同: 原線維性星状細胞腫

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/03/29 23:42:24」(JST)

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Diffuse fibrillary astrocytomas arising in the brain stem favor the pons. The tumor here produces the classic hypertrophy of the affected region.

Fibrillary astrocytomas also called low grade or diffuse astrocytomas, are a group of primary slow growing brain tumors. They typically occur in adults between the ages of twenty and fifty.^{[citation needed]}

Pathology

Fibrillary astrocytomas arise from neoplastic astrocytes, a type of glial cell found in the central nervous system. They may occur anywhere in the brain, or even in the spinal cord,^[1] but are most commonly found in the cerebral hemispheres. As the alternative name of "diffuse astrocytoma" implies, the outline of the tumour is not clearly visible in scans, because the borders of the neoplasm tend to send out tiny microscopic fibrillary tentacles that spread into the surrounding brain tissue. These tentacles intermingle with healthy brain cells, making complete surgical removal difficult. However, they are low grade tumors, with a slow rate of growth, so that patients commonly survive longer than those with otherwise similar types of brain tumour, such as glioblastoma multiforme.^[1]

Symptoms and diagnosis

Seizures, frequent mood changes, and headaches are among the earliest symptoms of the tumor. Hemiparesis, or physical weakness on one side of the body, is also common.^[1] A continuous EEG recording of the brain's electrical activity may help to identify and localize seizure activity, especially in children. CT scans and MRI scans of the brain may show the presence of a diffuse mass that fails to light up when a contrast dye is given.^{[citation needed]} In some cases, a biopsy may be required to confirm the nature of the tumour.

Treatment

Treatment options include surgery, radiotherapy, radiosurgery, and chemotherapy.

The infiltrating growth of microscopic tentacles in fibrillary astrocytomas makes complete surgical removal difficult or impossible without injuring brain tissue needed for normal neurological function. However, surgery can still reduce or control tumor size.^{[citation needed]} Possible side effects of surgical intervention include brain swelling, which can be treated with steroids, and epileptic seizures. Complete surgical excision of low grade tumors is associated with a good prognosis. However, the tumor may recur if the resection is incomplete, in which case further surgery or the use of other therapies may be required.

Standard radiotherapy for fibrillary astrocytoma requires from ten to thirty sessions, depending on the sub-type of the tumor, and may sometimes be performed after surgical resection to improve outcomes and survival rates. Side effects include the possibility of local inflammation, leading to headaches, which can be treated with oral medication. Radiosurgery uses computer modelling to focus minimal radiation doses at the exact location of the tumor, while minimizing the dose to the surrounding healthy brain tissue. Radiosurgery may be a complementary treatment after regular surgery, or it may represent the primary treatment technique.^{[citation needed]}

Although chemotherapy for fibrillary astrocytoma improve overall survival, it is effective only in about 20% of cases. Researchers^[who?] are currently investigating a number of promising new treatment techniques including gene therapy, immunotherapy, and novel chemotherapies.^{[citation needed]}

References

^ ^a ^b ^c Low-Grade Astrocytoma at eMedicine

External links

Pediatric lowgrade astrocytomas
British Columbia cancer management guidelines
Neurosurgery UCLA
Braintumor.org

UpToDate Contents

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1. 低悪性度神経膠腫の診断および分類 diagnosis and classification of low grade gliomas
2. 成人におけるてんかんの外科的治療 surgical treatment of epilepsy in adults
3. 脊髄腫瘍 spinal cord tumors
4. 小児における神経画像検査へのアプローチ approach to neuroimaging in children
5. 限局性脳幹部神経膠腫 focal brainstem glioma

English Journal

Response to everolimus is seen in TSC-associated SEGAs and angiomyolipomas independent of mutation type and site in TSC1 and TSC2.

Kwiatkowski DJ1, Palmer MR2, Jozwiak S3, Bissler J4, Franz D5, Segal S6, Chen D6, Sampson JR7.
European journal of human genetics : EJHG.Eur J Hum Genet.2015 Dec;23(12):1665-72. doi: 10.1038/ejhg.2015.47. Epub 2015 Mar 18.
Tuberous sclerosis complex is an autosomal dominant disorder that occurs owing to inactivating mutations in either TSC1 or TSC2. Tuberous sclerosis complex-related tumors in the brain, such as subependymal giant cell astrocytoma, and in the kidney, such as angiomyolipoma, can cause significant morbi
PMID 25782670

Astrocytic tumour grading: a comparative study of three-dimensional pseudocontinuous arterial spin labelling, dynamic susceptibility contrast-enhanced perfusion-weighted imaging, and diffusion-weighted imaging.

Xiao HF1, Chen ZY2, Lou X3,4, Wang YL2, Gui QP5, Wang Y2, Shi KN6, Zhou ZY6, Zheng DD6, Wang DJ7, Ma L8.
European radiology.Eur Radiol.2015 Dec;25(12):3423-30. doi: 10.1007/s00330-015-3768-2. Epub 2015 May 23.
OBJECTIVES: We hypothesized that three-dimensional pseudocontinuous arterial spin labelling (pCASL) may have similar efficacy in astrocytic tumour grading as dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI), and the grading accuracy may be further improved when combined
PMID 26002128

Screening for cognitive deficits in 8 to 14-year old children with cerebellar tumors using self-report measures of executive and behavioral functioning and health-related quality of life.

Bull KS1, Liossi C1, Peacock JL1, Yuen HM1, Kennedy CR1; Children's Cancer and Leukaemia Group (CCLG).
Neuro-oncology.Neuro Oncol.2015 Dec;17(12):1628-36. doi: 10.1093/neuonc/nov129. Epub 2015 Jul 22.
BACKGROUND: We aimed to identify a brief screening measure for detection of cognitive deficit in children treated for cerebellar tumors that would be useful in clinical practice.METHODS: A sample of 72 children, aged 8-14 years, and within 3 years post diagnosis for standard-risk medulloblastoma (n
PMID 26203065

Japanese Journal

Gliosarcoma arising from a fibrillary astrocytoma

Kobayashi Tatsuya,Sakai Keiichi,Tada Tsuyoshi,Sekiguchi Yasuyuki,Hara Yosuke,Kodama Kunihiko,Goto Tetsuya,Tanaka Yuichiro,Sano Kenji,Nakayama Jun,Hongo Kazuhiro
JOURNAL OF CLINICAL NEUROSCIENCE 18(9), 1251-1254, 2011-09
… We report a 67-year-old woman who was diagnosed with a gliosarcoma at a second operation after diagnosis of a fibrillary astrocytoma 5 months previously. … Histological examination showed fibrillary astrocytoma (World Health Organization [WHO] grade II). …
NAID 120005248197

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

Diffuse astrocytomaの疾患概念と病理学的鑑別診断(<特集>Diffuse astrocytoma grade 2の治療)

中里洋一,金城佐和子,田中優子
脳神経外科ジャーナル 18(6), 423-427, 2009-06-20
… Diffuse astrocytoma(DA)は,頻度の高いlow grade gliomaである.増殖は緩徐であるが,強い浸潤性格を持つため治療は困難である.組織学的には3亜型に分類され,その中ではfibrillary astrocytomaの頻度が高い.Pilocytic astrocytoma,anaplastic astrocytoma,oligoastrocytomaおよびoligodendroliomaとの鑑別を要する.鑑別にあたっては,臨床所見,画像所見,病理組織学的所見,免疫組織化学 …
NAID 110007227576

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リンク元	「subependymal giant cell astrocytoma」「astrocytic glioma」「astroglioma」「mixed oligoastrocytoma」「線維性星細胞腫」
関連記事	「fibrillary」「fibrillar」