Astrocytoma, IDH-mutant

Case contributed by Frank Gaillard
Diagnosis certain

Presentation

Seizures

Patient Data

Age: 35 years
Gender: Male
ct
This study is a stack
Axial
non-contrast
This study is a stack
Axial C+
delayed
This study is a stack
Sagittal
non-contrast
This study is a stack
Sagittal
C+ delayed
This study is a stack
Coronal
non-contrast
This study is a stack
Coronal C+
delayed
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Info

A left frontal region of low density is present with mass effect. A small curvilinear region of increased density is noted, which is of uncertain significance. 

mri
This study is a stack
Axial
T1
This study is a stack
Axial
T1 C+
This study is a stack
Axial
T2
This study is a stack
Axial
FLAIR
This study is a stack
Axial
DWI
This study is a stack
Axial
ADC
This study is a stack
Axial
Gradient Echo
This study is a stack
Sagittal
FLAIR
This study is a stack
Sagittal
T1
This study is a stack
Sagittal T1
C+ fat sat
This study is a stack
Coronal T1
C+ fat sat
This study is a stack
Coronal
T1
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Info

A large left frontal mass is demonstrated without enhancement, calcification, necrosis or hemorrhage. 

Features favor a diffuse low grade glioma. 

Case Discussion

The patient went on to have surgery.

Histology

The sections show features of a moderately cellular astrocytic tumor. The tumor cells have elongated, angulated and hyperchromatic nuclei. Some gemistocytes are noted, occupying about 5% of the cell population. 1 mitosis is seen. No microvascular proliferation or necrosis is present. There is no oligodendroglial component. The features are those of diffuse astrocytoma.

The tumor cells are p53 and IDH-1 positive (mutated). ATRX shows loss of staining (mutated). MGMT is negative (likely methylated). The topoisomerase index is about 3%.

Final diagnose

Astrocytoma, IDH-mutant (WHO Grade 2)

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