Supratentorial pilocytic astrocytoma

Case contributed by Dr Jeremy Jones


1 month history of right-sided weakness and slurred speech.

Patient Data

Age: 5 years
Gender: Female

Large part-cystic, part-solid mass centered around the posterior limb of the internal capsule and extending into the centrum semiovale. Avid post-contrast enhancement.


Fragments of a tumor of low cellularity with loose and compact areas.  There are areas of microcystic change.  The tumor cells have uniform of ovoid nuclei, inconspicuous nuclei and elongated eosinophilic cytoplasmic processes.  Occasional Rosenthal fibers are present.  Eosinophilic granular bodies are not identified.  There are hyalinised blood vessels and a patchy mild chronic inflammatory cell infiltrate.  There is focal infarct-like necrosis and glomeruloid microvascular proliferation.  Increased cellularity or mitoses are not seen.  

Features are consistent with a pilocytic astrocytoma.

Case Discussion

This large supratentorial tumor centered in the white matter adjacent to the thalamus and extending into the centrum semiovale enhances avidly and has solid and cystic components. It has imaging characteristics of a pilocytic astrocytoma and this was confirmed on histological examination.

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