Pleomorphic xanthoastrocytoma: Report of six cases with special consideration of diagnostic and therapeutic pitfalls

Malignant transformation of pleomorphic xanthoastrocytoma: case report

“…Our case is in accordance with these observations. The patient presented a typical PXA that recurred as glioblastoma five months later, comparable to the cases reported by Kepes et al 3,4 , WeldonLinne et al 11 and one case described by Tonn et al 10 .…”

“…However, in cases proven to be fatal, they usually have undergone transition to anaplastic astrocytoma or glioblastoma. Recurrences may show a histological pattern analogous to the original tumor, but increasing anaplasia may also be set [4][5][6][7][8][9][10][11] . Pleomorphism may cease to be a feature and closely packed smaller cells may come to dominate the tumor.…”

Anaplastic Pleomorphic Xanthoastrocytomas

“…Our search revealed 15 fully documented PXA cases that had shown malignant transformation [7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18]. Case 4 of Whittle et al [40], who had an extensive recurrence that took place only 5 months after initial surgery, was not included since a specimen for histological evaluation was not available either from surgery or autopsy.…”

“…Early PXA literature with a short follow-up quoted a 6–9% rate for malignant transformation of typical PXA cases [6]. A review of the literature revealed 15 cases with PXA that had undergone anaplastic transformation [7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18]. PXAs with anaplastic features at first presentation are more exceptional lesions, with only 11 reported cases of primary anaplastic PXA [19, 20, 21, 22, 23, 24].…”

Histology of Primary Brain Tumors

“…Oil-red O confirms the intra-cytoplasmic lipid content on fresh material. An infiltrating astrocytoma pattern is seen at the deeper aspect of the tumor and this does not affect the outcome [19]. Invasion of the overlying meninges can be encountered in some tumors, creating resemblance with meningioma.…”