Diffuse fibrillary astrocytoma
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FLAIR hyperintensity is identified involving the insular cortex on the left with superior extension into the periventricular white matter of the left frontal lobe. Subtle FLAIR hyperintensity also noted at the inferior left frontal and mesiotemporal lobes. The affected region demonstrates mildly decreased T1 signal and demonstrates mild mass effect with partial effacement of the involved sulci.
Region demonstrates no discernible enhancement and no susceptibility induced signal loss. Mild irregular diffusion restriction centrally (not shown). MRS demonstrates a mild to moderately elevated creatine peak, slightly increased choline, moderately decreased NAA peak and mild increased myoinositol peak without a significant lactate peak (not shown).
Ventricular size is age appropriate. No other focal lesions identified.
Imaging appearances would be in keeping with tumour (such as a low-grade astrocytoma).
The patient went on to have a stereotactic biopsy.
MICROSCOPIC DESCRIPTION: Paraffin sections show 9 cores of brain tissue. There is a mild increase in cell density and some architectural disturbance, most notably in the three cores in specimen 3. There is mild atypia of fibrillary astrocytes with aggregates of 2-4 nuclei noted and foci of perivascular secondary structuring. Scattered mature neurons are noted. Some of these also show secondary structuring. No mitotic figures are identified and there is no vascular endothelial cell hyperplasia and no necrosis. The features are of diffuse fibrillary astrocytoma, WHO Grade II.
FINAL DIAGNOSIS: 1 Diffuse fibrillary astrocytoma (WHO Grade II)