Brain Tumor Res Treat.  2017 Oct;5(2):105-109. 10.14791/btrt.2017.5.2.105.

Supratentorial Pilocytic Astrocytoma Mimicking Convexity Meningioma with Early Anaplastic Transformation: A Case Report

• Lee JH
• Sung SK
• Choi CH

• KMID: 2396455
• DOI: http://doi.org/10.14791/btrt.2017.5.2.105

Abstract

Meningiomas and pilocytic astrocytomas are benign intracranial tumors. Pilocytic astrocytomas arises frequently at the posterior fossa in childhood. Meningiomas have several image findings, such as a dural tail sign, bony erosion, and sunburst appearance on angiography. However, pilocytic astrocytomas with these findings have been rarely reported. In this report, we describe a mass with typical image findings of a meningioma, but diagnosed as a supratentorial pilocytic astrocytoma with early anaplastic transformation.

Keyword

Astrocytoma; Meningioma; Radiography; Anaplasia

MeSH Terms

Anaplasia
Angiography
Astrocytoma*
Meningioma*
Radiography
Tail

Figure

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  Fig. 1 Preoperative radiographic images. A: T2 weighted MRI showing a mass with multiple cystic portion and peritumoral edema. B: MRI with gadolinium reveals a well-enhancing mass with large dural base on the right frontal convexity area. C: Dura tail signs (black arrows) are identified on MRI with gadolinium. D: Bony thinning on right frontal bone (white arrow) is revealed on computed tomography scans. E: The angiographic image demonstrates sunburst appearance (dotted arrow). F: Sunburst appearance also shows on the lateral image (dotted arrow). MRI, magnetic resonance imaging.

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  Fig. 2 Intraoperative photography (A) reveals a non-dural based and cystic mass. Photomicrograph of tumor shows Rosenthal fibers (B) and eosinophilic granular bodies (hematoxylin-eosin stain, ×200) (C).

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  Fig. 3 Postoperative radiographic and pathologic findings. A: No remnant mass is identified on postoperative enhanced CT scans. B: Follow-up CT scans after 9 months shows a mass lesion suspicious of tumor recurrence (white arrow). C: Magnetic resonance imaging with gadolinium reveals a new well-enhancing mass on previous operative site. D: Pathologic findings shows increased cellularity, increased nuclear pleomorphism, and some mitoses (3 mitoses/10 high power field). There was no necrosis. Ki-index was about 30% (hematoxylin-eosin stain, ×200). CT, computed tomography.

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