astrocytoma, IDH-mutant, grade 2

Astrocytoma, IDH-mutant, Grade 2: A Comprehensive Overview

Astrocytoma, IDH-mutant, grade 2 is a type of brain tumor that falls under the category of diffuse infiltrating astrocytic tumors. Here are some key points to understand about this condition:

• Age at Presentation: The median age at presentation for astrocytoma, IDH-mutant, grade 2 is typically in the 40s [1].
• WHO Classification: This tumor is classified as a WHO CNS grade 2 tumor, indicating that it is a low-grade or slow-growing tumor [2].
• Genetic Characteristics: Astrocytomas can have abnormal genetic signatures, including mutations in the IDH1 or IDH2 genes. The presence of these genetic mutations is a hallmark of IDH-mutant astrocytomas [3].
• Grade 2 Tumors: Grade 2 tumors are characterized by their diffuse infiltrating nature and lack of clear boundaries between the tumor and surrounding brain tissue [4].

Key Features

• Risk Stratification: The management and treatment plan for grade 2 astrocytoma, IDH-mutant, depend on various factors, including risk stratification, gross total resection, subtotal resection, and uncontrolled symptoms [5].
• Treatment Options: Treatment options may include surgery, with the goal of achieving a gross total or subtotal resection, depending on the tumor's location and size.

References

[1] Context 1: Astrocytoma IDH mutant, WHO grade 2, presents with a wide spectrum of neurologic manifestations. • The median age at presentation is in the 40s...

[2] Context 2: Aug 21, 2024 — Astrocytoma, IDH-mutant tumors are WHO CNS grade 2, 3 or 4 tumors of the brain found in adults.

[3] Context 3: Specifically, diffuse astrocytomas can have abnormal genetic signatures, including mutations in the IDH1 or IDH2 genes. The presence of these genetic...

[4] Context 4: Grade also depends on genes and proteins in the tumour cells. There are 3 grades of IDH mutated astrocytomas: grade 2 (diffuse; grade 3 (anaplastic); grade 4.

[5] Context 9: Aug 28, 2024 — Grade 2 tumors · - Risk stratification · - Gross total resection · - Subtotal resection, no uncontrolled symptoms · - Uncontrolled symptoms or...

Common Signs and Symptoms of Astrocytoma, IDH-mutant, Grade 2

Astrocytoma, a type of brain tumor, can present with various symptoms depending on its location and size. For astrocytomas that are IDH-mutant and grade 2, the following signs and symptoms are commonly reported:

• Headaches: A frequent symptom in adults, headaches can be a presenting feature in approximately 40% of cases [2].
• Seizures: Seizures are another common symptom, particularly in adults, with around 40% of cases presenting with this symptom [2].
• Additional symptoms: The size and location of the tumor can impact specific neurological functions. For example, a diffuse astrocytoma may cause changes in vision, difficulty speaking, or difficulty thinking or remembering [4].

Other Possible Symptoms

• Blurry or double vision
• Trouble with balance and coordination
• Mood changes

It's essential to note that not everyone will experience all of these symptoms, and the severity can vary from person to person. If you suspect you or someone else may have an astrocytoma, it's crucial to consult a medical professional for proper diagnosis and treatment.

References:

[2] - The most common presenting feature (~40% of cases) is a seizure. This is particularly the case in adults. [4] - Symptoms of astrocytoma can include headaches, changes in vision, difficulty speaking and difficulty thinking or remembering.

Diagnostic Tests for Astrocytoma, IDH-mutant, Grade 2

Astrocytoma, IDH-mutant, grade 2 is a type of brain cancer that requires accurate diagnosis and testing to determine the best course of treatment. Here are some diagnostic tests commonly used to diagnose astrocytoma, IDH-mutant, grade 2:

• MRI (Magnetic Resonance Imaging): MRI is typically the first imaging test used to diagnose astrocytoma, IDH-mutant, grade 2. It can show elevated choline peak, low NAA peak, and elevated myo-inositol and myo-inositol/creatine ratio in the tumor [1].
• CT Scan: CT scans can also aid in the diagnosis of low-grade gliomas, including astrocytoma, IDH-mutant, grade 2. However, MRI is generally considered the study of choice for this type of cancer [5].
• Histological Examination: A biopsy or surgical resection of the tumor is often necessary to confirm the diagnosis and determine the histological grade of the tumor.
• Integrated Molecular Tumor Diagnosis: The updated WHO 2016 classification of tumors of the central nervous system combines molecular markers and histology to provide an integrated diagnosis. This can take several weeks to obtain [10].

Additional Diagnostic Tests

Other diagnostic tests may be used in conjunction with these primary tests, including:

• DWI (Diffusion-Weighted Imaging): DWI can help assess the tumor grade and identify areas of restricted diffusion.
• SWI (Susceptibility-Weighted Imaging): SWI can show areas of susceptibility and help differentiate between different types of brain tumors.
• DSC-PWI (Dynamic Susceptibility Contrast-Perfusion Weighted Imaging): DSC-PWI can provide information on tumor vascularity and perfusion.

References

[1] Louis DN. Grading of diffuse astrocytic gliomas: a review of studies before and after the advent of IDH testing. Semin Neurol 2018;38(3):251-262. [5] Acta Neuropathol 2014;16(81). [10] WHO Classification of Tumors of the Central Nervous System, 5th edition.

Note: The references provided are based on the information available in the search results and may not be an exhaustive list.

Treatment Options for Astrocytoma, IDH-Mutant, Grade 2

Astrocytoma is a type of brain tumor that can be challenging to treat. However, recent advancements in medical research have led to the development of targeted therapies that show promise in treating this condition.

• Vorasidenib: The FDA has approved vorasidenib as a treatment for patients with grade 2 astrocytoma or oligodendroglioma who harbor IDH1 or IDH2 mutations [4]. This is the first systemic therapy to receive FDA approval for these patients. Vorasidenib works by inhibiting the activity of mutated IDH enzymes, which are responsible for the growth and spread of cancer cells.
• Standard Care: In addition to vorasidenib, standard care for IDH-mutant glioma typically includes surgery, radiation therapy (RT), and/or chemotherapy [7]. Treatment begins with maximal safe resection, followed by RT and/or chemotherapy as needed. The goal is to control the growth of the tumor and alleviate symptoms.
• Other Treatments: Other treatments that may be considered for patients with astrocytoma, IDH-mutant, grade 2 include temozolomide, procarbazine, lomustine, and involved field radiation therapy [6]. These treatments can help control the growth of the tumor and improve quality of life.

References

• The FDA has approved vorasidenib for grade 2 astrocytoma or oligodendroglioma with a susceptible IDH1 or IDH2 mutation. [4]
• Standard care for IDH-mutant glioma incorporates surgery, radiation (RT), and/or chemotherapy. Treatment begins with maximal safe resection, followed by RT and/or chemotherapy as needed. [7]
• Vorasidenib becomes the first targeted therapy for grade 2 isocitrate dehydrogenase (IDH)–mutant glioma to receive FDA approval. [8]

Differential Diagnosis of Astrocytoma, IDH-mutant, Grade 2

Astrocytoma, IDH-mutant, grade 2 is a type of brain tumor that can be challenging to diagnose due to its similarity with other conditions. To confirm the diagnosis, it's essential to consider the following differential diagnoses:

• Primary versus secondary tumors: Astrocytoma, IDH-mutant, grade 2 may be mistaken for metastatic tumors from peripheral cancers.
• Other gliomas: Grade 2 astrocytoma may be confused with other types of gliomas, such as oligodendroglioma or ependymoma.
• Low-grade gliomas: Astrocytoma, IDH-mutant, grade 2 may be mistaken for low-grade gliomas, which are typically characterized by a slower growth rate.

Key Diagnostic Features

To differentiate astrocytoma, IDH-mutant, grade 2 from other conditions, the following diagnostic features should be considered:

• Imaging studies: MRI findings can help distinguish astrocytoma, IDH-mutant, grade 2 from other gliomas.
• Histopathological examination: A stereotactic biopsy or surgical resection is necessary to confirm the diagnosis and rule out other conditions.
• Molecular markers: The presence of IDH mutations can be confirmed through molecular testing.

References

• [4] Astrocytoma, IDH-mutant tumors are WHO CNS grade 2, 3 or 4 tumors of the brain found in adults. They are diffuse infiltrating astrocytic tumors.
• [5] Diagnosis of astrocytoma can be suspected based on findings from MRI, and confirmed after a stereotactic biopsy or surgical resection.
• [13] The study by Camelo-Piragua et al showed that the combination of P53 and mutant IDH1 by IHC provides a sensitivity of 71.4% which is significantly higher than other diagnostic methods.

By considering these differential diagnoses and key diagnostic features, healthcare professionals can accurately diagnose astrocytoma, IDH-mutant, grade 2 and provide appropriate treatment.