Brain Tumor Res Treat.  2018 Apr;6(1):39-42. 10.14791/btrt.2018.6.e6.

Intermediate Pilomyxoid Astrocytoma in the Cerebellum of a 5-Year-Old Boy

• Kil JS
• Lee KH
• Eom KS
• Kim TY

• KMID: 2410236
• DOI: http://doi.org/10.14791/btrt.2018.6.e6

Abstract

Intermediate pilomyxoid tumors (IPTs) were defined by the presence of some features typical of pilomyxoid astrocytoma (PMA) in combination with features that could be considered more consistent with pilocytic astrocytoma (PA). PMA is rare in the cerebellum. And, IPT in the cerebellum is rarer than PMA. To our knowledge, only 2 reports have described IPT in the cerebellum. A 5-year-old boy had nausea and vomiting. Computed tomography revealed a large, round, low-density tumor in the cerebellar vermis area. On enhanced magnetic resonance imaging (MRI), the tumor showed inhomogeneous diffuse enhancement; the central portion showed homogenous enhancement, while the peripheral portion showed inhomogeneous enhancement. The patient underwent a midline suboccipital craniotomy, and gross total resection was performed. The tumor was gray-colored, rubbery hard, and severely hemorrhagic with a clear boundary. On pathologic examination, the combined features of both PA and PMA were retrospectively indicative of an IPT. The patient was symptom-free for 18 months, with no evidence of tumor recurrence on MRI. More observation and further studies on PMA and IPT are required to determine the most appropriate treatment for these tumors.

Keyword

Cerebellum; Neoplasm; Pilomyxoid; Intermediate

MeSH Terms

Astrocytoma*
Cerebellar Vermis
Cerebellum*
Child, Preschool*
Craniotomy
Humans
Magnetic Resonance Imaging
Male*
Nausea
Recurrence
Retrospective Studies
Vomiting

Figure

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  Fig. 1 A 5-year-old boy presented with a nausea and vomiting. Computed tomography showed a 4.5-cm large, bulging, round, low density, solid brain tumor with mild peritumoral edema at the cerebellar vermis area. Mild hydrocephalus was observed due to fourth ventricle compression by the tumor. The tumor showed multifocal inhomogeneous enhancement.

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  Fig. 2 Magnetic resonance imaging with gadolinium enhancement. A: The tumor had a low signal intensity on T1 imaging. B: The tumor had a high signal intensity with homogeneous signal intensity on T2 imaging. C: The tumor showed inhomogeneous diffuse enhancement on axial T1 imaging. D: The tumor showed inhomogeneous diffuse enhancement on coronal T1 imaging. E: The tumor showed inhomogeneous diffuse enhancement on sagittal T1 imaging. The central portion showed homogenous enhancement, while the peripheral portion showed inhomogeneous enhancement.

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  Fig. 3 A: The resected lesion comprised monomorphous tumor cells with moderate cellularity (hematoxylin and eosin staining, original magnification ×100). B: Some areas showed oligodendroglioma-like tumor cells with perinuclear halos and distinct cytoplasmic borders (hematoxylin and eosin staining, original magnification ×400). C: There was angiocentric arrangement of tumor cells around focally hyalinized vessels (hematoxylin and eosin staining, original magnification ×200). D: Immunohistochemistry of glial fibrillary acidic protein revealed strong positivity in the tumor cells with cytoplasmic processes (immunohistochemistry, original magnification ×200).

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