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Anaplastic astrocytoma (WHO grade III)

Case contributed by Dr Mohammad A. ElBeialy


Heaviness and numbness in the left upper limb. Few attacks of convulsions started in the last week.

Patient Data

Age: 45 years
Gender: Female
  • right fronto-parietal cortical and subcortical mass lesion is seen demonstrating heterogenous predominantly low T1 with patchy areas of T1 hyperintensity (met Hb sign) as well as heterogeneously hyperintense T2 / FLAIR signal. The lesion shows some restricted diffusion. 
  • the lesion shows mild heterogenous post-contrast enhancement. 
  • the lesion is surrounded by mild vasogenic brain edema with compression of the right lateral ventricle as well as subtle about 3 mm contra-lateral midline shift. 
  • MR spectroscopy of the examination shows: 
    • marked elevation of the choline (Cho) with moderate depression of the neuronal markers N-acetyl aspartate (NAA) and creatine (Cr) with elevation of the Cho / Cr and Cho / NAA rations
    • Myoinositol (MI) is not significantly depressed, with MI / Cr ratio ~ 0.53
    • single voxel MR spectroscopy show mild elevation of the lipid / lactate peak
  • no hydrocephalic changes
  • normal sellar region
  • normal posterior fossa.

Case Discussion

Right fronto-parietal hemorrhagic mass lesion with mild mass effect. 

Conventional and spectroscopic features of anaplastic astrocytoma (WHO grade III) 

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