Presentation
Temporal epilepsy.
Patient Data
Relatively well-defined left temporal solid-cystic mass of cortical location. The solid component elicits an isosignal on T1, T2 and FLAIR with vivid heterogeneous enhancement. The cystic components are of low signal on T1 and high signal on T2 and FLAIR (due to higher protein contents) with no restricted diffusion. No calcification or hemorrhagic component seen on the GE sequence. Moderate surrounding vasogenic edema is noted. Moderate thickening with enhancement of the adjacent dura "dural tail sign". No scalloping of the overlying bone.
Case Discussion
The clinical presentation, patient's age and MRI features are most consistent with a pleomorphic xanthoastrocytoma.
The patient underwent complete resection of the tumor with a histopathological exam that confirmed the diagnosis of pleomorphic xanthoastrocytoma WHO grade II.
Pleomorphic xanthoastrocytomas (PXA) are rare circumscribed astrocytic tumors, accounting for only 1% of primary brain tumors. Usually found in children or young adults and can be WHO grade 2 or 3. They have a predilection for the temporal lobe, typically located superficially abutting the leptomeninges. On imaging, they appear as a solid enhancing lesion with a peripheral eccentric cystic component (50-60%). Due to their peripheral location and leptomeningeal involvement, they are one of the tumors that may exhibit a dural tail sign (reactive rather than true direct dural invasion).
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