[High-grade astrocytoma with piloid features: case report and systematic review]

Area of Science:

• Neuro-oncology
• Molecular Pathology

Background:

• The 2021 WHO classification introduced high-grade astrocytoma with piloid features (HGAP).
• HGAP presents diagnostic challenges due to morphological and neuroimaging similarities to pilocytic astrocytoma.
• Accurate detection currently relies on molecular genetic testing, particularly methylation profiling.

Purpose of the Study:

• To present a case of HGAP in an adult.
• To conduct a systematic review of adult HGAP cases.
• To analyze clinical course, diagnosis, treatment protocols, and outcomes.

Main Methods:

• Systematic literature review adhering to PRISMA guidelines.
• Independent analysis of selected studies by authors.
• Detailed case report co-authored by clinicians and pathologists.

Main Results:

• HGAP demonstrates rapid progression and therapeutic resistance.
• This case highlights the need for neurosurgeon awareness and molecular testing for HGAP.
• Analysis of methylation profiles is essential for tumors with atypical pilocytic astrocytoma features.

Conclusions:

• HGAP is a rare and aggressive neoplasm with no established treatment algorithm.
• Global treatment experience is limited to individual case series.
• Methylation profile analysis is critical for diagnosing atypical tumors resembling pilocytic astrocytoma.