J Korean Neurosurg Soc.  2016 Sep;59(5):533-536. 10.3340/jkns.2016.59.5.533.

Massive Calcified Cerebellar Pilocytic Astrocytoma with Rapid Recurrence : A Rare Case

• Aydemir F
• Kardes O
• Kayaselçuk F
• Tufan K

• KMID: 2351726
• DOI: http://doi.org/10.3340/jkns.2016.59.5.533

Abstract

Pilocytic astrocytomas (PAs) are World Heath Organization Grade I tumors and are most common in children. PA calcification is not a common finding and has been reported more frequently in the optic nerve, hypothalamic/thalamus and superficially located cerebral tumors. We present a cerebellar PA in a 3-year-old male patient with cystic components and massive calcification areas. The residual tumor grew rapidly after the first operation, and the patient was operated on again. A histopathological examination revealed polar spongioblastoma-like cells. Massive calcification is not a common feature in PAs and can lead to difficulties in radiological and pathological differential diagnoses.

Keyword

Calcification; Pilocytic astrocytoma; Polar spongioblastoma

MeSH Terms

Astrocytoma*
Child
Child, Preschool
Diagnosis, Differential
Humans
Male
Neoplasm, Residual
Neoplasms, Neuroepithelial
Optic Nerve
Recurrence*

Figure

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  Fig. 1 Preoperative radiological findings. A : Preoperative CT demonstrated cystic, peripheral enhancing calcified lesion. B : Axial T2-weighted MRI demonstrated cystic heterogeneously mass with peripheral edema. C : Axial T1-weighted MRI demonstrated hypodense cystic mass. D : Post-contrast axial T1-weighted MRI demonstrated peripheral contrast enhancing mass.

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  Fig. 2 Pathologic findings after first operation. A : Rare eosinophilic bodies reveal adjacent to calcification (arrow) (H&E ×200). B : Eosinophilic bodies and biphasic pilocytic areas (arrows) (H&E ×200). C : Rosenthal fibers and biphasic dense areas of the tumor (arrow) (H&E ×200).

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  Fig. 3 CTs and MRI showing residual calcified tumor growth. A : Post-operative CT on first day. B : Post-operative CT on 6-month. C : Post-operative CT on 12-month. D : There is no contrast enhancing area on the 6-month axial post-contrast T1-weighted MRI. E : T2-weighted MRI revealed cystic and heterogeneous appearance on the 12-month. F : Post-contrast T1-weighted MRI revealed prominent contrast-enhancing regions.

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  Fig. 4 Pathologic findings after second operation. A : Areas with palisading sequence and calcification (H&E ×200). B : Oligodendroglioma-like cells (H&E ×200).

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  Fig. 5 Tumor pathology was not detected after second operation. A : Axial CT. B : Axial T2-weighted MRI. C : Sagittal T1-weighted MRI.

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