Gemistocytic astrocytoma (anaplastic)

Case contributed by Dr Mostafa El-Feky

Presentation

Headache

Patient Data

Age: 60 years
Gender: Male
MRI

Brain

Left frontoparietal para-falcine ill-defined cortical based space-occupying lesion with gyral swelling showing the following :

  • size: averaging 2.5x1.5x1.8 cm, in maximum AP, SS and CC dimensions
  • signal pattern: T1 hypo, T2 hyperintensity with no detected appreciable post-contrast enhancement
  • vasogenic edema: surrounded by grade I perifocal edema 
  • mass effect: mild effacement of the related cortical sulci
  • enhancement pattern: heterogeneous enhancement with small central none enhancing spot
  • SWI: no blooming 
  • diffusion-weighted imaging: the lesion shows no diffusion restriction. The mean ADC value of the lesion = 1.382 x 10-3 mm2/sec

Spectroscopy (TE 135 msec)

  • Cho/Cr ratio =0.81
  • Cho/NAA ratio=1.56
  • NAA/Cho ratio = 0.64
  • NAA/Cr ratio = 0.52
  • Lactate peak is detected

The short echo time TE 30 msec spectroscopy showed reduction in the choline levels with high MI levels.

Case Discussion

The imaging features are suspicious for neoplastic lesion, especially when furthur assessed using MRI perfusion and diffusion tensor imaging (not available). The patient underwent surgery and pathology revealed gemistocytic anaplastic astrocytoma. It has a variety of imaging appearances, with the gemiocytic type characterized by post-contrast enhancement. Anaplastic astrocytomas lack frank necrosis, unlike glioblastomas.  

Pathology

Specimen: left frontoparietal intra-axial lesion, excision biopsy.

Gross: several grayish white friable pieces of tissue about 6 cm in aggregate.

Microscopic:

  • cellular tumor tissue formed of astrocytic cells showing oval vesicular nuclei against a fibrillary background
  • focal nuclear atypia, as well as mitotic figures, are noted
  • a prominent gemistocytic component is identified
  • no necrosis or vascular proliferation are noted in submitted biopsy

Opinion: Anaplastic astrocytoma (gemistocytic), WHO grade III.

 

Case courtesy Dr. Mohaked Kaed, Radiology consultant, Alexandria, Egypt.

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Case information

rID: 78696
Published: 4th Aug 2020
Last edited: 6th Aug 2020
Inclusion in quiz mode: Included
Institution: Dar El Ashaa Center

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