Skip to main content
SpringerLink
Log in

Neuroradiologic characteristics of astroblastoma and systematic review of the literature: 2 new cases and 125 cases reported in 59 publications

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Astroblastoma is a rare tumor of uncertain origin most commonly presenting in the cerebrum of children and young adults. The literature contains only case reports and small series regarding its radiologic features. This systematic review is the largest study of imaging findings of astroblastoma to date and serves to identify features that might differentiate it from other neoplasms.

Objective

This study describes the imaging features of astroblastoma based on a systematic review of the literature and two new cases.

Materials and methods

We conducted a PubMed and Google Scholar database search that identified 59 publications containing 125 cases of pathology-confirmed astroblastoma, and we also added two new cases from our own institution. Data collected include patient age, gender, tumor location, morphology, calcifications and calvarial changes. We recorded findings on CT, MRI, diffusion-weighted imaging (DWI), MR spectroscopy, positron emission tomography (PET) and catheter angiography.

Results

Age at diagnosis ranged 0–70 years (mean 18 years; median 14 years). Female-to-male ratio was 8:1. Of 127 cases, 66 reported CT, 78 reported MRI and 47 reported both findings. Not all authors reported all features, but the tumor features reported included supratentorial in 96% (122/127), superficial in 72% (48/67), well-demarcated in 96% (79/82), mixed cystic–solid in 93% (79/85), and enhancing in 99% (78/79). On CT, 84% (26/31) of astroblastomas were hyperattenuated, 73% (27/37) had calcifications and 7 cases reported adjacent calvarial erosion. Astroblastomas were hypointense on T1-W in 58% (26/45) and on T2-W in 50% (23/46) of MRI sequences. Peritumoral edema was present in 80% (40/50) of cases but was typically described as slight. Six cases included DWI findings, with 100% showing restricted diffusion. On MR spectroscopy, 100% (5/5) showed nonspecific tumor spectra with elevated choline and decreased N-acetylaspartate (NAA). PET revealed nonspecific reduced uptake of [F-18] 2-fluoro-2-deoxyglucose (18F-FDG) and increased uptake of [11C]-Methionine in 100% (3/3) of cases. Catheter angiography findings (n=12) were variable, including hypervascularity in 67%, arteriovenous shunting in 33% and avascular areas in 25%.

Conclusion

Astroblastomas occur most often in adolescent girls. Imaging often shows a supratentorial, superficial, well-defined, cystic–solid enhancing mass. On CT, most are hyperattenuated, have calcifications, and may remodel adjacent bone if superficial. MRI characteristically reveals a hypointense mass on T1-W and T2-W sequences with restricted diffusion. MR spectroscopy, PET and catheter angiography findings are nonspecific.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Navarro R, Reitman AJ, de León GA et al (2005) Astroblastoma in childhood: pathological and clinical analysis. Childs Nerv Syst 21:211–220

    Article  PubMed  Google Scholar 

  2. Louis DN, Ohgaki H, Wiestler OD et al (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114:97–109

    Article  PubMed  PubMed Central  Google Scholar 

  3. Baka JJ, Patel SC, Roebuck JR et al (1993) Predominantly extraaxial astroblastoma: imaging and proton MR spectroscopy features. AJNR Am J Neuroradiol 14:946–950

    CAS  PubMed  Google Scholar 

  4. Sener RN (2002) Astroblastoma: diffusion MRI, and proton MR spectroscopy. Comput Med Imaging Graph 26:187–191

    Article  CAS  PubMed  Google Scholar 

  5. Cabrera-Zubizarreta A, Caton B, Martinez de Guerenu B et al (2002) Low grade astroblastoma: pathological and magnetic resonance findings. Rev Neurol 34:936–939

    CAS  PubMed  Google Scholar 

  6. Bell JW, Osborn AG, Salzman KL et al (2007) Neuroradiologic characteristics of astroblastoma. Neuroradiology 49:203–209

    Article  PubMed  Google Scholar 

  7. Port JD, Brat DJ, Burger PC et al (2002) Astroblastoma: radiologic-pathologic correlation and distinction from ependymoma. AJNR Am J Neuroradiol 23:243–247

    PubMed  Google Scholar 

  8. Agarwal V, Mally R, Palande DA et al (2012) Cerebral astroblastoma: a case report and review of literature. Asian J Neurosurg 7:98–100

  9. Alaraj A, Chan M, Oh S et al (2007) Astroblastoma presenting with intracerebral hemorrhage misdiagnosed as dural arteriovenous fistula: review of a rare entity. Surg Neurol 67:308–313

    Article  PubMed  Google Scholar 

  10. Bannykh SI, Fan X, Black KL (2007) Malignant astroblastoma with rhabdoid morphology. J Neurooncol 83:277–278

    Article  PubMed  Google Scholar 

  11. Bergkasa M, Sundstrom S, Gulati S et al (2011) Astroblastoma — a case report of a rare neuroepithelial tumor with complete remission after chemotherapy. Clin Neuropathol 30:301–306

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Bhattacharjee S, Pulligopu AK, Uppin MS et al (2011) Astroblastoma with bone invasion. Asian J Neurosurg 6:113–115

    Article  PubMed  PubMed Central  Google Scholar 

  13. Binesh F, Akhavan A, Navabii H et al (2011) Anaplastic astroblastoma: a rare glial tumour. BMJ Case Rep. doi:10.1136/bcr.06.2011.4323

    Google Scholar 

  14. Bonnin JM, Rubinstein LJ (1989) Astroblastomas: a pathological study of 23 tumors, with a postoperative follow-up in 13 patients. Neurosurgery 25:6–13

    Article  CAS  PubMed  Google Scholar 

  15. Brat DJ, Hirose Y, Cohen KJ et al (2000) Astroblastoma: clinicopathologic features and chromosomal abnormalities defined by comparative genomic hybridization. Brain Pathol 10:342–352

    Article  CAS  PubMed  Google Scholar 

  16. De la Garma VH, Arcipreste AA, Vazquez FP et al (2014) High-grade astroblastoma in a child: report of one case and review of literature. Surg Neurol Int 5:111

    Article  PubMed  PubMed Central  Google Scholar 

  17. Denaro L, Gardiman M, Calderone M et al (2008) Intraventricular astroblastoma. Case report. J Neurosurg Pediatr 1:152–155

    Article  PubMed  Google Scholar 

  18. Eom KS, Kim JM, Kim TY (2008) A cerebral astroblastoma mimicking an extra-axial neoplasm. J Korean Neurosurg Soc 43:205–208

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fathi AR, Novoa E, El-Koussy M et al (2008) Astroblastoma with rhabdoid features and favorable long-term outcome: report of a case with a 12-year follow-up. Pathol Res Pract 204:345–351

    Article  PubMed  Google Scholar 

  20. Fu YJ, Taniguchi Y, Takeuchi S et al (2013) Cerebral astroblastoma in an adult: an immunohistochemical, ultrastructural and genetic study. Neuropathology 33:312–319

    Article  PubMed  Google Scholar 

  21. Ganapathy S, Kleiner LI, Mirkin DL et al (2009) Unusual manifestations of astroblastoma: a radiologic-pathologic analysis. Pediatr Radiol 39:168–171

    Article  PubMed  Google Scholar 

  22. Han YM, Kim JT, Chung DS et al (2006) A case of astroblastoma. J Korean Neurosurg Soc 40:373–376

    Google Scholar 

  23. Hata N, Shono T, Yoshimoto K et al (2006) An astroblastoma case associated with loss of heterozygosity on chromosome 9p. J Neurooncol 80:69–73

    Article  PubMed  Google Scholar 

  24. Hirano H, Yunoue S, Kaji M et al (2008) Consecutive histological changes in an astroblastoma that disseminated to the spinal cord after repeated intracranial recurrences: a case report. Brain Tumor Pathol 25:25–31

    Article  PubMed  Google Scholar 

  25. Hoag G, Sima AA, Rozdilsky B (1986) Astroblastoma revisited: a report of three cases. Acta Neuropathol 70:10–16

    Article  CAS  PubMed  Google Scholar 

  26. Husain AN, Leestma JE (1986) Cerebral astroblastoma: immunohistochemical and ultrastructural features. Case report. J Neurosurg 64:657–661

    Article  CAS  PubMed  Google Scholar 

  27. Janz C, Buhl R (2014) Astroblastoma: report of two cases with unexpected clinical behavior and review of the literature. Clin Neurol Neurosurg 125:114–124

    Article  PubMed  Google Scholar 

  28. Johnson KA, Bonnin JM, Boaz JC et al (2010) Anaplastic astroblastoma presenting as massive, sudden-onset, intraparenchymal hemorrhage. Pediatr Neurosurg 46:457–461

    Article  PubMed  Google Scholar 

  29. Kaji M, Takeshima H, Nakazato Y et al (2006) Low-grade astroblastoma recurring with extensive invasion. Neurol Med Chir 46:450–454

    Article  Google Scholar 

  30. Kantar M, Ertan Y, Turhan T et al (2009) Anaplastic astroblastoma of childhood: aggressive behavior. Childs Nerv Syst 25:1125–1129

    Article  CAS  PubMed  Google Scholar 

  31. Kemerdere R, Dashti R, Ulu MO et al (2009) Supratentorial high grade astroblastoma: report of two cases and review of the literature. Turk Neurosurg 19:149–152

    PubMed  Google Scholar 

  32. Khosla D, Yadav BS, Kumar R et al (2012) Pediatric astroblastoma: a rare case with a review of the literature. Pediatr Neurosurg 48:122–125

    Article  PubMed  Google Scholar 

  33. Kim BS, Kothbauer K, Jallo G (2004) Brainstem astroblastoma. Pediatr Neurosurg 40:145–146

    Article  PubMed  Google Scholar 

  34. Kim DS, Park SY, Lee SP (2004) Astroblastoma: a case report. J Korean Med Sci 19:772–776

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kubota T, Sato K, Arishima H et al (2006) Astroblastoma: immunohistochemical and ultrastructural study of distinctive epithelial and probable tanycytic differentiation. Neuropathology 26:72–81

    Article  PubMed  Google Scholar 

  36. Kujas M, Faillot T, Lalam T et al (2000) Astroblastomas revisited. Report of two cases with immunocytochemical and electron microscopic study. Histogenetic considerations. Neuropathol Appl Neurobiol 26:295–298

    Article  CAS  PubMed  Google Scholar 

  37. Kurashiki Y, Kageji T, Mizobuchi Y et al (2013) Differential diagnosis of and therapy for anaplastic astroblastoma: case report and review of the literature. No Shinkei Geka 41:891–899

    PubMed  Google Scholar 

  38. Kurwale NS, Agrawal D, Sharma BS (2008) Astroblastoma: aradio-histological diagnosis. J Pediatr Neurosci 3:160

    Article  Google Scholar 

  39. Lau PP, Thomas TM, Lui PC et al (2006) ‘Low-grade’ astroblastoma with rapid recurrence: a case report. Pathology 38:78–80

    Article  PubMed  Google Scholar 

  40. Mangano FT, Bradford AC, Mittler MA et al (2007) Astroblastoma. Case report, review of the literature, and analysis of treatment strategies. J Neurosurg Sci 51:21–27

    CAS  PubMed  Google Scholar 

  41. Mastrangelo S, Lauriola L, Coccia P et al (2010) Two cases of pediatric high-grade astroblastoma with different clinical behavior. Tumori 96:160–163

    PubMed  Google Scholar 

  42. Mierau GW, Tyson RW, McGavran L et al (1999) Astroblastoma: ultrastructural observations on a case of high-grade type. Ultrastruct Pathol 23:325–332

    Article  CAS  PubMed  Google Scholar 

  43. Miranda P, Lobato RD, Cabello A et al (2006) Complete surgical resection of high-grade astroblastoma with long time survival: case report and review of the literature. Neurocirugia 17:60–63

    Article  CAS  PubMed  Google Scholar 

  44. Nasit JG, Trivedi P (2013) Recurrent low-grade astroblastoma with signet ring-like cells and high proliferative index. Fetal Pediatr Pathol 32:284–292

    Article  PubMed  Google Scholar 

  45. Notarianni C, Akin M, Fowler M et al (2008) Brainstem astroblastoma: a case report and review of the literature. Surg Neurol 69:201–205

    Article  PubMed  Google Scholar 

  46. Pizer BL, Moss T, Oakhill A et al (1995) Congenital astroblastoma: an immunohistochemical study. Case report. J Neurosurg 83:550–555

    Article  CAS  PubMed  Google Scholar 

  47. Salvati M, D’Elia A, Brogna C et al (2009) Cerebral astroblastoma: analysis of six cases and critical review of treatment options. J Neurooncol 93:369–378

    Article  PubMed  Google Scholar 

  48. Scheithauer BW, Aker AT, Ketterling RP et al (2010) Anaplastic astroblastoma-sarcoma in neurofibromatosis type 1. Clin Neuropathol 29:289–296

    Article  CAS  PubMed  Google Scholar 

  49. Shen F, Chen LC, Yao Y et al (2014) Astroblastoma: rare incidence and challenges in the pattern of care. World Neurosurg 82:e125–e127

    Article  PubMed  Google Scholar 

  50. Shuangshoti S, Mitphraphan W, Kanvisetsri S et al (2000) Astroblastoma: report of a case with microsatellite analysis. Neuropathology 20:228–232

    Article  CAS  PubMed  Google Scholar 

  51. Singh DK, Singh N, Singh R et al (2014) Cerebral astroblastoma: a radiopathological diagnosis. J Pediatr Neurosci 9:45–47

    Article  PubMed  PubMed Central  Google Scholar 

  52. Sugita Y, Terasaki M, Shigemori M et al (2002) Astroblastoma with unusual signet-ring-like cell components: a case report and literature review. Neuropathology 22:200–205

    Article  PubMed  Google Scholar 

  53. Thiessen B, Finlay J, Kulkarni R et al (1998) Astroblastoma: does histology predict biologic behavior? J Neurooncol 40:59–65

    Article  CAS  PubMed  Google Scholar 

  54. Tumialan LM, Brat DJ, Fountain AJ et al (2007) An astroblastoma mimicking a cavernous malformation: case report. Neurosurgery 60:E569–E570

    PubMed  Google Scholar 

  55. Turkmen E, Raisanen J, Dogan M et al (2011) A newborn with massive congenital astroblastoma. Fetal Pediatr Pathol 30:325–328

    Article  PubMed  Google Scholar 

  56. Unal E, Koksal Y, Vajtai I et al (2008) Astroblastoma in a child. Childs Nerv Syst 24:165–168

    Article  PubMed  Google Scholar 

  57. Weintraub D, Monteith SJ, Yen CP et al (2011) Recurrent astroblastoma treated with gamma knife radiosurgery. J Neurooncol 103:751–754

    Article  PubMed  Google Scholar 

  58. Yamashita J, Handa H, Yamagami T et al (1985) Astroblastoma of pure type. Surg Neurol 24:218–222

    Article  CAS  PubMed  Google Scholar 

  59. Yao K, Li TF, Zhu MW et al (2013) Mixed astroblastoma-arteriovenous malformation complex: a case report. Neurol India 61:439–442

    Article  PubMed  Google Scholar 

  60. Yunten N, Ersahin Y, Demirtas E et al (1996) Cerebral astroblastoma resembling an extra-axial neoplasm. J Neuroradiol 23:38–40

    CAS  PubMed  Google Scholar 

  61. Bailey P, Cushing H (1926) A classification of the tumors of the glioma group on a histogenetic basis with a correlated study of prognosis. J.B. Lippincott Co., Philadelphia

    Google Scholar 

  62. Bailey P, Bucy P (1930) Astroblastomas of the brain. Acta Psychiatr Neurol 5:439–461

    Article  Google Scholar 

  63. Fuller GN, Scheithauer BW (2007) The 2007 revised World Health Organization (WHO) classification of tumours of the central nervous system: newly codified entities. Brain Pathol 17:304–307

    Article  PubMed  Google Scholar 

  64. Mellai M, Piazzi A, Casalone C et al (2015) Astroblastoma: beside being a tumor entity, an occasional phenotype of astrocytic gliomas? Onco Targets Ther 8:451–460

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Sughrue ME, Choi J, Rutkowski MJ et al (2011) Clinical features and post-surgical outcome of patients with astroblastoma. J Clin Neurosci 18:750–754

    Article  PubMed  Google Scholar 

  66. Asha U, Mahadevan A, Sathiyabama D et al (2015) Lack of IDH1 mutation in astroblastomas suggests putative origin from ependymoglial cells? Neuropathology 35:303–311

    Article  CAS  PubMed  Google Scholar 

  67. Bulakbasi N, Kocaoglu M, Ors F et al (2003) Combination of single-voxel proton MR spectroscopy and apparent diffusion coefficient calculation in the evaluation of common brain tumors. AJNR Am J Neuroradiol 24:225–233

    PubMed  Google Scholar 

  68. Chen W (2007) Clinical applications of PET in brain tumors. J Nucl Med 48:1468–1481

    Article  PubMed  Google Scholar 

  69. Buchbender C, Heusner TA, Lauenstein TC et al (2012) Oncologic PET/MRI, part 1: tumors of the brain, head and neck, chest, abdomen, and pelvis. J Nucl Med 53:928–938

    Article  PubMed  Google Scholar 

  70. Aki T, Nakayama N, Yonezawa S et al (2012) Evaluation of brain tumors using dynamic 11C-methionine-PET. J Neurooncol 109:115–122

    Article  PubMed  Google Scholar 

  71. Brant WE, Helms CA (2012) Fundamentals of diagnostic radiology, 4th edn. Wolters Kluwer/Lippincott Williams & Wilkins Health, Philadelphia

    Google Scholar 

  72. Petropoulou K, Whiteman ML, Altman NR et al (1995) CT and MRI of pleomorphic xanthoastrocytoma: unusual biologic behavior. J Comput Assist Tomogr 19:860–865

    Article  CAS  PubMed  Google Scholar 

  73. Moore W, Mathis D, Gargan L et al (2014) Pleomorphic xanthoastrocytoma of childhood: MR imaging and diffusion MR imaging features. AJNR Am J Neuroradiol 35:2192–2196

    Article  CAS  PubMed  Google Scholar 

  74. Bulakbasi N, Kocaoglu M, Sanal TH et al (2007) Dysembryoplastic neuroepithelial tumors: proton MR spectroscopy, diffusion and perfusion characteristics. Neuroradiology 49:805–812

    Article  PubMed  Google Scholar 

  75. Rees JH, Smirniotopoulos JG, Jones RV et al (1996) Glioblastoma multiforme: radiologic-pathologic correlation. Radiographics 16:1413–1438

    Article  CAS  PubMed  Google Scholar 

  76. Rumboldt Z, Camacho DL, Lake D et al (2006) Apparent diffusion coefficients for differentiation of cerebellar tumors in children. AJNR Am J Neuroradiol 27:1362–1369

    CAS  PubMed  Google Scholar 

  77. Yuh EL, Barkovich AJ, Gupta N (2009) Imaging of ependymomas: MRI and CT. Childs Nerv Syst 25:1203–1213

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Missouri-Kansas City School of Medicine, 2411 Holmes St., Kansas City, MO, 64108, USA

    Danielle A. Cunningham, Lisa H. Lowe, Lei Shao & Natasha R. Acosta

  2. Department of Radiology, Children’s Mercy Hospital and Clinics, Kansas City, MO, USA

    Lisa H. Lowe

  3. Department of Pathology, Children’s Mercy Hospital and Clinics, Kansas City, MO, USA

    Lei Shao

  4. Department of Radiology, Truman Medical Center, Kansas City, MO, USA

    Natasha R. Acosta

Authors
  1. Danielle A. Cunningham
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisa H. Lowe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lei Shao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Natasha R. Acosta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Danielle A. Cunningham.

Ethics declarations

Conflicts of interest

None

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 43 kb)

ESM 2

(DOCX 32 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cunningham, D.A., Lowe, L.H., Shao, L. et al. Neuroradiologic characteristics of astroblastoma and systematic review of the literature: 2 new cases and 125 cases reported in 59 publications. Pediatr Radiol 46, 1301–1308 (2016). https://doi.org/10.1007/s00247-016-3607-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-016-3607-x

Keywords

Search

Navigation