Atypical Presentation of a Pilocytic Astrocytoma at the Regional Hospital of Ségou in Mali country

Abstract

Introduction: Pilocytic astrocytoma is the most common cerebral glioma in pediatric age, preferentially located in the posterior cerebral fossa. Atypical presentations have rarely been described in the literature. Clinical Case: We report a case of pilocytic astrocytoma whose appearance on CT scan is unusual. It concerns a young boy of 9 years old, who presented convulsive seizures since the age of 6 years old, followed by general practitioners with irregular treatment based on gardenal. 2 months ago the seizures became more frequent and this prompted a specialist consultation with the neurologist, after a brain scan he referred the patient to us. The neurological examination was unremarkable today. Brain CT with contrast showed a right parietal lesion. It was a lesion with a double cystic and fleshy component associated with calcifications with heterogeneous enhancement which amputated the posterior horn of the lateral ventricle. The radiological appearance was in favor of a low-grade oligodendroglioma. The patient underwent surgery with complete macroscopic excision of the lesion. Histological examination revealed a pilocytic astrocytoma (grade I). Conclusion: The usual radiological appearance of pilocytic astrocytoma combines a cystic part and a highly contrasting mural nodule. It rarely presents in the form of a supratentorial lesion with calcifications. This form of presentation is rare and can lead to confusion with other gliomas. We can achieve healing for the patient with total excision.