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Pleomorphic Xanthoastrocytoma
PXA

Images

WIKIDATA, Public Domain
WIKIDATA, Public Domain
WIKIDATA, CC BY-SA 3.0

Presentation

The present case was of a 55-year-old male who presented with weakness and numbness of right upper and lower limbs since 3 months along with difficulty in walking as well as difficulty in speaking since then. [ccij-online.org]

A case of a non-anaplastic pleomorphic xanthoastrocytoma (PXA) presenting with leptomeningeal dissemination (LMD) affecting a 9-year-old girl is presented. [ncbi.nlm.nih.gov]

Entire Body System

  • Epilepsy

    METHODS: The Rush Surgical Epilepsy Database was queried to identify patients with chronic intractable epilepsy who underwent resection of a temporal lobe PXA at Rush University Medical Center. [ncbi.nlm.nih.gov]

    PXA are generally found in young children who also have temporal lobe epilepsy, the most common type of partial epilepsy. What are the signs and symptoms of Pediatric Pleomorphic Xanthoastrocytoma? Most children with PXA have seizures. [childrens.com]

    Epilepsy can appear at any age: however, the majority of cases present with an epilepsy onset in adolescence and young adulthood. [wjgnet.com]

  • Surgical Procedure

    A second surgical procedure may be performed if the tumor cannot be completely removed and increases in size, or if it comes back. Radiation therapy may be considered, but does not influence long-term outcomes. [danafarberbostonchildrens.org]

    Finally, a biopsy of the tumor, taken through a needle during a simple surgical procedure, helps to confirm the diagnosis. Treatment[edit] Surgery is often the treatment of choice. Total resection (removal of the tumor) is often possible. [en.wikipedia.org]

  • Swelling

    Radiation therapy[edit] Radiation therapy may cause swelling in the brain, related to tissue inflammation. This inflammation may lead to symptoms like headaches. It may be treated with oral medication. [en.wikipedia.org]

    Symptoms include a large abdominal mass, abdominal swelling or pain, and jaundice. Pleuropulmonary blastoma Symptoms of pleuropulmonary blastoma (PPB) may be similar to symptoms of pneumonia. [healthline.com]

  • Hodgkin Lymphoma

    Non-Hodgkin lymphoma is more likely to occur in younger children than Hodgkin lymphoma, but it is still rare in children younger than 3. The most common types of non-Hodgkin lymphoma in children are different from those in adults. [roswellpark.org]

    [23][24] + +/− +/− − + − Usually deep in the white matter Single mass with ring enhancement B cell origin Similar to non hodgkin lymphoma (diffuse large B cell) Biopsy Usually in young immunocompromised patients (HIV) or old immunocompetent person. [wikidoc.org]

  • Camping

    Reviewed by: Jack Wolfsdorf, MD, FAAP This page was last updated on: June 21, 2019 02:20 AM Upcoming Events Camp UOTS Date: Saturday, July 25, 2020 Camp U.O.T.S. is an annual weeklong, overnight camp for children with cancer and blood disorders who are [nicklauschildrens.org]

    Support Sources Camp Sunshine A retreat for children with life threatening illnesses, and their families. CaringBridge A free way to create a website where you can share updates, photos, and videos, with family and friends. [theasstarofhope.org]

Skin

  • Eruptions

    Grade 1 transaminitis was observed without other evidence of systemic hypersensitivity; the reaction was managed with topical corticosteroids and antihistamines, with eventual improvement in the skin eruption and transaminitis. [ascopost.com]

Neurologic

  • Seizure

    Average age of seizure onset was 16.5 years and delay to surgery was 90 months. Complex partial seizures were the most common presenting symptom, shown in all 4 patients, and 3 of 4 patients presented with simple partial seizures as well. [ncbi.nlm.nih.gov]

    Seizures and headaches are common clinical features. Familiarity with this lesion is important in the differential diagnosis of enhancing cortical-based masses. [ajronline.org]

    Medication is administered to minimize or prevent seizure activity. Additionally, after surgery, parents should be informed of the risk of seizures, and educated on what to do in the event of a seizure. [en.wikipedia.org]

  • Meningism

    Primary meningeal gliomas are rare tumors composed of a heterogeneous group of neoplasms. We present 2 clinically aggressive cases of primary meningeal pleomorphic xanthoastrocytoma that clinically mimicked meningioma. [ncbi.nlm.nih.gov]

    This extraaxial component, which represents meningeal involvement is highly suggestive of pleomorphic xanthoastrocytoma. [eurorad.org]

    These lesions are often attached to the meninges. Histopathology PXA is a pleomorphic tumor composed of fibrillary and giant, often multi-nucleated, neoplastic astrocytes. [prod.wiki.cns.org]

  • Intracranial Hemorrhage

    We report a patient with a PXA who became symptomatic with a life-threatening intracranial hemorrhage. [barrowneuro.org]

    Furthermore, pleomorphic xanthoastrocytoma (PXA) with intracranial hemorrhage, especially in a children, is extremely rare. We report here a rare case of child PXA with intracranial hemorrhage. [readbyqxmd.com]

    Hemorrhage in a Child. ( 30701155 ) Takamine Y...Yoshino A 2019 5 BRAF activating mutations involving the I^3-I+C loop in V600E-negative anaplastic pleomorphic xanthoastrocytoma. ( 29544532 ) Pratt D....Venneti S. 2018 6 Peritumoral Edema Affects the [malacards.org]

    The patient died 3.5 months later due to a fatal intracranial hemorrhage. A review of the entire PXA literature revealed 15 well-documented cases of PXA with subsequent malignant transformation and 11 cases of primary anaplastic PXA. [doi.org]

Workup

Endocrine workup was unremarkable. [surgicalneurologyint.com]

After beginning vemurafenib at 720 mg twice daily, the patient developed grade 2 diffuse morbilliform eruption with xerosis and follicular prominence at 10 to 14 days, with workup revealing a superficial and deep perivascular lymphocytic infiltrate with [ascopost.com]

Detection of many of the molecular changes that underlie the development of gliomas and other BT can now be done by immunohistochemistry and is getting into the mainstream of the diagnostic workup of BT. [neuropathology-web.org]

Treatment

We report the second published case of successful treatment with the BRAF inhibitor dabrafenib in a female patient with relapsed anaplastic PXA with a BRAFV600 mutation, and the first published case of dabrafinib treatment following intolerance to vemurafenib [ncbi.nlm.nih.gov]

Treatment[edit] Surgery is often the treatment of choice. Total resection (removal of the tumor) is often possible. [en.wikipedia.org]

Prognosis

However, PXA cases having several recurrent patterns with poor prognosis have been reported in recent years, and a new concept of "PXA with anaplastic features" has been proposed. [ccij-online.org]

Although a rare and benign tumour type, PXA in the elderly tend to be more malignant, may have the radiological appearance of a malignant tumour and have poor prognosis. [ncbi.nlm.nih.gov]

Grade 3 pleomorphic xanthoastrocytomas have a substantially worse prognosis: 40-50% 5-year survival 6. [radiopaedia.org]

Since the pathologic factors determining prognosis are not well understood, it is difficult to identify anaplastic PXAs. [jkns.or.kr]

Etiology

[…] life (90% are between 0 - 2 years old) Type I may be found in very young children (birth to 2 years of age) Types II and III tend to be found after 2 years of age (Pediatr Dev Pathol 2015;18:504) Sites PPB may arise in the lung, mediastinum and pleura Etiology [pathologyoutlines.com]

Prior studies have shown that TP53 mutations may occur in up to 25% of PXAs, suggesting that PXA may have an etiology similar to diffuse astrocytoma rather than pilocytic astrocytoma. [scinapse.io]

MTS is the most common cause of partial complex epilepsy in adults and is also the most common etiology in young adult patients undergoing surgery. [radiologyassistant.nl]

The PXA affects individuals of both sexes and its etiology is unknown and most of the cases arise sporadically without evidence of a specific genetic susceptibility (4,5). [thefreelibrary.com]

Epidemiology

Abstract To study the clinical characteristics, treatment approach and outcome of pleomorphic xanthoastrocytoma (PXA), patients were identified using the National Cancer Intitute's Surveillance, Epidemiology, and End Results (SEER) database. [ncbi.nlm.nih.gov]

Epidemiology PXA typically develops in children and young adults. It accounts for less than 1% of all astrocytic neoplasms. Localization PXA typically occurs in the superficial cerebral hemispheres, most commonly in the temporal lobe. [prod.wiki.cns.org]

Department of Biostatistics and Epidemiology University of Pennsylvania Philadelphia USA [link.springer.com]

This is the leading international professional reference text that also serves as a bench book, describing all aspects of the pathology of brain tumours - genetics, molecular biology, epidemiology, morphology, immunohistochemistry, diagnostic criteria [books.google.com]

Pathophysiology

It brings together the pathophysiology of disease with detailed clinical guidance on diagnosis and management for the full range of childhood cancers, including aspects important in optimal supportive care. [books.google.com]

Therefore this pathophysiology seems unlikely. Similar to hemorrhage within an arachnoid cyst, trauma can cause a vessel stretched by a tumor mass to tear. Our patient, however, had no history of trauma. [barrowneuro.org]

The discovery of BRAF mutations within a substantial percentage of PXA fosters a clearer understanding of the pathophysiology of these tumors with clear prognostic and therapeutic implications. [read.qxmd.com]

Therefore, we cannot state with certainty whether the imaging parameters represent true pathophysiologic information of the tumor. Thus, further prospective study with strict pathologic validation is recommended. [ajnr.org]

Prevention

It remains unclear whether adjuvant radiation and chemotherapy are able to prevent progression or dissemination. [ncbi.nlm.nih.gov]

Medication is administered to minimize or prevent seizure activity. Additionally, after surgery, parents should be informed of the risk of seizures, and educated on what to do in the event of a seizure. [en.wikipedia.org]

Knowing what these side effects are can help physicians prepare for and, in some cases, prevent these symptoms from occurring. Progressive or recurrent disease Recurrences can happen with PXAs. [danafarberbostonchildrens.org]

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