Pilocytic astrocytoma

Case contributed by Dr Ian Bickle

Presentation

Altered vision. Referred to ophthalmology. Field defect on objective testing.

Patient Data

Age: 30 years
Gender: Female
Modality: CT

8.4 cm solid-cystic mass centred on the trigone of the right lateral ventricle. This has a lobulated avidly enhancing 4 cm solid component which is closely related to the choroid plexus. The mass extends into the right temporal and parietal lobes.

Resultant midline shift.

Modality: MRI

MRI BRAIN with contrast

8.4 cm solid-cystic mass centred on the trigone of the right lateral ventricle. This has a lobulated avidly enhancing 4 cm mural nodule which is closely related to the choroid plexus. The mass extends into the right temporal and parietal lobes.

This is causing significant mass effect on the pons/brainstem with mild-moderate midline shift. No hydrocephalus.

No synchronous lesion.

HISTOLOGY - SURGICAL SPECIMEN

A malignant tumour composed of round-elongated cells containing hyperchromatic nuclei situated in a fibrillary stroma.  Several cells contain bizarre nuclei. There are Rosenthal fibres and eosinophilic protein droplets (granular bodies). Tumour cells stain positively for GFAP.

The appearances are those of a pilocytic astrocytoma.

Case Discussion

This case was of interest from the initial imaging as there was some debate between the radiologists and clinicians as to the potential tumour type.

Some were of the belief it was centred on and arising from the choroid plexus, although the demographics of the patient (adult vs. young child) were not typical.

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Case Information

rID: 50807
Case created: 23rd Jan 2017
Last edited: 6th Apr 2017
Inclusion in quiz mode: Included

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