Diffuse fibrillary astrocytoma
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There is an ill defined non enhancing area of T1 hypointensity and T2 hyperintensity in the inferolateral aspect of the left temporal lobe. It involves the middle temporal gyrus but appears to spare the superior temporal gyrus, hippocampus and parahippocampal gyrus. Corresponding hyperintensity on both DWI and ADC is in keeping with vasogenic edema. No restricted diffusion is detected.
Mild local mass effect with sulcal effacement is seen. No definite increase in cerebral blood volume is seen in the region of signal abnormality (not shown). Spectroscopy was technically inadequate.
No hydrocephalus or midline shift. No abnormal leptomeningeal enhancement. No intracranial hemorrhage.
Non enhancing area of signal abnormality in the inferolateral aspect of the left temporal lobe most likely represents a low grade glioma.
The patient went on to have a biopsy.
MICROSCOPIC DESCRIPTION: Paraffin sections show a mild increase in the cellularity of white matter. There is loss of normal white matter architecture and increased numbers of astrocytic cells with mild to moderate nuclear atypia. Aggregates of 3-4 astrocytic nucei are noted. There is prominent perineuronal satellitosis by atypical astrocytes in cortex. No mitotic figures are identified and there is no vascular endothelial cell proliferation and no necrosis. The features are of diffuse fibrillary astrocytoma (WHO Grade II). The Topoisomerase labeling index is approximately 1%.
FINAL DIAGNOSIS: Diffuse fibrillary astrocytoma WHO Grade II