Diffuse thalamic and brainstem glioma

Case contributed by A.Prof Frank Gaillard

Presentation

No presenting history available.

Patient Data

Age: 35 years
Gender: Female

Case Discussion

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. 

The pons is markedly expanded trapping the basilar artery between the clivus and the anterior surface of the pons. 

MRS demonstrates elevation of choline, elevation of the choline : creatine ratio and depression of NAA, consistent with a glioma. 

Features are quite characteristic of an extensive intermediate grade glioma (both brainstem glioma and thalamic glioma

Pathology

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%.

DIAGNOSIS: Diffuse astrocytoma (WHO Grade II).

Notes

This case was part of Royal Melbourne Hospital Radiology Department Quiz (May 2011). 

Case discussion by: Dr Frank Gaillard, consultant neuroradiologist, Royal Melbourne Hospital. 

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Case information

rID: 13701
Case created: 8th May 2011
Last edited: 22nd Jul 2017
Inclusion in quiz mode: Included

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