Protoplasmic astrocytoma

Case contributed by Dr Bruno Di Muzio

Presentation

Headache.

Patient Data

Age: 38
Gender: Male

CT Brain

Modality: CT

There is a soft tissue hypoattenuating mass involving the cortex in the right superior frontal gyrus. No vasogenic oedema or significant mass effect. 

MRI Brain

Modality: MRI

 

The superior frontal gyrus is expanded and FLAIR-hyperintense. The margins are quite well defined. No abnormal diffusion restriction, magnetic susceptibility or enhancement is appreciated. Spectroscopy suggests only mild choline elevation (non-specific), without significant NAA depletion or lactate/lipid peak (not shown). Cerebral blood volume is not elevated. Mild remodelling / scalloping of the overlying skull vault is noted.

No further mass is identified. Note is made of a prominent cisterna magna (a normal variant) and maxillary sinus mucosal thickening.

Conclusion: Findings most in keeping with a low-grade glioma in the right superior frontal gyrus.

Modality: Annotated image

Comparison between T2 and FLAIR showing tumour substantial T2 FLAIR suppression. 

Case Discussion

This case was histologically proven to be a protoplasmic astrocytoma, which is one of the variants of diffuse low grade astrocytomas

This tumour tends to occur in young adults with a reported predilection to frontal and temporal lobe. On imaging, they typically present as a cortical mass with a very high signal on T2 that characteristically suppress on FLAIR sequence (represent the areas with abundant microcystic change). 

Until recently, protoplasmic astrocytomas were classified as a subtype low-grade astrocytoma, however, in the latest (2016) update to WHO classification of CNS tumours, protoplasmic astrocytomas no longer exists as a distinct entity. 

PlayAdd to Share

Case Information

rID: 38388
Case created: 17th Jul 2015
Last edited: 22nd Feb 2017
Tag: rmh
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.