Presentation
35 years old patient with 3-4 months history of headache and convulsions underwent sterotactic biopsy
Patient Data
A supra-tentorial SOL is seen centered upon the rostrum & genu of the corpus callosum extending into the anterior two-thirds of the body of the corpus callosum & into the frontal lobes of both cerebral hemispheres, more on the left side reaching to subcortical region. It is seen eliciting isointense signal on T1 & isointense to high signal on T2 WIs. In diffusion weighted images, it showed restricted diffusion with high DWI & low ADC signals. In post contrast series it showed faint patchy enhancement. It is seen surrounded by vasogenic edema extending into the cerebral frontal lobes. The SOL together with surrounding edema is seen exerting mass effect in the form of the compression of the underlying lateral ventricles with mild dilatation of the rest of the cerebral ventricles.
A patch of high T1 & T2 WI signal is seen at left frontal subcortical region likely post interventional sequel
Case Discussion
Corpus callosal SOL with differential diagnosis including lymphoma & intermediate grade glioma.
Stereotactic biopsy revealed two cores of brain tissue infiltrated by scattered neoplastic astrocytic cells displaying mildly pleomorphic hyperchromatic nuclei with no mitotic figures and separated by fibrillary background with prominent micro cystic spaces. No tumor necrosis or vascular endothelial proliferation detected.
Immuno-histochemical staining:
- GFAP: Diffuse positive staining.
- LCA: scattered mature lymphocytes showing positive staining. Neoplastic cells were negative excluding the possibility of lymphoma.
- Ki67: Few scattered cells showed positive nuclear staining.
- Proliferation index2%.
Final diagnosis:- Diffuse astrocytoma, WHO grade II.
Note: As part of the current WHO classification of CNS tumors both IDH mutation status and 1p19q status (if IDH positive) should be obtained for correct classification.
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