Presentation
This patient presented with a recent onset of seizures and worsening headache.
Patient Data
Large left well-defined intraparenchymal supratentorial lesion centered in the left parietal region with cystic foci within showing a mild bubbly appearance at the superior aspect. It is heterogeneously hyperintense on T2/FLAIR with blooming on gradient images suggesting hemorrhage. A dependent fluid level is noted as well. This area is hyperintense on T1.
Not post-contrast T1 images are available, although it is likely that they would show enhancement of the anterior solid component.
Case Discussion
Astroblastomas are extremely rare supratentorial lesions in young adults and children. They were categorized under the "other gliomas" in 2016 by WHO, however recently considered as a high-grade neuroepithelial tumor. They classicly have GFAP+ astroblastic pseudorosettes on microscopy. They predominantly contain epithelioid tumor cells in comparison to astrocytomas. Immunophenotype shows an MN1 rearrangement, having a better survival than BRAF V600E and a spectrum of neuroepithelial tumors.
Our case was a histologically proven astroblastoma, which showed astroblastic rosettes, diffusely positive for EMA and a large proportion was positive for Olig2, GFAP.
Special credits to Dr Harsha Chadaga, Dr Sriram and Dr. Ratna Sutanto.