Hemorrhagic presentation of intracranial pilocytic astrocytomas: literature review

  • G. Lakshmi Prasad
  • B. N. Nandeesh
  • Girish R. Menon
Review
First Online:
Received:
Revised:
Accepted:

Abstract

Pilocytic astrocytomas (PAs) are seemingly innocuous and benign tumors. However, in recent times, many case series have documented high rates of hemorrhage in these neoplasms. We hereby provide a detailed analysis on hemorrhagic pilocytic astrocytomas (HPA) in adults and report one such case managed at our institute. In addition, salient differences between adult and pediatric hemorrhagic PA have been briefed. Hospital records were retrieved for our case. Literature review was conducted by searching online databases for the following keywords—pilocytic astrocytoma, hemorrhage, cranial, pediatric, and adults. A 22-year-old male with neurofibromatosis-1 presented with sudden onset headache and vomiting of 3-day duration. Imaging revealed a lobulated suprasellar lesion with obstructive hydrocephalus. Pterional transsylvian approach and subtotal resection were performed. Histopathology showed features of PA with bleed. Including current report, a total of 26 cases have been reported. Mean age was 37 years (21–75 years) and they are mostly found in the third decade. The male:female ratio was 2.1:1. Sudden headache with vomiting was the most common symptoms. Tumors were mostly located in cerebral hemispheres (n = 9/34.6%), hypothalamus/suprasellar region (n = 7/27%), and cerebellum (n = 6/23%). Two-thirds underwent gross total excision. There were two deaths and except one case, no recurrences were reported in those with available follow-ups. Hemorrhagic presentation of a PA is rare, although more commonly seen in adults and most commonly located in cerebral hemispheres. Maximal safe resection is the standard treatment and recurrences are rare.

Keywords

Pilocytic astrocytoma Hemorrhage Hemorrhagic onset Suprasellar Chiasmatic hypothalamic Cerebellum 
This is a preview of subscription content, log in to check access.

Notes

Funding

No funding was obtained for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was felt not necessary as it was a single case operated in standard manner and a review of existing world literature was done.

Informed consent

Informed consent was taken from the patient.

References

  1. 1.
    Burkhard C, Di Patre PL, Schuler D, Schuler G, Yasargil MG, Yonekawa Y et al (2003) A population-based study of the incidence and survival rates in patients with pilocytic astrocytoma. J Neurosurg 98:1170–1174CrossRefPubMedGoogle Scholar
  2. 2.
    Collins VP, Jones DTW, Gianini C (2015) Pilocytic astrocytoma: pathology, molecular mechanisms and markers. Acta Neuropathol 129:775–788CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Koeller KK, Rushing EJ (2004) From the archives of the AFIP: pilocytic astrocytoma: radiologic-pathologic correlation. Radiographics 24:1693–1708CrossRefPubMedGoogle Scholar
  4. 4.
    Theeler BJ, Ellezam B, Sadighi ZS, Mehta V, Tran MD, Adesina AM (2014) Adult pilocytic astrocytomas: clinical features and molecular analysis. Neuro Oncol 16:841–847CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Lieu AS, Hwang SL, Howng SL, Chai CY (1999) Brain tumors with hemorrhage. J Formos Med Assoc 98:365–367PubMedGoogle Scholar
  6. 6.
    Shibahara I, Kanamori M, Kumabe T et al (2009) Hemorrhagic onset of pilocytic astrocytoma and pilomyxoid astrocytoma. Brain Tumor Pathol 26:1–5CrossRefPubMedGoogle Scholar
  7. 7.
    Wakai S, Yamakawa K, Manaka S, Takakura K (1982) Spontaneous intracranial hemorrhage caused by brain tumor : its incidence and clinical significance. Neurosurgery 10:437–444CrossRefPubMedGoogle Scholar
  8. 8.
    White JB, Piepgras DG, Scheithauer BW et al (2008) Rate of spontaneous hemorrhage in histologically proven cases of pilocytic astrocytoma. J Neurosurg 108:223–226CrossRefPubMedGoogle Scholar
  9. 9.
    Bell D, Chitnavis BP, Al-Sarraj S, Connor S, Sharr MM, Gullan RW (2004) Pilocytic astrocytoma of the adult-clinical features, radiological features and management. Br J Neurosurg 18:613–616CrossRefPubMedGoogle Scholar
  10. 10.
    Byard RW, Bourne AJ, Hanieh A (1991–1992) Sudden and unexpected death due to hemorrhage from occult central nervous system lesions. A pediatric autopsy study. Pediatr Neurosurg 17:88–94Google Scholar
  11. 11.
    Charles NC, Nelson L, Brookner AR, Lieberman N, Breinin GM (1981) Pilocytic astrocytoma of the optic nerve with hemorrhage and extreme cystic degeneration. Am J Ophthalmol 92:691–695CrossRefPubMedGoogle Scholar
  12. 12.
    Devi BI, Shukla D, Bhat D, Santosh V (2001) Hypothalamic tumour with haemorrhage. Childs Nerv Syst 17:567–569CrossRefPubMedGoogle Scholar
  13. 13.
    Fogelson MH, Oppenheim RE, McLaurin RL (1980) Childhood cerebellar astrocytoma presenting with hemorrhage. Neurology 30:669–670CrossRefPubMedGoogle Scholar
  14. 14.
    Frassanito P, Massimi L, Caldarelli M, Di Rocco C (2009) Cerebellar mutism after spontaneous intratumoral bleeding involving the upper cerebellar vermis: a contribution to the physio-pathogenic interpretation. Childs Nerv Syst 25:7–11CrossRefPubMedGoogle Scholar
  15. 15.
    Galgano MA, Padalino DJ, Fullmer J, Krishnamurthy S (2016) Hemorrhagic pilocytic astrocytomas in Adults: a case report and literature review. Cureus 8:e510PubMedPubMedCentralGoogle Scholar
  16. 16.
    Garg A, Chugh M, Gaikwad SB, Gupta SOCMV, Mishra NK, Sharma MC (2004) Juvenile pilocytic astrocytoma presenting with subarachnoid hemorrhage: case report and review of the literature. J Neurosurg 100(5 Suppl Pediatrics):525–529PubMedGoogle Scholar
  17. 17.
    Glew WB (1977) Simulated pituitary apoplexy: report of an unusual case due to hemorrhage into hypothalamic astrocytoma. Ann Ophthalmol 9:139–142PubMedGoogle Scholar
  18. 18.
    Golash A, Thorne J, West CG (1998) Low grade pilocytic astrocytoma presenting as a spontaneous intracerebral haemorrhage in a child. Br J Neurosurg 12:59–62CrossRefPubMedGoogle Scholar
  19. 19.
    Harada K, Hayashi T, Okamoto Y et al (1986) Cerebellar astrocytoma presenting with cerebellar hemorrhage: a case report. No Shinkei Geka 14(3 Suppl):411–416PubMedGoogle Scholar
  20. 20.
    Hwang SL, Huang TY, Chai CY, Howng SL (1998) Hypothalamic juvenile pilocytic astrocytoma presenting with intracerebral hemorrhage. J Formos Med Assoc 97(11):784–787PubMedGoogle Scholar
  21. 21.
    Kapoor A, Savardekar A, Tewari MK, Chatterjee D, Radotra BD (2015) Spontaneous hemorrhages in pediatric supratentorial pilocytic astrocytomas. Malignant presentation of a benign entity. Childs Nerv Syst 31:1617–1620CrossRefPubMedGoogle Scholar
  22. 22.
    Kato K, Moteki Y, Nakagawa M, Kadoyama S, Ujiie H (2011) Subarachnoid hemorrhage caused by pilocytic astrocytoma-case report. Neurol Med Chir (Tokyo) 51:82–84CrossRefGoogle Scholar
  23. 23.
    Kim MS, Kim SW, Chang CH, Kim OL (2011) Cerebellar pilocytic astrocytomas with spontaneous intratumoral hemorrhage in adult. J Korean Neurosurg Soc 49:363–366CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Kumar A, Deopujari CE, Biyani N, Mhatre MV (2010) Pediatric cerebellar pilocytic astrocytoma presenting with hemorrhage. Neurol India 58:972–974CrossRefPubMedGoogle Scholar
  25. 25.
    Lee CS, Huh JS, Sim KB, Kim YW (2009) Cerebellar pilocytic astrocytoma presenting with intratumor bleeding, subarachnoid hemorrhage, and subdural hematoma. Childs Nerv Syst 25:125–128CrossRefPubMedGoogle Scholar
  26. 26.
    Li HM, Hsu SS, Wang JS et al (2008) Cerebral pilocytic astrocytoma with spontaneous intracranial hemorrhage in adults. J Chin Med Assoc 71:587–593CrossRefPubMedGoogle Scholar
  27. 27.
    Lones MA, Verity MA (1991) Fatal hemorrhage in a cerebral pilocytic astrocytoma-adult type. Acta Neuropathol 81:688–690CrossRefPubMedGoogle Scholar
  28. 28.
    Lyons MK (2007) Pilocytic astrocytoma with spontaneous intracranial hemorrhages in an elderly adult. Clin Neurol Neurosurg 109:76–80CrossRefPubMedGoogle Scholar
  29. 29.
    Matsumoto K, Akagi K, Abekura M et al (1997) Hypothalamic pilocytic astrocytoma presenting with intratumoral and sub-arachnoid hemorrhage. Neurol Med Chir (Tokyo) 37:849–851CrossRefGoogle Scholar
  30. 30.
    Mesiwala AH, Avellino AM, Roberts TS, Ellenbogen RG (2001) Spontaneous cerebellar hemorrhage due to a juvenile pilocytic astrocytoma. Pediatr Neurosurg 34:235–238CrossRefPubMedGoogle Scholar
  31. 31.
    Mauersberger W, Cuevas-Solorzano JA (1977) Spontaneous intracerebellar hematoma during childhood caused by spongioblastoma of the IVth ventricle. Neuropadiatrie 8:443–450CrossRefPubMedGoogle Scholar
  32. 32.
    Oka F, Yamashita Y, Kumabe T, Tominaga T (2007) Total resection of a hemorrhagic tectal pilocytic astrocytoma. Neurol Med Chir (Tokyo) 47:219–221CrossRefGoogle Scholar
  33. 33.
    Ramdurg SR, Maitra J (2016) A rare case of infantile cerebellar pilocytic astrocytoma and thrombocytopenia presenting with intratumoral hemorrhage. J Pediatr Neusosci 11:249–251CrossRefGoogle Scholar
  34. 34.
    Sekula RF Jr, Marchan EM, Quigley MR, Frederickson AM, Pu C (2008) A case of an elderly adult presenting with obstructive hydrocephalus secondary to a rare hemorrhagic suprasellar pilocytic astrocytoma. Clin Neuropathol 27:396–399CrossRefPubMedGoogle Scholar
  35. 35.
    Shibao S, Kimura T, Sasaki H, Fujiwara H, Akiyama T, Ueno M (2012) Hemorrhagic onset of cerebellar pilocytic astrocytoma in an adult: a case report and review of the literature implying a possible relation of degenerative vascular changes to the massive intratumoral hemorrhage. Brain Tumor Pathol 29:96–102CrossRefPubMedGoogle Scholar
  36. 36.
    Soliman RK, Budai C, Mundada P, Aljohani B, Rushing EJ, Kollias SS (2016) Suprasellar pilocytic astrocytoma in an adult with hemorrhage and leptomeningeal dissemination: case report and review of literature. Radiol Case Rep 11:411–418CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Sorenson EJ, Silbert PL, Benarroch EE, Jack CR, Parisi JE (1995) Transient amnestic syndrome after spontaneous haemorrhage into a hypothalamic pilocytic astrocytoma. J Neurol Neurosurg Psychiatry 58:761–763CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Taraszewska A, Czernicki Z, Andrychowski J (2005) Hemosiderin pigmentation of tumour cells in cerebellar pilocytic astrocytoma associated with post-traumatic hemorrhage in adults. Folia Neuropathol 43:172–177PubMedGoogle Scholar
  39. 39.
    van Ouwerkerk WJ, Dirven CM (1998) Hematoma in a low-grade medullary astrocytoma: report of an unusual case and literature review. Childs Nerv Syst 14:742–746CrossRefPubMedGoogle Scholar
  40. 40.
    Vincent FM, Bartone JR, Jones MZ (1980) Cerebellar astrocytoma presenting as a cerebellar hemorrhage in a child. Neurology 30:91–93CrossRefPubMedGoogle Scholar
  41. 41.
    Wilson MP, Johnson ES, Hawkins C, Atkins K, Alshaya W, Pugh JA (2016) Hemorrhagic presentations of cerebellar pilocytic astrocytomas in children resulting in death: report of 2 cases. J Neurosurg Pediatr 17:446–452CrossRefPubMedGoogle Scholar
  42. 42.
    Simonova G, Kozubikova P, Liscak R, Novotny J Jr (2016) Leksell Gamma Knife treatment for pilocytic astrocytomas: long-term results. J Neurosurg Pediatr 18:58–64CrossRefPubMedGoogle Scholar
  43. 43.
    Shingu T, Akiyama Y, Daisu M et al (2007) Symptomatic hemorrhage associated with recurrent pilocytic astrocytoma with granulation tissue. Neurol Med Chir (Tokyo) 47:222–228CrossRefGoogle Scholar
  44. 44.
    Bitoh S, Hasegawa H, Ohtsuki H, Obashi J, Fujiwara M, Sakurai M (1984) Cerebral neoplasms initially presenting with massive intracerebral hemorrhage. Surg Neurol 22:57–62CrossRefPubMedGoogle Scholar
  45. 45.
    Scheithauer BW, Hawkins C, Tihan T, VandenBerg SR, Burger PC (2007) Pilocytic astrocytoma. In: David NL, Ohgaki H, Otmar DW (eds) WHO Classification of tumours of the central nervous system. IARC, Lyon, pp 14–21Google Scholar
  46. 46.
    Kadota Y, Hatashita S, Sakakibara T, Takagi S (1989) Intracerebral hemorrhage from a peripheral aneurysm associated with an astrocytoma—case report. Neurol Med Chir (Tokyo) 29:241–244CrossRefGoogle Scholar
  47. 47.
    Yoshikawa G, Kawamoto S, Yakou K, Tsutsumi K (2010) Massive intracranial hemorrhage associated with pleomorphic xanthoastrocytoma-case report. Neurol Med Chir (Tokyo) 50:220–223CrossRefGoogle Scholar
  48. 48.
    Sie M, de Bont ESJM, Scherpen FJG, Hoving EW, den Dunnen WFA (2010) Tumour vasculature and angiogenic profile of paediatric pilocytic astrocytoma; is it much different from glioblastoma? Neuropathol Appl Neurobiol 36:636–647CrossRefPubMedGoogle Scholar
  49. 49.
    Leung SY, Chan ASY, Wong MP, Yuen ST, Cheung N, Chung LP (1997) Expression of vascular endothelial growth factor and its receptors in pilocytic astrocytoma. Am J Surg Pathol 21:941–950CrossRefPubMedGoogle Scholar
  50. 50.
    Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (2007) WHO classification of tumours of the central nervous system. IARC, Lyon, pp 14–21Google Scholar
  51. 51.
    Stüer C, Vilz B, Majores M, Becker A, Schramm J, Simon M (2007) Frequent recurrence and progression in pilocytic astrocytoma in adults. Cancer 110:2799–2808CrossRefPubMedGoogle Scholar
  52. 52.
    Ogiwara H, Bowman RM, Tomita T (2012) Long-term follow-up of pediatric benign cerebellar astrocytomas. Neurosurgery 70:40–47CrossRefPubMedGoogle Scholar
  53. 53.
    Pencalet P, Maixner W, Sainte-Rose C, Lellouch-Tubiana A, Cinalli G, Zerah M et al (1999) Benign cerebellar astrocytomas in children. J Neurosurg 90:265–273CrossRefPubMedGoogle Scholar
  54. 54.
    Steinbok P, Poskitt K, Hendson G (2006) Spontaneous regression of cerebellar astrocytoma after subtotal resection. Childs Nerv Syst 22:572–576CrossRefPubMedGoogle Scholar
  55. 55.
    Ishkanian A, Laperriere NJ, Xu W, Millar BA, Payne D, Mason W et al (2011) Upfront observation versus radiation for adult pilocytic astrocytoma. Cancer 117:4070–4079CrossRefPubMedGoogle Scholar
  56. 56.
    Bonfield CM, Steinbok P (2015) Pediatric cerebellar astrocytoma: a review. Childs Nerv Syst 31:1677–1685CrossRefPubMedGoogle Scholar
  57. 57.
    Brown PD, Buckner JC, O'Fallon JR, O’Neill BP, Gianini C, Galanis E, Shah SA, et al (2015) Adult patients with supratentorial pilocytic astrocytomas: long-term follow-up of prospective multicenter clinical trial NCCTG-867251 (Alliance). Neurooncol Pract 2:199–204Google Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Neurosurgery, Kasturba Medical CollegeManipal UniversityManipalIndia
  2. 2.Department of NeuropathologyNational Institute of Mental Health and Neuro SciencesBangaloreIndia

Personalised recommendations