Diffuse thalamic and brainstem glioma
No presenting history available.
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MRI of the brain demonstrates extensive abnormality involving the brainstem and thalami characterised by high T2 signal and positive mass effect. There is faint contrast enhancement and restricted diffusion.
MRS demonstrates elevation of choline, elevation of the choline : creatine ratio and depression of NAA, consistent with a glioma.
MICROSCOPIC DESCRIPTION: The section shows cores of a moderately hypercellular astrocytic glioma. Tumour cells are fibrillary in type with round and elongated nuclei and bipolar processes and are arranged in loose fasciculi. No mitotic figures are seen and there is no vascular endothelial cell hyperplasia and no necrosis. Foci of microcalcification are also noted. Tumour cells show strong immunostaining for GFAP and nestin. The featues are of diffuse astrocytoma (WHO Grade II). The topoisomerase labelling index is approximately 1%.
This case was part of Royal Melbourne Hospital Radiology Department Quiz (May 2011).
Case discussion by: Dr Frank Gaillard, consultant neuroradiologist, Royal Melbourne Hospital.