Presentation
Adult patient presenting with seizures.
Patient Data
Selected images from an MRI demonstrate a multifocal mass extendign both across the corpus callosum and subependymally around the trigone of the left lateral ventricle.
Contrast enhanced T1 sequences (not shown) demonstrated no significant enhancement.
Case Discussion
The differential in such a case is primarily between a high-grade glioma (astrocytoma) or primary CNS lymphoma. The absence of significant enhancement makes the former far more likely.
Histology
The section shows fragments of a densely hypercellular astrocytic glioma. Tumor cells show moderate nuclear and cellular pleomorphism. Frequent mitotic figures are identified and there is prominent vascular endothelial cell hyperplasia. No necrosis is seen in any of the fragments submitted. The features are of anaplastic astrocytoma.
FINAL DIAGNOSIS: anaplastic astrocytoma
Note: IDH mutation status is not provided in this case and according to the current (2016) WHO classification of CNS tumors, this tumor would, therefore, be designated as an anaplastic astrocytoma NOS.
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