Diffuse astrocytoma NOS ("protoplasmic")
Headaches and first seizure.
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Large tumor centered on the left middle frontal gyrus. It is T2 bright with areas of T2 hyperintensity that suppress on FLAIR. Rim-like diffusion restriction and virtually no contrast enhancement.
The patient went on to have surgery.
Section show a moderately cellular tumor comprising astrocytes showing hyperchromatic nuclei, moderate nuclear pleomorphism and ill-defined eosinophilic cytoplasm.
Mitotic activity is not seen. Rosenthal fibers or eosinophilic granular bodies are not identified. There is no necrosis or microvascular proliferation. A Ki-67 stain shows a proliferative index of approximately 10%.
Features consistent with a low-grade glioma and most in keeping with a protoplasmic astrocytoma.
Until recently, protoplasmic astrocytomas were classified as a subtype low-grade astrocytoma, however, in the latest (2016) update to WHO classification of CNS tumors, protoplasmic astrocytomas no longer exists as a distinct entity.
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- Louis DN, Perry A, Reifenberger G et-al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016;131 (6): 803-20. doi:10.1007/s00401-016-1545-1 - Pubmed citation