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of or relating to anaplasia

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/10/30 02:58:58」(JST)

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Anaplastic astrocytoma is a WHO grade III type of astrocytoma, which is a type of cancer of the brain. The overall age-standardized incidence is 3.5 per million person years with a peak incidence of 8 per million population in the 75 to 79 year age group.^[1]

Pathology

Anaplastic astrocytomas fall under the category of high grade gliomas (WHO grade III-IV), which are pathologically undifferentiated gliomas that carry a poor clinical prognosis. Unlike glioblastomas (WHO grade IV), anaplastic astrocytomas lack vascular proliferation and necrosis on pathologic evaluation.^[2] Compared to grade II tumors, anaplastic astrocytomas are more cellular, demonstrate more atypia, and mitoses are seen.

Symptoms

Initial presenting symptoms most commonly are headache, depressed mental status, focal neurological deficits, and/or seizures.^[3] The growth rate and mean interval between onset of symptoms and diagnosis is approximately 1.5–2 years but is highly variable,^[3] being intermediate between that of low-grade astrocytomas and glioblastomas.^[3] Seizures are less common among patients with anaplastic astrocytomas compared to low-grade lesions.^[3]

Causes

Most high-grade gliomas occur sporadically or without identifiable cause.^[4] However, a small proportion (less than 5%) of persons with malignant astrocytoma has a definite or suspected hereditary predisposition.^[5] The main hereditary predispositions are mainly neurofibromatosis type I, Li-Fraumeni syndrome, hereditary nonpolyposis colorectal cancer and tuberous sclerosis.^[4] Anaplastic astrocytomas have also been associated with previous exposure to vinyl chloride and to high doses of radiation therapy to the brain.^[4]

Treatment

The standard initial treatment is to remove as much of the tumor as possible without worsening neurologic deficits. Radiation therapy has been shown to prolong survival and is a standard component of treatment. There is no proven benefit to adjuvant chemotherapy or supplementing other treatments for this kind of tumor. Although temozolomide is effective for treating recurrent anaplastic astrocytoma, its role as an adjuvant to radiation therapy has not been fully tested.

Quality of life after treatment depends heavily on the area of the brain that housed the tumor. In many cases, patients with anaplastic astrocytoma may experience various types of paralysis, speech impediments, difficulties planning and skewed sensory perception. Most cases of paralysis and speech difficulties can be rehabilitated with speech, occupational, physical, and vision therapy.

Prognosis

The age-standardized 5-year relative survival rate is 23.6%.^[1] Patients with this tumor are 46 times more likely to die than matched members of the general population.^[1] It is important to note that prognosis across age groups is different especially during the first three years post-diagnosis. When the elderly population is compared with young adults, the excess hazard ratio (a hazard ratio that is corrected for differences in mortality across age groups) decreases from 10.15 to 1.85 at 1 to 3 years, meaning that the elderly population are much more likely to die in the first year post-diagnosis when compared to young adults (aged 15 to 40), but after three years, this difference is reduced markedly.^[1] Typical median survival for anaplastic astrocytoma is 2-3 years. Secondary progression to glioblastoma multiforme is common. Radiation, younger age, female sex, treatment after 2000, and surgery were associated with improved survival in AA patients.^[6]

References

^ ^a ^b ^c ^d Smoll NR, Hamilton B (2014). "Incidence and relative survival of anaplastic astrocytomas". Neuro-Oncology 0: 1–8. doi:10.1093/neuonc/nou053.
^ http://www.pathologyoutlines.com/topic/cnstumoranaplasticastrocytoma.html
^ ^a ^b ^c ^d Astrocytoma; Author: Benjamin Kennedy, Columbia University College of Physicians and Surgeons; Coauthor(s): Jeffrey N Bruce, MD, Edgar M Housepian Professor of Neurological Surgery Research, Professor of Neurological Surgery, Director of Brain Tumor Tissue Bank, Director of Bartoli Brain Tumor Laboratory, Department of Neurosurgery, Columbia University College of Physicians and Surgeons; Jan 23 2009, http://emedicine.medscape.com/article/283453-overview
^ ^a ^b ^c Children's Hospital Boston > Anaplastic Astrocytoma. Retrieved on August 2010
^ Malignant astrocytomas By Edward J Dropcho MD. Contributing editor: Dr. Dropcho. Originally released November 11, 1996; last updated December 7, 2009
^ Nuño M, Birch K, Mukherjee D, Sarmiento JM, Black KL, Patil CG. Survival and prognostic factors of anaplastic gliomas. Neurosurgery. 2013 Sep;73(3):458-65. doi: 10.1227/01.neu.0000431477.02408.5e. PubMed PMID: 23719055.

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1. 悪性神経膠腫に対する補助化学療法 adjuvant chemotherapy for malignant gliomas
2. 神経膠腫の分類 classification of gliomas
3. 悪性神経膠腫患者の臨床症状および初回外科的アプローチ clinical manifestations and initial surgical approach to patients with malignant gliomas
4. 悪性神経膠腫に対する補助放射線療法 adjuvant radiation therapy for malignant gliomas
5. 再発悪性神経膠腫のマネージメント management of recurrent malignant gliomas

English Journal

Unilateral multilevel interlaminar fenestration: A minimally invasive approach for cervical intramedullary lesions.

Xie T1, Qian J1, Lu Y1, Jiang Y1, Wan Z1, Zhang L1, Luo C2.
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia.J Clin Neurosci.2014 Jul;21(7):1196-204. doi: 10.1016/j.jocn.2013.10.025. Epub 2014 Jan 2.
The traditional approach for cervical intramedullary lesions is laminectomy, but the procedure may result in spinal instability and spinal deformity. Unilateral multilevel interlaminar fenestration (UMIF) is an alternative minimally invasive approach that may have great advantages in preserving spin
PMID 24674700

In vivo imaging of brain cancer using epidermal growth factor single domain antibody bioconjugated to near-infrared quantum dots.

Fatehi D, Baral TN, Abulrob A.
Journal of nanoscience and nanotechnology.J Nanosci Nanotechnol.2014 Jul;14(7):5355-62.
Diagnosis of glioblastoma multiform (GBM) with MRI lacks molecular information and requires a biopsy for pathologic confirmation. The EGFRvIII, is a constitutively active mutant of the EGF receptor, identified in a high percentage of brain cancers and associated with increased invasiveness and resis
PMID 24758031

Sperm‑associated antigen 9 promotes astrocytoma cell invasion through the upregulation of podocalyxin.

Jiang J1, Liu Y2, Fang W3, Liu F1.
Molecular medicine reports.Mol Med Rep.2014 Jul;10(1):417-22. doi: 10.3892/mmr.2014.2168. Epub 2014 Apr 24.
Podocalyxin (PODXL) has been found to increase the aggressive phenotype of a number of cancers, including astrocytoma. In addition, the progression of astrocytoma has been associated with sperm‑associated antigen 9 (SPAG9), a recently characterized oncoprotein. In the present study, the associati
PMID 24788963

Japanese Journal

Secondary gliosarcomaの臨床病理学的検討

伊東民雄,尾崎義丸,佐藤憲市,及川光照,中村博彦,田中伸哉,谷野美智枝,長嶋和郎
脳神経外科ジャーナル 20(4), 289-298, 2011-04-20
今回われわれは,悪性神経膠腫の放射線療法後にgliosarcoma(GS)へ転化した,いわゆるsecondary GS(SGS)の3例を経験し,臨床病理学的検討を行った.3症例はいずれも女性で,年齢は平均44.3歳と比較的若年であった.初回の病理は,GB:2例,AA:1例で,初期治療は開頭腫瘍摘出術後,放射線・化学療法を行った.複数回の再発後よりSGSになったのが2例で,初回再発時よりSGSになっ …
NAID 110008593915

Primary Cerebellar Pilocytic Astrocytoma With Anaplastic Features in a Patient With Neurofibromatosis Type 1 : Case Report

TSUDA Kyoji,ISHIKAWA Eiichi,SAITO Atsushi,SATOMI Kaishi,SAKATA Akiko,TAKANO Shingo,MORISHITA Yukio,NOGUCHI Masayuki,MATSUMURA Akira
Neurologia medico-chirurgica = 神経外科 51(4), 315-318, 2011-04-15
… A 70-year-old woman with neurofibromatosis type 1 (NF-1) presented with a primary cerebellar pilocytic astrocytoma (PA) with anaplastic features manifesting as worsening headache and ataxia. … The final diagnosis was PA with anaplastic features. … Previous PA cases with mitotic activity and endothelial proliferation, and/or palisading necrosis have been classified as anaplastic PA (or PA with anaplastic features). …
NAID 10028105382

Related Pictures

★リンクテーブル★

リンク元	「脳腫瘍」「星状細胞腫」「神経膠腫」「subependymal giant cell astrocytoma」「astrocytic glioma」
関連記事	「anaplastic」

「脳腫瘍」

Anaplastic astrocytoma
	Classification and external resources
	Micrograph of an anaplastic astrocytoma. H&E stain.

　　[★]

英: brain tumor, cerebral tumor
同: 脳新生物 brain neoplasm
関: 頭蓋内腫瘍

概念

分類

原発性脳腫瘍

神経膠腫 glioma

星状細胞腫 astrocytoma

胚腫 germinoma

転移性脳腫瘍

疫学

発生率：10万人対10-15人。罹患率：10万人対46人　→

腫瘍別発生頻度

腫瘍別発生頻度		小児	成人
神経膠腫	33%	星状細胞腫	髄膜腫
髄膜腫	22%	髄芽腫	膠芽腫
下垂体腺腫	15%	頭蓋咽頭腫	下垂体腺腫
神経鞘腫	9%	胚細胞腫	神経鞘腫
頭蓋咽頭腫	5%	上衣腫	転移性脳腫瘍

YN.J.188

部位	種類	小児	成人
頭蓋骨	頭蓋骨腫瘍	○	○
大脳半球	神経膠腫		○
大脳半球	髄膜腫		○
松果体	胚細胞腫	○
小脳半球	星細胞腫	○
小脳半球	血管芽腫		○
小脳虫部	髄芽腫	○
第四脳室	上衣腫	○
鞍上部・視交叉部・下垂体部	頭蓋咽頭腫	○
	視神経膠腫	○
	胚細胞腫	○
	下垂体腺腫		○
	髄膜腫		○
小脳橋角部	聴神経鞘腫		○
脳幹部	神経膠腫	○	○

小児の脳腫瘍

SCN.173

腫瘍：星細胞腫、髄芽腫、頭蓋咽頭腫、胚細胞腫、上衣腫の順に多い。
部位：1歳まではテント上、2-7歳まではテント下、8-15歳まではテント上に多い。

SRA.163

	後発年齢	好発部位
小脳星細胞腫	5～10歳	小脳半球
髄芽腫	5～10歳(男児に多い)	小脳虫部から発生
頭蓋咽頭腫	10～15歳	トルコ鞍上部
上衣腫	10～15,30～40歳	第四脳室、側脳室
髄芽腫	10～30歳	松果体部、トルコ鞍上部
脳幹部膠腫	～15歳	橋
視神経膠腫	～15歳	視神経視交叉

放射線感受性

SCN.173

(高い)髄芽腫、胚細胞腫　＞　(低い)神経膠腫

転移性脳腫瘍

肺癌(約半数)、乳癌、消化器癌、腎癌
頻度：肺癌＞乳癌＞胃・腸癌　(SCN.173)

石灰化が見られる脳腫瘍

乏突起膠腫：CT上、低吸収領域の中に石灰化がみられる。(SCN.173)
上衣腫：CT：(単純CT)等～低吸収、(造影CT)中～強度の増強。小嚢胞や壊死、石灰化を認める
髄膜腫：腫瘍の一部石灰化が少なからず見られる
頭蓋咽頭腫：小児において石灰沈着が高頻度にみられる。

嚢胞性腫瘍

小児の小脳星細胞腫、星状細胞系腫瘍(びまん性星状細胞腫、退形成性星状細胞腫、膠芽腫)、頭蓋咽頭腫

参考

1. がんサポートセンター　脳腫瘍

http://www.gsic.jp/cancer/cc_19/hc/02.html

1-1. がんサポートセンター　脳腫瘍　フローチャート

http://www.gsic.jp/cancer/cc_19/hc/cc_19_021.html

2. 脳腫瘍　治療法ガイドライン　［総論］

http://www.ebm.jp/disease/brain/07noshuyo1/guide.html

3. 資料

http://ganjoho.ncc.go.jp/public/cancer/data/brain_adult.html

4. 資料

http://ganjoho.ncc.go.jp/public/cancer/data/brain_child.html

5. 小児脳腫瘍

http://www.geocities.jp/ululu_o_ululu/report-11.html

国試

098D043

「星状細胞腫」

　　[★]

英: astrocytoma
同: 星細胞腫、アストロサイトーマ、星状膠細胞腫
関: 星状腫、アストログリオーマ、astroglioma、astrocytic glioma、退形成星状細胞腫、毛様細胞性星細胞腫、上衣下巨細胞星状細胞腫、混合神経膠腫、星状細胞腫、星状芽細胞腫、肥胖性星細胞腫、グレードII星細胞腫、グレードIII星細胞腫、グレードI星細胞腫、線維性星細胞腫、若年性毛細胞性星細胞腫

[show details]

星状膠細胞腫 : 約 53,000 件
星膠細胞腫 : 40 件
星状膠腫 : 33 件
星膠腫 : 78 件

星細胞腫 : 約 226,000 件
星状細胞腫 : 約 14,800 件

好発部位

小児：小脳半球　→　小脳失調
成人：大脳半球　→　痙攣

分類

原発性脳腫瘍

神経膠腫 glioma

星状細胞腫 astrocytoma

特徴

浸潤性に発育　→　全摘が困難　→　再発しやすい・再発時に悪性化する傾向がある
遠隔転移はきわめて稀
放射線に対する感受性が低い
抗癌薬が効きにくい。

「神経膠腫」

　　[★]

英: glioma
同: 神経上皮性腫瘍、グリオーマ、神経膠細胞性腫瘍 glial tumor、神経膠細胞腫、膠腫
関: 脳腫瘍

分類

神経膠腫 glioma

悪性神経膠腫の予後規定因子

悪性度(悪性度が低いこと = WHO gradeが小さい)
年齢(若いこと)
腫瘍切除(腫瘍の残存が少ないこと)
放射線療法(70Gy以上がよい)
Performance status(PS)(治療前の神経症状が軽いこと)
secondary glioblastoma(悪性転化型であること)

primary glioblastomaは放射線に抵抗性であり、治療しづらい。

参考

1. 神経膠腫：[がん情報サービス]

http://ganjoho.jp/public/cancer/data/glioma.html

「subependymal giant cell astrocytoma」

　　[★]

上衣下巨細胞星状細胞腫

関: anaplastic astrocytoma、astrocytic glioma、astrocytoma、astroglioma、fibrillary astrocytoma、gemistocytic astrocytoma、grade I astrocytoma、grade II astrocytoma、grade III astrocytoma、juvenile pilocytic astrocytoma、mixed oligoastrocytoma、pilocytic astrocytoma

同: 上衣下巨細胞性星状細胞腫

「astrocytic glioma」

　　[★]

星細胞腫、星状芽細胞腫

関: anaplastic astrocytoma、astroblastoma、astrocytoma、astroglioma、fibrillary astrocytoma、gemistocytic astrocytoma、grade I astrocytoma、grade II astrocytoma、grade III astrocytoma、juvenile pilocytic astrocytoma、mixed oligoastrocytoma、pilocytic astrocytoma、subependymal giant cell astrocytoma

「anaplastic」

　　[★]

未分化の、低分化の、退形成の

関: anaplasia、poorly-differentiated、undifferentiated

同: malignant astrocytoma, 退形成性悪性星状細胞腫

[smoll_2014-1] Smoll NR, Hamilton B (2014). "Incidence and relative survival of anaplastic astrocytomas". Neuro-Oncology 0: 1–8. doi:10.1093/neuonc/nou053.

[2] ttp://www.pathologyoutlines.com/topic/cnstumoranaplasticastrocytoma.html

[kennedy-3] Astrocytoma; Author: Benjamin Kennedy, Columbia University College of Physicians and Surgeons; Coauthor(s): Jeffrey N Bruce, MD, Edgar M Housepian Professor of Neurological Surgery Research, Professor of Neurological Surgery, Director of Brain Tumor Tissue Bank, Director of Bartoli Brain Tumor Laboratory, Department of Neurosurgery, Columbia University College of Physicians and Surgeons; Jan 23 2009, http://emedicine.medscape.com/article/283453-overview

[shb-4] Children's Hospital Boston > Anaplastic Astrocytoma. Retrieved on August 2010

[5] Malignant astrocytomas By Edward J Dropcho MD. Contributing editor: Dr. Dropcho. Originally released November 11, 1996; last updated December 7, 2009

[6] Nuño M, Birch K, Mukherjee D, Sarmiento JM, Black KL, Patil CG. Survival and prognostic factors of anaplastic gliomas. Neurosurgery. 2013 Sep;73(3):458-65. doi: 10.1227/01.neu.0000431477.02408.5e. PubMed PMID: 23719055.

Anaplastic astrocytoma
Classification and external resources
Micrograph of an anaplastic astrocytoma. H&E stain.

匿名

検索

案内

anaplastic astrocytoma