Pilocytic Astrocytoma

6 Sep


Your next patient is a 7 year old boy presenting with headache. Mom tells you he has been “dealing with headaches all summer”, but things got worse a few days ago when he started having nausea, vomiting, and fatigue.

On your exam, the patient’s vital signs are stable. He is sitting in mom’s lap, irritable, and uncooperative with the exam.

During the neuro exam, you notice his unsteady gait and dysmetria isolated to the left.

A head CT shows the following:

 A large cystic left cerebellar mass with a solid nodule, a typical imaging appearance of a pilocytic astrocytoma. 


Now, when you share this with mom and dad, first they are shocked and upset, followed by a barrage of questions. What can you tell them to expect?


Pilocytic astrocytomas are well-circumscribed, slow-growing tumors representing 20% of all childhood brain tumors.


The clinical manifestations depend on the location of the tumor, but may include visual deficits if the optic pathways are involved, obstructive hydrocephalus, ataxia, and a focal neurological exam.


The history of illness is typically long since these tumors are slow-growing.


The main therapy is surgical resection, which is curative if the entire tumor is removed. Radiation and chemotherapy are typically not required unless the tumor is progressive or unresectable (think brainstem, spinal cord, hypothalamus).


The prognosis is excellent, with the 5-year recurrence-free survival of greater than 90% after total resection. Malignant transformation in children is rare.


The bottom line:

pilocytic astrocytomas typically favor a good prognosis depending on tumor location, extent of tumor resection, side effects of surgery, chemotherapy and radiation.


Submitted by K Estes:


Source: Daroff: Bradley’s Neurology in Clinical Practice, 6th ed.; picture




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