Pleomorphic xanthoastrocytoma

Case contributed by Ryan Thibodeau
Diagnosis certain

Presentation

New onset seizures.

Patient Data

Age: 20 years
Gender: Female
mri
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Axial
T2
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Coronal T2
fat sat
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Axial
FLAIR
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Coronal
FLAIR
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Axial T1
fat sat
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Axial T1
C+ fat sat
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Axial
DWI
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Axial
ADC
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Axial
SWI
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Sagittal
T1 fat sat
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Sagittal
T1 C+
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Axial
T1 C+
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Coronal
T1
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Coronal
T1 C+
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Coronal T1
C+ fat sat
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Axial
MIP SWI
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Axial
Phase
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Sagittal
T1
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Info

In the anterosuperior right temporal lobe, there is patchy predominantly subcortical white matter T2 hyperintensity with a few associated cystic-appearing areas. There is minimal enhancement in the anterior aspect of the lesion.

Also noted is a small hemorrhage-fluid level in a pineal cyst.

Case Discussion

The patient underwent resection of the temporal lobe lesion.

Macroscopic appearance

Gross pathologic analysis showed that the lesion was tan-pink.

Histology

Histopathologic findings were consistent with an astrocytoma, with differential considerations including a pilocytic astrocytoma versus a pleomorphic xanthoastrocytoma. The latter was pathologically favored given the immunohistochemical staining pattern, including CD34 expression and Reticulin and focal collagen deposition on the Trichrome stain. A ganglioglioma was ruled out given the Neu-N and synaptophysin show reactive (and non-neoplastic) glial neuronal tissue. Furthermore, the lesion was highlighted by GFAP and patchy EGFR positivity. The Ki-67 index was low.

Final diagnosis: pleomorphic xanthoastrocytoma.

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