Presentation
Further investigation of an abnormal CT scan in a child with language problems.
Patient Data
Lobulated mass involving the optic chiasm, adjacent optics nerves and optic pathways.
Perilesional hyperintensity onT1-weighted imaging.
The mass is larger on the left, with displacement of the left posterior communicating artery.
The samples obtained in the surgical event were sent to the pathology service that suspected astrocytoma pilocytic as a diagnosis.
Histology
[Translated and abbreviated]
Compatible with low-grade glial neoplasm. Images show fragments of a biphasic neoplasm formed by cells with low cytoplasm on a dense fibrillary background alternating with areas of microcytic appearance. No mitoses or necrosis or endothelial hyperplasia.
The differential diagnosis includes well-circumscribed glial tumors like pilocytic astrocytomas but no Rosenthal fibers and/or eosinophilic granular bodies were identified so it is not possible to conclusively establish the diagnosis.
Clinicoradiological correlation is important.
Case Discussion
Gliomas of the optic pathway have a prevalence that ranges between 3% and 5% of all tumors of the pediatric central nervous system, ranking as the most common intrinsic tumors of the optic nerve. Only 25% are limited to the optic nerves and most involve the chiasm.
Patients may have no relevant symptoms, as in this case. The manifestations vary depending on the location of the lesion, with visual loss being the most common presentation.
Pilocytic astrocytoma of the optic tract was an unexpected finding in this patient with language disorder. This appears to be an isolated finding with no other features to suggest neurofibromatosis type 1.
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