Pilocytic astrocytoma - atypical

Case contributed by Dr Ian Bickle

Presentation

3 months of progressive headache. No past medical history.

Patient Data

Age: 21 years
Gender: Female

Largely cystic posterior fossa mass, centered on the vermis, with a small foci of high density within.

Effaced 4th ventricle with a resultant biventricular hydrocephalus.

Several further small cystic foci in the right cerebellar hemisphere and adjacent to the right temporal horn.

Largely cystic posterior fossa mass, centered on the vermis, with a small solid focus and susceptibility artifact.

Effaced 4th ventricle with a resultant biventricular hydrocephalus.  No transependymal edema.

Several further small cystic foci in the right cerebellar hemisphere and adjacent to the right temporal horn.

Case Discussion

Surgical biopsy identified a pilocytic astrocytoma. By far the most likely location is in the cerebellum ( more than 50% ).

Although one of the commonest posterior fossa tumors in a teenager/young adult, it is uncommon to have mutlifocality as in this case.

It is not a primary brain tumor recognized for multifocality of CSF seeding unlike others, such as medulloblastoma.

 

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