Presentation
Persistent headaches for many months and sudden onset seizures.
Patient Data
A large uni-loculated cystic lesion within the deep white matter of the right frontoparietal region of the brain has smooth enhancing walls and an eccentric mural nodule within the right-inferior wall of the cyst which is predominantly isointense to grey matter on T1, hyperintense on T2 heterogeneously enhancing. There is a mass effect causing near-complete effacement of the right lateral ventricle with a midline shift towards the left side. No significant perilesional edema.
Conclusion:
Large right frontoparietal cystic mass with an eccentric enhancing mural nodule. Differentials include: pilocytic astrocytoma, glioneuronal tumor (e.g. ganglioglioma/gangliocytoma), supratentorial ependymoma or perhaps a hemangioblastoma.
HISTOLOGY REPORT
Section of brain tissue reveals sheets of astrocytes that are mildly pleomorphic on a fibrillary background. There are areas showing extensive microcysts formation with eosinophilic hyaline globules. Extensive areas show a fascicular pattern with spindle-shaped cells. Areas of hemorrhages are also seen. Adjoining normal tissue is seen. There are no necrosis or mitotic figures
FINAL DIAGNOSIS:
Pilocytic astrocytoma (WHO grade 1)
Case Discussion
Pilocytic astrocytoma, the most common glial cell tumor frequently occurs in children and young adults. Location-wise, they occur in or near the midline, usually from the cerebellum, optic nerve, chiasm, hypothalamus, and optic radiations. In adults as in this case, they occur commonly in the cerebral hemispheres. Other less common locations include the cerebral ventricles, brain stem, velum interpositum, and spinal cord.
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