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Vol. 21. Issue 3.
Pages 245-252 (January 2010)
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Vol. 21. Issue 3.
Pages 245-252 (January 2010)
Spontaneous malignant transformation of a supratentorial pilocytic astrocytoma
Transformación maligna espontánea de un astrocitoma pilocítico supratentorial
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A. Otero-Rodríguez
Corresponding author
alvarotero_es@hotmail.com

Adress: Servicio de Neurocirugía. Complejo Asistencial Universitario de Salamanca. Paseo de San Vicente, 58–182. 37008, Salamanca, España.
, R. Sarabia-Herrero
Servicios de Neurocirugía. Hospital Clínico Universitario. Valladolid. España
M. García- Tejeiro*
* Servicios de Neurocirugía y de Anatomía Patológica Hospital Universitario Río Hortega. Valladolid. España
T. Zamora-Martínez**
** Servicio de Anatomía Patológica. Hospital Universitario Río Hortega. Valladolid. España
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Summary

Pilocytic astrocytoma (PA) is a circumscribed neoplasia considered as a grade I astrocytoma by the World Health Organization. Its most common location is the cerebellum and it develops during the first two decades of the life. Prognosis is mostly excellent if gross-total resection can be achieved, with 10-year survival rates of up to 80%. Anaplastic or malignant transformation (MT) can rarely occur and is usually related to previous radiation. Spontaneous MT has exceptionally been reported. Histological criteria for diagnosis of MT are unclear, so no consensus exists. We present an atypical case of MT of a frontal PA without previous radiotherapy in a 28 years old patient. Also, we review the literature about prognostic factors of PA and discuss histological features that are considered as anaplastic or malignant in the PA.

Key words:
Pilocytic astrocytoma
Malignant transformation
Radiotherapy
Prognosis
Abreviaturas:
Cho
GFAP
MT
NAA
PA
WHO
Resumen

El astrocitoma pilocítico es un tumor bien delimitado, que según la clasificación de la Organización Mundial de la Salud, se cataloga dentro del grupo de los astrocitomas de grado I. La localización más frecuente de esta neoplasia es el cerebelo y se manifiesta fundamentalmente en las dos primeras décadas. Siempre y cuando se consiga una resección total, el pronóstico es muy bueno, alcanzando una tasa de supervivencia del 80% a los diez años. De manera excepcional, puede haber casos de transformación anaplásica o maligna, normalmente asociados a radioterapia previa; se han descrito muy pocas situaciones de transformación espontánea. Existe mucha discusión a la hora de considerar los criterios de malignidad desde un punto de vista anatomopatológico. Presentamos un caso excepcional de transformación anaplásica de un astrocitoma pilocítico en un paciente de 28 años, al igual que revisamos los criterios pronósticos de esta neoplasia y discutimos los datos anatomopatológicos que se consideran de anaplasia o malignidad.

Palabras clave:
Astrocitoma pilocítico
Transformación maligna
Radioterapia
Pronóstico

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