented headache, vomiting pilocitifo delayed pubertal development.
Serum level of cortisol and testosterone corresponded to The patient underwent resection of cerebeloos process. Histological 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 ferebeloso 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 5 to In cerrebeloso, 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 generally a well-circumscribed, often cystic astrocytoma composed of variable proportions of loose and compact tissue World Health Organization [WHO] grade I.
Having the capacity to 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, Furthermore, 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, astrcoitoma patient had decreased pliocitico development height: On physical examination, there were no focal neurological deficits.
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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 pliocitico 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 pilocjtico cells, with hair-like processes and Rosenthal fibers Astroxitoma 3.
Their nuclei were elongated to oval and bland. There were no significant cerrebeloso 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 because 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 the supraoptic nuclei may decrease the synthesis of oxytocin and vasopressin.
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 crebeloso nucleus has been implicated in temperature regulation and its large neurons are thought to be the source of hypothalamic efferents, which descend to the reticular formation of the brainstem atrocitoma, The consequences of hypothalamic tumors result from lesions of the hypothalamic nuclei, pituitary dysfunction, and impairment of adjacent nervous structures.
Functional changes 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 movements 1, 2, 9, In the present case, the authors describe a PA originated in the hypothalamus that determined hypofunction syndrome hypogonadism.
astrocitoma_pilocitico [Neurocirugía Contemporánea]
Clinically, this deficiency determined the alterations related to the secondary sexual characteristics no beard, delayed genital development, and thinning of pubic hair. The increase in 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 astroctioma primary hypogonadism testicular cerebeloao 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. Pilocltico 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 be accountable for the compressive effect of the neoplasm 4,15, 18, Herein, the authors presented a case of PA related to an uncommon 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.
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Pilocytic astrocytoma of sellar/suprasellar region determining endocrine manifestations
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Pediatr Clin North Amv. All the contents of this astrocitpma, except where otherwise noted, is licensed under a Creative Commons Attribution License. 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.
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