Astroblastoma

Case contributed by Prof Alan Coulthard

Presentation

Presented with two episodes of tonic clonic seizures and headache.

Patient Data

Age: 26
Gender: Female
CT

Hyperdense mass on non contrast CT.

MRI

MRI confirms a cortically-based right parietal mass lesion with vasogenic oedema.

MRI

Post contrast MRI 18 months post excision

Contrast-enhanced T1 MRI acquired 18 months post excision shows a small area of encephalomalacia at the operative site, but no evidence of residual or recurrent tumour.

Case Discussion

The combination of a hyperdense lesion on CT and an avidly enhancing lesion on MRI is often seen in lymphoma, however typically there is fairly marked diffusion restriction within the lesion, not seen here. The moderate edge restriction was not thought typical of lymphoma. The imaging appearance in conjunction with the prominent vasogenic oedema raised the possibility of a metastasis. Given the age of the patient metastatic melanoma was suggested in the differential. 

At histology the morphology and immunophenotype were felt to be consistent with an astroblastoma. The histological features were considered low grade (no WHO grading currently exists for these lesions) with a favourable prognosis. Follow up 18 months post surgery shows no residual lesion. 

Astroblastoma is an uncommon glial neoplasm (0.45-2.8% brain gliomas) which is almost always supratentorial, occurring most commonly in young adults. The figure of 85% of lesions showing calcification on CT quoted in the literature is based on a series of 7 patients. No overt calcification was seen on CT in this case, although the lesion was hyperdense. The lesion in this case was predominantly isointense, with heterogenous features in keeping with the reported solid and cystic components in this pathology.

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Case information

rID: 39792
Case created: 21st Sep 2015
Last edited: 21st Sep 2015
Inclusion in quiz mode: Included

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