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

Case contributed by Dr Ernest Lekgabe


Presented with decreased level of consciousness.

Patient Data

Age: 30 years
Gender: Male

Massive left sided non enhancing tumor 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 tumor was performed.


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


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


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

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Case information

rID: 54573
Published: 2nd Oct 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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