Thalamic glioma

Case contributed by Dr Hani Al Salam

Presentation

18 year old female presented with headache and vomiting

Patient Data

Age: 18
Gender: Female
Modality: MRI

Case Discussion:

CT and MRI demonstrates a left thalamic lesion. Follow up study after initiation of radio-chemotherapy demonstrates mild reduction in the size of the left thalamic lesion.

Pathology:

Immunohistochemistry:

GFAP (clone polyclonal) is positive (weak)

Ki-67 (MMI) approximatly 1% nuclear staining

P53 (D0-7) is positive.

Low grade glial tumour consistent with astrocytoma WHO grade II . Sections consist with predominantly gray and white matter brain tissue with only small fragment of increased cellularity consistent with low grade astrocytoma of WHO grade II . However, in view of the small size of the biopsy material this grade might be not representative of the actual grade of the tumour so correlation with radiological finding is mandatory.

It should be noted that the biopsy is not from the enhancing component,
located posteriorly. With enhancement and such a high cho:cr ratio, i
would have guessed anapestic / Grade III astrocytoma. So there may well be, as the pathologist says, sampling error.

The enhancing nodules on follow up MRI are presumably from the biopsy.

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Case Information:

rID: 10966
Diagnostic certainty: Certain
Tags: thalamus, tumour
Inclusion in quiz mode: Included

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