Astrocytoma is a type of brain tumor. Astrocytomas (also astrocytomata) originate from a specific kind of star-shaped glial cell in the cerebrum called an astrocyte. This type of tumor does not usually spread outside the brain and spinal cord, and it does not usually affect other organs. After glioblastomas, astrocytomas are the second most common glioma and can occur in most parts of the brain and occasionally in the spinal cord.

Within the astrocytomas, two broad classes are recognized in literature, those with:

  • Narrow zones of infiltration (mostly noninvasive tumors; e.g., pilocytic astrocytoma, subependymal giant cell astrocytoma, pleomorphic xanthoastrocytoma), that often are clearly outlined on diagnostic images
  • Diffuse zones of infiltration (e.g., high-grade astrocytoma), that share various features, including the ability to arise at any location in the central nervous system, but with a preference for the cerebral hemispheres; they occur usually in adults, and have an intrinsic tendency to progress to more advanced grades.

People can develop astrocytomas at any age. The low-grade type is more often found in children or young adults, while the high-grade type is more prevalent in adults. Astrocytomas in the base of the brain are more common in young people and account for roughly 75% of neuroepithelial tumors.

Pathophysiology

Astrocytoma causes regional effects by compression, invasion, and destruction of brain parenchyma, arterial and venous hypoxia, competition for nutrients, release of metabolic end products (e.g., free radicals, altered electrolytes, neurotransmitters), and release and recruitment of cellular mediators (e.g., cytokines) that disrupt normal parenchymal function.

Diagnosis

An X-ray computed tomography (CT) or magnetic resonance imaging (MRI) scan is necessary to characterize the extent of these tumors (size, location, consistency). CT will usually show distortion of third and lateral ventricles with displacement of anterior and middle cerebral arteries. Until 2021, histologic analysis was used as the primary method for grading astrocytomas. The current diagnostic grading criteria recommended by the World Health Organization (WHO), now utilizes both histopathological and molecular findings for a more comprehensive diagnosis. Even if the surgeon is not able to remove the entire tumor, it may remain inactive or be successfully treated with radiation.

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| II

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  • Low-grade (fibrillary) astrocytoma
  • Pleomorphic xanthoastrocytoma
  • Mixed oligoastrocytoma

| Consist of relatively slow-growing astrocytomas, usually considered benign that sometimes evolve into more malignant or as higher grade tumors. They are prevalent in younger people who often present with seizures. Median survival varies with the cell type of the tumor. Grade 2 astrocytomas are defined as being invasive gliomas, meaning that the tumor cells penetrate into the surrounding normal brain, making a surgical cure more difficult. People with oligodendrogliomas (which might share common cells of origin) have better prognoses than those with mixed oligoastrocytomas, who in turn have better prognoses than patients with (pure) low-grade astrocytomas. Other factors which influence survival include age (younger the better) and performance status (ability to perform tasks of daily living). Due to the infiltrative nature of these tumors, recurrences are relatively common. Depending on the patient, radiation or chemotherapy after surgery is an option. Individuals with grade 2 astrocytoma have a 5-year survival rate of about 34% without treatment and about 70% with radiation therapy. The prognosis is worst for these grade 4 gliomas. Few patients survive beyond 3 years. Individuals with grade 4 astrocytoma have a median survival time of 17

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thumb|Diagnosis of diffuse glioma, with astrocytomas mainly being diagnosed under IDH mutant and nuclear ATRX lost.

According to the WHO data, the lowest grade astrocytomas (grade I) make up only 2% of recorded astrocytomas, grade II 8%, and the higher grade anaplastic astrocytomas (grade III) 20%. The highest graded astrocytoma (grade IV GBM) is the most common primary nervous system cancer and second most frequent brain tumor after brain metastasis. Despite the low incidence of astrocytomas compared to other human cancers, mortality is significant, as the higher grades (III & IV) present high mortality rates (mainly due to late detection of the neoplasm).

Prevention

There are no precise guidelines because the exact cause of astrocytoma is not known.

Treatment

[[File:Management of IDH-mutant glioma.png|thumb|Management of IDH-mutant gliomas, with astrocytomas at center and right.

University of Texas sniper Charles Whitman, who killed multiple people during a mass murder event in 1966, was diagnosed with astrocytoma post-mortem. The Connally Commission investigating the shooting disagreed, and identified it as a glioblastoma, and concluded the tumor "conceivably could have contributed to his inability to control his emotions and actions".

Major League pitcher Dan Quisenberry was diagnosed with grade IV astrocytoma in January 1998. He died at the age of 45 in 1998 in Leawood, Kansas.

Richard Burns, winner of the 2001 World Rally Championship, was diagnosed with astrocytoma in 2003. Four years to the day after winning the World Rally Championship, on 25 November 2005, Burns died in Westminster, London, aged 34, after having been in a coma for some days as a result of his brain tumour.

Professional wrestler Matt Cappotelli was diagnosed with a grade 2/3 astrocytoma in December 2005, scuttling plans to promote Cappottelli to the main WWE roster. Cappotelli, who won a contract with WWE through the third season of their reality program Tough Enough, was the Ohio Valley Wrestling Heavyweight Champion at the time of his diagnosis and vacated the title in February 2006 after confirming the tumor was cancerous. Cappotelli underwent successful surgery and chemotherapy, but was unable to return to active wrestling work. He did return to OVW as a trainer in 2013. He died on June 29, 2018.

Kelley Mack was an American actress. She played Addy in season 9 of the series The Walking Dead (2018–2019). She also had roles in the films Profile (2018) and Broadcast Signal Intrusion (2021). In January 2025, Mack announced she had been diagnosed with astrocytoma. By April 2025, she had completed proton radiation treatment.

References

Bibliography

  • "Astrocytomas." KidsHealth - the Web's most visited site about children's health. Web. 01 May 2024. KidsHealth.org - Nemours KidsHealth.
  • "Astrocytoma - Diagnosis and Treatment Options at Mayo Clinic." Mayo Clinic: Medical Treatment and Research Centers. Web. 07 Dec. 2009. Glioma - Symptoms and causes.
  • "Glioblastoma Multiforme Treatment at Mayo Clinic." Mayo Clinic: Medical Treatment and Research Centers. Web. 07 Dec. 2009. Glioma - Symptoms and causes.
  • "The new WHO Classification of Tumors affecting the Central Nervous System" by Stephen B. Tatter, M.D., Ph.D.; MGH
  • Cancer.Net: Astrocytoma, Childhood
  • Imaging Astrocytoma MR, CT, Pathology