Advertisement

Malignant Astrocytomas of the Spinal Cord: Clinicopathologic Parameters

  • Mariarita SantiEmail author
  • Elisabeth J. Rushing
Chapter
  • 1.1k Downloads
Part of the Tumors of the Central Nervous System book series (TCNS, volume 6)

Abstract

Malignant spinal cord astrocytomas are uncommon neoplasms that typically manifest with the acute onset of symptoms such as pain accompanied by motor and/or sensory disturbances. Most intramedullary spinal cord astrocytomas are low-grade, either diffuse WHO (World Health Organization) grade II, or less commonly, pilocytic astrocytomas (PA, grade I). Only 7.5% are diagnosed as high-grade astrocytomas, either anaplastic (AA, grade III) or glioblastoma (GBM, grade IV). Given the limited number of cases and often extremely small biopsies, there is no consensus regarding the prognostic significance of AA compared to GBM. In the largest retrospective study that stratified these two histopathologic grades, Santi et al. (Cancer 98:554–561, 2003) were unable to detect a difference in outcome. The authors acknowledge, however, that inadequate sampling may have biased the interpretation of the often tiny specimens. Only age appeared to correlate with prognosis, with shorter survival reported in patients older than 40 years at the onset of disease. More recently, McGirt et al. (Neurosurgery 63:55–66, 2008) found that patients with nondisseminated AA treated with radical resection showed a trend towards increased survival. With respect to patients with GBM who underwent radical resection, the overall survival was only 9 months. Despite largely anecdotal indications that local control may be beneficial, controversy persists regarding the prognostic value of the extent of resection. Similar concerns have been voiced regarding the benefits of adjuvant radiation or chemotherapy. The overall experience with high-grade spinal cord astrocytomas is that of relentless, aggressive growth with minimal chance of long term or recurrence-free survival.

Keyword

Astrocytoma Spinal cord 

References

  1. Allen JC, Aviner S, Yates AJ, Boyett JM, Cherlow JM, Turski PA, Epstein F, Finlay JL (1998) Treatment of high-grade spinal cord astrocytoma of childhood with 8-in 1 chemotherapy and radiotherapy: a pilot study of CCG-945. J Neurosurg 88:215–220PubMedCrossRefGoogle Scholar
  2. Balmaceda C (2000) Chemotherapy for intramedullary spinal cord tumors. J Neurooncol 47:293–307PubMedCrossRefGoogle Scholar
  3. Berhouma M, Bahri K, Houissa S, Zemmel I, Khouja N, Aouidj L, Jemel H, Khaldi M (2009) Management of intramedullary spinal cord tumors: surgical considerations and results in 45 cases. Neurochirurgie 55:293–302PubMedCrossRefGoogle Scholar
  4. Bonde V, Balasubramaniam S, Goel AJ (2008) Glioblastoma multiforme of the conus medullaris with holocordal spread. Clin Neurosci 15:601–603CrossRefGoogle Scholar
  5. Burger P, Scheithauer B, Vogel F (eds) (2002) Surgical pathology of the nervous system and its covering, 4th edn. Churchill LivingstonGoogle Scholar
  6. Ciappetta P, Salvati M, Capoccia G, Artico M, Raco A, Fortuna A (1991) Spinal glioblastomas: report of seven cases and review of the literature. Neurosurgery 28:302–306PubMedCrossRefGoogle Scholar
  7. Cohen AR, Wisoff JH, Allen JC, Epstein F (1989) Malignant astrocytoma of the spinal cord. J Neurosurg 70:50–54PubMedCrossRefGoogle Scholar
  8. Constantini S, Miller DC, Allen JC, Rorke LB, Freed D, Epstein FJ (2000) Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg Spine 93:183–193CrossRefGoogle Scholar
  9. Epstein FJ, Farmer JP, Freed D (1992) Adult intramedullary astrocytomas of the spinal cord. J Neurosurg 77:355–359PubMedCrossRefGoogle Scholar
  10. Garcés-Ambrossi GL, McGirt MJ, Mehta VA, Sciubba DM, Witham TF, Bydon A, Wolinksy JP, Jallo GI, Gokaslan ZL (2009) Factors associated with progression-free survival and long-term neurological outcome after resection of intramedullary spinal cord tumors: analysis of 101 consecutive cases. J Neurosurg Spine 11:591–599PubMedCrossRefGoogle Scholar
  11. Goh KY, Velasquez L, Epstein FJ (1997) Pediatric intramedullary spinal cord tumors: is surgery alone enough? Pediatr Neurosurg 27:34–39PubMedCrossRefGoogle Scholar
  12. Grimm S, Chamberlain MC (2009) Adult primary spinal cord tumors. Expert Rev Neurother 10:1487–1495CrossRefGoogle Scholar
  13. Guidetti B, Fortuna A (1974) Differential diagnosis of intramedullary and extramedullary tumors. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology. North-Holland, AmsterdamGoogle Scholar
  14. Hegi ME, Diserens AC, Gorlia T, Hamou MF, de Tribolet N, Weller M, Kros JM, Hainfellner JA, Mason W, Mariani L, Bromberg JE, Hau P, Mirimanoff RO, Cairncross JG, Janzer RC, Stupp R (2005) MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 352:997–1003PubMedCrossRefGoogle Scholar
  15. Henson JW, Thornton AF, Louis DN (2000) Spinal cord astrocytoma: response to PCV chemotherapy. Neurology 54:518–520PubMedGoogle Scholar
  16. Iwata K, Nakagawa H, Hashizume Y (1996) Significance of MIB-1, PCNA indices, and p53 protein over-expression in intramedullary tumors of the spinal cord. Noshuyo Byori 13:73–78PubMedGoogle Scholar
  17. Jallo GI, Freed D, Epstein F (2003) Intramedullary spinal cord tumors in children. Childs Nerv Syst 9:641–649CrossRefGoogle Scholar
  18. Kim MS, Chung CK, Choe G, Kim IH, Kim HJ (2001) Intramedullary spinal cord astrocytoma in adults: postoperative outcome. J Neurooncol 52:85–94PubMedCrossRefGoogle Scholar
  19. Koeller KK, Rosenblum RS, Morrison AL (2000) Neoplasms of the spinal cord and filum terminale: radiologic-pathologic correlation. Radiographics 20:1721–1749PubMedGoogle Scholar
  20. Komotar RJ, Carson BS, Rao C, Chaffee S, Goldthwaite PT, Tihan T (2005) Pilomyxoid astrocytoma of the spinal cord: report of three cases. Neurosurgery 56:191PubMedGoogle Scholar
  21. Kyoshima K, Ito K, Tanabe A et al (2002) Malignant astrocytoma of the conus medullaris treated by spinal cordectomy. J Clin Neurosci 9:211–216PubMedCrossRefGoogle Scholar
  22. McGirt MJ, Goldstein IM, Chaichana KL, Tobias ME, Kothbauer KF, Jallo GI (2008) Extent of surgical resection of malignant astrocytomas of spinal cord: outcome analysis of 35 patients. Neurosurgery 63:55–66PubMedCrossRefGoogle Scholar
  23. McLendon RE, Provenzale JM, Friedman AH (2006) Astrocytoma of the spinal cord. In: McLendon RE, Rosemblum MK, Bigner DD (eds) Russel and Rubinstein’s pathology of tumors of the nervous system, 7th edn. Hodder ArnoldGoogle Scholar
  24. Miller DC (2000) Surgical pathology of intramedullary spinal cord neoplasms. J Neurooncol 47:189–194PubMedCrossRefGoogle Scholar
  25. Miller DJ, McCutcheon IE (2000) Hemangioblastomas and other uncommon intramedullary tumors. J Neurooncol 47:253–270PubMedCrossRefGoogle Scholar
  26. Raco A, Piccirilli M, Landi A, Lenzi J, Delfini R, Cantore G (2010) High-grade intramedullary astrocytomas: 30 years’ experience at the Neurosurgery Department of the University of Rome “Sapienza”. J Neurosurg Spine 12:144–153PubMedCrossRefGoogle Scholar
  27. Rovin RA, Winn R (2007) Expression of O6-methylguanine-deoxyribose nucleic acid methyltransferase and temozolomide response in a patient with a malignant spinal cord Expression of O6-methylguanine-deoxyribose nucleic acid methyltransferase and temozolomide response in a patient with a malignant spinal cord. J Neurosurg Spine 5:447–450CrossRefGoogle Scholar
  28. Santi M, Mena H, Wong K, Koeller K, Olsen C, Rushing EJ (2003) Spina cord malignant astrocytomas. Clinicopathologic features in 36 cases. Cancer 98:554–561PubMedCrossRefGoogle Scholar
  29. Sarkar C, Ralte AM, Sharma MC, Mehta VS (2002) Recurrent astrocytic tumours-a study of p53 immunoreactivity and malignant progression. Br J Neurosurg 16:335–342PubMedCrossRefGoogle Scholar
  30. Schittenhelm J, Ebner FH, Tatagiba M, Wolff M, Nägele T, Meyermann R, Mittelbronn M (2009) Holocord pilocytic astrocytoma–case report and review of the literature. Clin Neurol Neurosurg 111:203–207PubMedCrossRefGoogle Scholar
  31. Sciubba DM, Liang D, Kothbauer KF, Noggle JC, Jallo GI (2009) The evolution of intramedullary spinal cord tumor surgery. Neurosurgery 65(6 Suppl):84–91PubMedGoogle Scholar
  32. Shenkin HA, Alpers BJ (1994) Clinical and pathological features of gliomas of the spinal cord. Arch Neurol Psychiatry 52:87–107Google Scholar
  33. Yang S, Yang X, Hong G (2009) Surgical treatment of one hundred seventy-four intramedullary spinal cord tumors. Spine 34(24):2705–2710PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Pathology and Laboratory MedicineUniversity of Pennysylvania School of Medicine, Neuropathologist, The Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Institut für NeuropathologieUniversitäts Spital ZürichZürichSwitzerland

Personalised recommendations