Low grade glioma underwent malignant degeneration
Ataxia, dystonia and headache of long duration. CT was unremarkable
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A large ill defined infiltrative lesion is seen involving the right cerebellar hemisphere and extending through the middle cerebellar peduncle to involve the right hemipons. This lesion displays iso intense signal in T1 and hyperintense sginal in T2 with mild diffusion restriction as shown in DWI and ADC map. Post contrast study reveals a moderately enhancing nodule at the periphery of the right cerebellum however most of the lesion lack contrast enhancement.
Microscopy: diffuse astrocytoma (Fibrillary type) degenerated into anaplastic astrocytoma ( WHO Grade III)
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Diffuse astrocytomas are classified as WHO grade II tumors, which are low grade tumors with median survival of 6-10 years yet with intrinsic tendency to malignant transformation into anaplastic astrocytoma (WHO grade III) or GBM (WHO grade IV)
Differential considerations for this case include ischemia, cerebritis and tumefactive demyelination.