Presentation
New onset seizures.
Patient Data
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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.