Diffuse astrocytoma

Case contributed by Dr Bruno Di Muzio

Presentation

Referred from evaluation of a brain lesion found on previous CT scan (not available).

Patient Data

Age: 30-year-old
Gender: Female

MRI Brain

Modality: MRI

Technique: Pre and postcontrast study including brain lab, perfusion and spectroscopy sequences. No prior imaging for comparison.

Findings: Ovoid well-defined heterogeneous but predominantly T1 hypointense / T2 hyperintense (which partially suppress on FLAIR) mass involving cortex and white matter of the posteroinferior left parietal lobe measures 3.8 x 3.3 x 3.4 cm. A thin rim of flair hyperintensity surrounds its margin.

No concerning central or marginal enhancement.

Equivocal segment of thin rim diffusion restriction at the anterolateral margin. No elevated CBV. No evidence of haemorrhage or calcification.

Spectroscopy traces within show elevated choline and depressed NAA, consistent with tumour.

Mild local positive mass-effect. Overlying calvarium is unremarkable.

No other intra or extra-axial mass.

Conclusion: Solitary 3.8 cm left parietal lobe mass, most likely a low grade glioma.

Modality: Pathology

MICROSCOPIC DESCRIPTION:  The sections show features of a moderately cellular astrocytic tumour. The tumour cells are of mixed fibrillary and protoplasmic types. Small numbers of gemistocytes are also seen. The tumour cells have enlarged hyperchromatic nuclei and variable amounts of cytoplasm. Focal microcystic change is seen in the background. Mitoses are inconspicuous. No endothelial cell hyperplasia or necrosis is present. Tumour cells are seen in the cortex. There is no oligodendroglial component. The features are those of diffuse astrocytoma. The Ki-67 index is 3-4%. IDH-1 immunostain is negative.

DIAGNOSIS: Left parietal lesion: Diffuse astrocytoma (WHO Grade II).

Case Discussion

The MRI features are those of a low-grade glioma, either a protoplasmic diffuse astrocytoma or an oligodendroglioma. The histology showed to be a diffuse astrocytoma. 

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Case Information

rID: 41396
Case created: 30th Nov 2015
Last edited: 22nd Dec 2015
Tag: rmh
Inclusion in quiz mode: Included

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