18 year old female presented with headache and vomiting
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CT and MRI demonstrates a left thalamic lesion. Follow up study after initiation of radio-chemotherapy demonstrates mild reduction in the size of the left thalamic lesion.
GFAP (clone polyclonal) is positive (weak)
Ki-67 (MMI) approximatly 1% nuclear staining
P53 (D0-7) is positive.
Low grade glial tumor consistent with astrocytoma WHO grade II . Sections consist with predominantly gray and white matter brain tissue with only small fragment of increased cellularity consistent with low grade astrocytoma of WHO grade II . However, in view of the small size of the biopsy material this grade might be not representative of the actual grade of the tumor so correlation with radiological finding is mandatory.
It should be noted that the biopsy is not from the enhancing component,
located posteriorly. With enhancement and such a high cho:cr ratio, i
would have guessed anapestic / Grade III astrocytoma. So there may well be, as the pathologist says, sampling error.
The enhancing nodules on follow up MRI are presumably from the biopsy.