CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2022; 11(03): 284-285
DOI: 10.1055/s-0042-1757206
Clinical Imaging

Cervicomedullary Purely Solid, Giant Pilocytic Astrocytoma

Hanuman Prasad Prajapati
1   Department of Neurosurgery, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India
,
Mohd Faheem
1   Department of Neurosurgery, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India
,
Sanjay Kumar Kannaujia
2   Department of Pathology, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India
,
Anurag Yadav
1   Department of Neurosurgery, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India
› Author Affiliations
Funding None.
 

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.


#

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.

Zoom Image
Fig. 1 (A) MRI posterior fossa T1W axial image showing a well-circumscribed hypointense lesion in the cervicomedullary region. (B) MRI posterior fossa T2W axial image showing a well-circumscribed hyperintense lesion in the cervicomedullary region. (C) MRI posterior fossa and cervical region T1W sagittal image showing a hypointense lesion in the cervicomedullary region. (D) MRI posterior fossa and cervical region T2W sagittal image showing a well-circumscribed, heterogenous, hyperintense lesion in the cervicomedullary region. There is syringomyelia in the cervical region of the cord. (E&F) Contrast MRI posterior fossa and cervical region sagittal and coronal image showing homogenous contrast-enhancing lesion in the cervicomedullary region. (G) Non-contrast CT posterior fossa showing postoperative bony defect with complete excision of the tumor.

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.

Zoom Image
Fig. 2 (A) Section showing a loose microcystic area with cells having round to oval nuclei (H/E 400 × ). (B) Tumor cells showing strong and diffuse positivity for GFAP (400 × ).

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.


#

Conflict of Interest

None declared.

  • 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]

Address for correspondence

Hanuman Prasad Prajapati, MCh
Department of Neurosurgery, Uttar Pradesh University of Medical Sciences (UPUMS) Saifai
Etawah 206130, Uttar Pradesh
India   

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/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • 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]

Zoom Image
Fig. 1 (A) MRI posterior fossa T1W axial image showing a well-circumscribed hypointense lesion in the cervicomedullary region. (B) MRI posterior fossa T2W axial image showing a well-circumscribed hyperintense lesion in the cervicomedullary region. (C) MRI posterior fossa and cervical region T1W sagittal image showing a hypointense lesion in the cervicomedullary region. (D) MRI posterior fossa and cervical region T2W sagittal image showing a well-circumscribed, heterogenous, hyperintense lesion in the cervicomedullary region. There is syringomyelia in the cervical region of the cord. (E&F) Contrast MRI posterior fossa and cervical region sagittal and coronal image showing homogenous contrast-enhancing lesion in the cervicomedullary region. (G) Non-contrast CT posterior fossa showing postoperative bony defect with complete excision of the tumor.
Zoom Image
Fig. 2 (A) Section showing a loose microcystic area with cells having round to oval nuclei (H/E 400 × ). (B) Tumor cells showing strong and diffuse positivity for GFAP (400 × ).