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These tumors have a range of imaging appearances, with the majority presenting as a large cystic lesion with a brightly enhancing mural nodule. Calcification can be present in around one-fifth of cases. The majority of pilocytic astrocytomas arise from the cerebellum. The remainder of this article focuses on a general discussion of pilocytic astrocytomas, particularly those in the cerebellum. There is no recognized gender predisposition.
Although only accounting for between 0. There is a strong association with neurofibromatosis type 1 NF1. Conversely, approximately one-third of pilocytic astrocytomas involving the optic nerves have associated NF1. Presentation depends on location. In the posterior fossa tumors , there is predominantly a mass effect with signs of raised intracranial pressure, especially when hydrocephalus is present.
Bulbar symptoms or cerebellar symptoms may also be present. By far the most common location is the cerebellum, with optic pathway being the next most common, particularly in patients with neurofibromatosis type 1. The distribution within the cerebellum varies with many tumors involving both the vermis and the cerebellar hemisphere.
The term pilocytic refers to the elongated hair-like projections from the neoplastic cells 4. The histological features are however, fairly heterogeneous even within the one tumor, with some areas mimicking diffuse astrocytomas and even oligodendrogliomas 6. Immunohistochemistry reflects astrocytic differentiation 6 :. Hemorrhage is an uncommon complication. Cystic tumors have even better prognosis while fibrillary variants tend to do worse. Surgical resection, if complete, is usually curative.
Some surgeons advocate that only the nodule need be resected to effect a cure, as the cyst walls are non-neoplastic, even if enhancing 2. In , Harvey Cushing was the first who described this tumor, based on his studies of 76 cases of cerebellar astrocytomas 5. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys.
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Quiz questions. From the archives of the AFIP: pilocytic astrocytoma: radiologic-pathologic correlation. Edit article Share article View revision history Report problem with Article. URL of Article. Article information. Systems: Central Nervous System , Paediatrics. Support Radiopaedia and see fewer ads. Cases and figures. Case 1: hemorrhagic Case 1: hemorrhagic.
Case 2 Case 2. Case 3 Case 3. Case 4 Case 4. Case 5: with hemorrhage Case 5: with hemorrhage. Case 6 Case 6. Case 7 Case 7. Case 8: with unusual supratentorial location Case 8: with unusual supratentorial location. Case 9 Case 9. Case with atypical supratentorial location Case with atypical supratentorial location. Case 11 Case Case with unusual supratentorial location Case with unusual supratentorial location. Case 13 Case Case adjacent to 3rd ventricle Case adjacent to 3rd ventricle.
Case predominantly cystic Case predominantly cystic. Case 16 Case Case 17 Case Case 18 Case Case 19 Case Imaging differential diagnosis. Medulloblastoma Medulloblastoma. Ependymoma Ependymoma. Hemangioblastoma Hemangioblastoma. Ganglioglioma Ganglioglioma. Pleomorphic xanthoastrocytoma Pleomorphic xanthoastrocytoma.
Cerebellar abscess Cerebellar abscess. Loading more images Close Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Loading Stack - 0 images remaining. By System:. Patient Cases. Contact Us.