Presentation
Headache. Previous MRI revealed bilateral cerebral cortical space occupying lesions. Surgical excision of right parietal and occipital lesions, pathologically proved pleomorphic xanthoastrocytoma. Follow up MRI.
Patient Data
There are right parietal parafalcine, right occipital and left frontal cortical heterogenous space-occupying lesions. They elicit low signal on T1 (except for the right parietal lesion which shows internal T1 signal likely representing a hemorrhagic, post operative sequela). They elicit heterogenous high T2 signal cystic/solid appearance with heterogenous contrast enhancement. The right cerebral lesions are surrounded by vasogenic edema and gliosis and exerting mild mass effect. The left frontal lesion causing thinning and indentation of the adjacent bone.
Right parietal and occipital craniotomy with underlying right high parietal area of encephalomalacia (postoperative sequela) with adjacent right high parietal cortical small enhancing nodule, likely recurrent lesion.
Impression: Synchronous multicentric pleomorphic xanthoastrocytoma.
Case Discussion
This is a rare case of synchronous multifocal pleomorphic xanthoastrocytoma (PXA) in both cerebral hemispheres.
The multiplicity of PXA lesions increases the risk of anaplastic transformation.
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