ASTROCYTOMA - GRADE III and IV
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ALTERNATE NAMES
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Astrocytoma Grade III; Anaplastic Astrocytoma; Anaplastic Malignant Astrocytoma; Astrocytoma
Grade IV; Mixed Glioblastoma Sarcoma; Gliosarcoma Astrocytoma Grade IV; Giant Cell
Glioblastoma; Anaplastic Astrocytoma; Anaplastic Oligoastrocytoma; Anaplastic Oligodendroglioma;
Anaplastic Pleomorphic Xanthoastrocytoma
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DESCRIPTION
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Astrocytoma is a tumor that begins in the brain or spinal cord in small, star-shaped cells called
astrocytes. These tumors are graded as defined by the World Health Organization (WHO)
and the grading is based on microscopic analysis of levels of mitotic activity and
nuclear atypia. Grades III and IV represent the most aggressive forms of the disease.
Grade III astrocytomas include anaplastic astrocytomas and sometimes the less malignant
of the glioblastoma multiforme group. Grade IV Astrocytomas are highly malignant and
include only glioblastoma types. Cerebellar astrocytomas start in the cerebellum,
which is located at the lower back of the brain. The cerebellum is the part of the
brain that controls movement, balance, and posture. These tumors affect both adults
and children. About 15-25% of all childhood brain tumors are cerebellar astrocytomas.
Although cancer is rare in children, brain tumors are the most common type of childhood
cancer other than leukemia and lymphoma. The symptoms of astrocytoma vary and often
depend on an individual's age and where the tumor is located.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing: Diagnostic testing for Astrocytoma includes a neurologic examination, and radiologic
imaging such as a CT scan and/or MRI (magnetic resonance imaging). A biopsy is performed,
either before surgery by a needle biopsy or at the time of surgical resection.
Physical findings: Symptoms and physical findings of Astrocytoma include:
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Morning headache or headache that goes away after vomiting;
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Unusual sleepiness or change in energy level;
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Change in personality or behavior;
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ICD-9: 191.9
ICD-10: C71.9
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PROGRESSION
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Astrocytomas tend to grow and become more malignant over time. Brain stem gliomas
have relatively poor prognoses. The overall median survival is between 44 and 74 weeks.
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TREATMENT
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Treatment depends on the location of the tumor and its progression. Standard treatment
is surgery followed by radiation therapy. If surgery is not an option, radiation therapy
is given. Chemotherapy is sometimes given during or after radiation therapy.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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Clinical history and examination that describes the diagnostic features of the impairment;
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If a pathology report is unavailable, a surgical report or all radiological studies
especially the MRI and CT scans may be substituted.
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Suggested Listings for Evaluation:
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DETERMINATION
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LISTING
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REMARKS
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Meets
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13.13 A 1
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Pathologically confirmed or clinically diagnosed astrocytoma or glioma of the brain
stem or thalamus (independent of grade).
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13.13 A 2
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Grade IIII or IV astrocytoma, oligodendroglioma, or glioblastoma.
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113.13 B
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Grade III or IV astrocytoma or glioblastoma.
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Equals
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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