Hypothalamic pilocytic astrocytoma

Case contributed by Jeremy Jones
Diagnosis certain

Presentation

Headache and blurred vision. Hypothalamic tumour. Right frontal VAD. Biopsy. Left occipital VP shunt.

Patient Data

Age: 8 years
Gender: Female
This study is a stack
Axial
T2
This study is a stack
Sagittal
T1
This study is a stack
Axial
ADC
This study is a stack
Axial
DWI
This study is a stack
Coronal
FLAIR
This study is a stack
Sagittal
T1 C+
This study is a stack
Axial
T1 C+
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Info

Large enhancing tumour centred in the hypothalamic region. Heterogeneous contrast enhancement. Obstructive hydrocephalus. No other abnormality.

Right frontal VAD. Left occipital VP shunt.

PATHOLOGY

Sections show fragments of a glial tumour composed of elongated bipolar piloid cells arranged in a composite solid and loose architecture. Nuclear pleomorphism is not marked.Mitotic activity is inconspicuous. No evidence of necrosis. No well-formed Rosenthal fibres or eosinophilic granular bodies.
 
Strong expression: glial fibrillary acidic protein and S100 protein
Negative reaction: antibodies to IDH1 and epithelial membrane antigen.

Cell proliferation index (MIB1 antibody) is overall low.
 
Pilocytic astrocytoma WHO Grade 1.

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