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DOI: 10.1055/s-0042-1757206
Cervicomedullary Purely Solid, Giant Pilocytic Astrocytoma
Abstract
Pilocytic astrocytomas are well-circumscribed, predominantly cystic mass lesions that have a discrete mural nodule. Giant, solid pilocytic astrocytoma is uncommon. Its characteristic imaging features are described.
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A 16-year-old male patient presented with a history of neck pain for past 3 years, and gradually progressive spastic weakness of all four limbs for last 6 months. There was no history of trauma, fever, loss of consciousness, seizure, or breathlessness. On examination, the patient was conscious and oriented. On motor examination, bulk was normal, tone slightly increased in all four limbs, power in bilateral upper and lower limbs four-fifth at all joints. Deep tendon reflexes were exaggerated in all four limbs and the planter was up going. On sensory examination, there were 75% sensation present for pain, touch, and temperature in all four limbs. Cerebellar signs were positive on the right side of the body. Bladder and bowel were not involved.
The patient was investigated with contrast magnetic resonance imaging MRI of the brain. On T1WI, there was a hypointense mass lesion present in the cervicomedullary region. On T2WI, the lesion was hyperintense. There were no surrounding cysts or edema. On contrast imaging, tumor showed homogenous contrast enhancement ([Fig. 1A-E]). The size of the mass lesion was 4.4 × 3.5 cm. The patient was managed with surgery. Intraoperatively, the lesion was well marginated, intramedullary tumor reaching up to the pial surface. Slowly, intra tumoral decompression was done with the help of CUSA and the tumor was excised completely. Grossly, the tumor was pinkish in color, soft to firm in consistency, nonsuckable, and had mild vascularity. The postoperative period was uneventful.
Histopathological examination of the tissue showed tumor comprising compact fibrillary and loose microcystic areas ([Fig. 2A]) with scattered Rosenthal fibers. The mitotic activity was inconspicuous with the absence of necrosis. Immunohistochemistry for GFAP was positive ([Fig. 2B]). Ki 67 index was low. Features favored the diagnosis of pilocytic astrocytoma.
Cervicomedullary tumors are usually slow growing, low-grade astrocytomas. Pilocytic astrocytomas are the most common lesions of these low-grade astrocytomas.[1] [2] The two-third of these tumors are found in less than 18 years of age group.[3] Radiologically, pilocytic astrocytomas are typically well-circumscribed, predominantly cystic masses, and have a discrete mural nodule.[4] Purely solid pilocytic astrocytomas are uncommon and giant, solid pilocytic astrocytomas are further uncommon.
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Conflict of Interest
None declared.
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References
- 1 Tibbetts KM, Emnett RJ, Gao F, Perry A, Gutmann DH, Leonard JR. Histopathologic predictors of pilocytic astrocytoma event-free survival. Acta Neuropathol 2009; 117 (06) 657-665 DOI: 10.1007/s00401-009-0506-3. [PubMed] [CrossRef] [Google Scholar]
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- 3 Prajapati HP, Kumar R. Spectrum of brain stem lesions in children. J Pediatr Neurol 2021; 19 (04) 247-251 DOI: 10.1055/s-0040-1714068.
- 4 Burkhard C, Di Patre PL, Schüler D. et al. A population-based study of the incidence and survival rates in patients with pilocytic astrocytoma. J Neurosurg 2003; 98 (06) 1170-1174 DOI: 10.3171/jns.2003.98.6.1170. [PubMed] [CrossRef] [Google Scholar]
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Publication History
Article published online:
27 September 2022
© 2022. Neurological Surgeons' Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Tibbetts KM, Emnett RJ, Gao F, Perry A, Gutmann DH, Leonard JR. Histopathologic predictors of pilocytic astrocytoma event-free survival. Acta Neuropathol 2009; 117 (06) 657-665 DOI: 10.1007/s00401-009-0506-3. [PubMed] [CrossRef] [Google Scholar]
- 2 Scheithauer BW, Hawkins C, Tihan T, Vandenberg SR, Burger PC. Pilocytic astrocytoma. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK. eds. WHO Classification of Tumours of the Central Nervous System. 4. Lyon: IARC; 2007: 14-21
- 3 Prajapati HP, Kumar R. Spectrum of brain stem lesions in children. J Pediatr Neurol 2021; 19 (04) 247-251 DOI: 10.1055/s-0040-1714068.
- 4 Burkhard C, Di Patre PL, Schüler D. et al. A population-based study of the incidence and survival rates in patients with pilocytic astrocytoma. J Neurosurg 2003; 98 (06) 1170-1174 DOI: 10.3171/jns.2003.98.6.1170. [PubMed] [CrossRef] [Google Scholar]