Diffuse low grade astrocytoma (grade II) with intraventricular extension.

Case contributed by Dr Ernest Lekgabe

Presentation

Presented with decreased level of consciousness.

Patient Data

Age: 30 years
Gender: Male

Massive left sided non enhancing tumour arising out of the left temporal lobe, with large component extending into the left lateral ventricle and with subfalcine, uncal and transtentorial herniation. Resultant severe mass effect with acute obstructive hydrocephalus and compression of the left PCA. Small infarct in the medial aspect of the temporo-occipital region.

Case Discussion

Partial resection of the tumour was performed.

MICROSCOPIC DESCRIPTION:

The sections show features of a moderately cellular astrocytic tumour. The tumour cells have slightly elongated and hyperchromatic nuclei with a microcystic background. 2 mitoses are seen within the entire tumour. No microvascular proliferation is present. One hypocellular fragment is necrotic, which may be related to previous surgery, rather than being tumour cell necrosis.

Immunohistochemistry:

  • p53 positive
  • IDH1-R132H immunostain is positive
  • MGMT is negative (likely methylated)
  • ATRX shows loss of staining (mutated)
  • the topoisomerase index is about 2%

DIAGNOSIS:

Diffuse astrocytoma, IDH-mutant, ATRX-mutant (WHO Grade II).

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Case information

rID: 54573
Case created: 16th Jul 2017
Last edited: 7th Nov 2017
Inclusion in quiz mode: Included

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