Pilocytic astrocytoma

Case contributed by Muthu Magesh
Diagnosis almost certain


History of vision loss and increased intracranial pressure.

Patient Data

Age: 16 years
Gender: Female

An altered signal intensity lesion that is T1 hypointense, T2 and FLAIR hyperintense with few tiny cystic areas within, showing heterogeneous contrast enhancement and no restriction on DWI is seen in the suprasellar cistern.There is intrasellar extension, elevation of the floor of the 3rd ventricle with its compression leading to obstructive hydrocephalus with mild transependymal CSF seepage.

The pituitary gland is separately seen at the inferior aspect of the lesion. The optic chiasm and infundibular stalk are not seen separately from the lesion.

  • superiorly – extending up to the fornix
  • inferiorly – into the sella with pituitary gland is seen at the inferior aspect of the lesion
  • anteriorly – encasing the M1 segments of middle cerebral arteries on both sides with no evidence of luminal narrowing or thrombosis
  • posteriorly – extending to the interpeduncular cistern abutting the top of basilar artery

No evidence of infiltration into the cavernous sinuses on either side.
No broad base to the dura/obvious dural tail noted.
No evidence infiltration of the skull base.

Case Discussion

This was histo-pathologically proven case of pilocytic astrocytoma (juvenile) with tumor cells showing GFAP positivity in their cytoplasmic processes.

Pilocytic astrocytomas represent the most common childhood brain tumor, frequently in the cerebellar region. This case shows a less common location in the optic pathway, which is seen in about 20% to 30% of cases. In this case it is a predominantly solid mass with minimal to no cyst-like component. No vasogenic edema is a valuable clue to diagnosis. Surgical resection is the treatment of choice with radiation and chemotherapy for optic and hypothalamic region tumors.

Differential, in this case, included suprasellar germinoma and craniopharyngioma.

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