ADULT HEMORRHAGIC PILOCYTIC ASTROCYTOMA IN A RARE LOCATION
Pilocytic astrocytoma (PA) is a low grade glioma that most commonly occurs in the pediatric population, typically in the cerebellum. Adult onset PAs are uncommon and more frequently located in the supratentorial compartment. Imaging findings are variable but mostly consist of a cystic lesion with an intensely enhanced mural nodule. Intratumoral hemorrhage is considered rare.
MATERIAL AND METHODS:
We report a case of a pilocytic astrocytoma with intratumoral hemorrhage in a 55 year old man.
A 55 year old man presented at the emergency department with frontal headache and memory impairment symptoms lasting for 1 week. The neurological examination was unremarkable. Head CT scan showed a heterogeneous expansive lesion apparently in the velum interpositum cistern with a hyperdense hemorraghic component and cystic areas. Subsequently, a brain MRI confirmed the location of the lesion with mixed solid and cystic components as well as marked hemorrhage. Surgical subtotal resection of the tumor was performed. Histopathologic evaluation was conclusive for pilocytic astrocytoma. The patient was discharged maintaining symptoms of memory impairment.
Hemorrhagic presentation of PA might be more frequent than classically described, with reported rates of up to 8%, and likely results from the frequently abnormal vasculature of these tumors. It has been shown to occur more often in adults and more frequently in supratentorial lesions. This case illustrates the need for considering PA in the differential diagnosis of hemorrhagic intracranial tumours.