Anaplastic pleomorphic xanthoastrocytoma
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Selected images from an MRI of the brain demonstrate an enhancing lesion of the left frontal lobe with surrounding oedema. Small peripheral cystic areas are present.
The patient went on to have a resection.
MICROSCOPIC FEATURES: Paraffin sections show a densely hypercellular glial tumour. Tumour cells are a mixture of gemistocytic astrocytes and large cells with foamy, GFAP positive cytoplasm. There are also scattered large cells with markedly pleomorphic hyperchromatic nuclei.
Frequent mitotic figures are noted (>10/10HPF) and there are occasional foci of vascular endothelial cell hyperplasia. Several perivascular cuffs of mononuclear inflammatory cells are also present. No necrosis is seen in any of the specimens submitted.
The Ki-67/MIB-1 proliferation index is approximately 8%.
FINAL DIAGNOSIS: anaplastic pleomorphic xanthoastrocytoma