Abstract
Background:Pilomyxoid astrocytoma (PMA) has recently been accepted as an aggressive variant of pilocytic astrocytoma with distinct histopathological features. PMAs have been frequently described in the pediatric population with a predilection for the hypothalamic/chiasmatic region.Case Description:A 72-year-old African American male presented with 6 months of memory loss, difficulty expressing himself, and a progressively worsening gait. Magnetic resonance imaging of the brain demonstrated a heterogeneously enhancing cystic mass centered within the cerebellar vermis with mass effect on the fourth ventricle and ventriculomegaly. The patient underwent placement of a ventriculoperitoneal shunt followed by a surgical resection of the lesion, which after immunohistopathologic evaluation, was diagnosed as a World Health Organization grade II PMA. The patient refused further treatment of the lesion and expired 11 months after initial symptom presentation and 4 months after surgery.Conclusion:To our knowledge, this is the first report of PMA of the cerebellar vermis in a previously unreported age group. This case report describes the natural history of this type of tumor in a patient who refused adjuvant therapy following surgical resection.
Highlights
ConclusionThis is the first report of Pilomyxoid astrocytoma (PMA) of the cerebellar vermis in a previously unreported age group
Pilomyxoid astrocytoma (PMA) has recently been accepted as an aggressive variant of pilocytic astrocytoma with distinct histopathological features
First described in 1999, Tihan et al identified a subset of 18 pilocytic astrocytomas with a distinctive pilomyxoid histological pattern as well as a higher recurrence rate than similar tumors with more classical pilocytic astrocytoma characteristics.[15]
Summary
This is the first report of PMA of the cerebellar vermis in a previously unreported age group This case report describes the natural history of this type of tumor in a patient who refused adjuvant therapy following surgical resection. This is the first report of PMA of the cerebellar vermis in an elderly patient This case report describes the natural history of this type of tumor in a patient who refused additional medical treatment following surgical resection. A computed tomography (CT) scan of the head revealed ventriculomegaly but no frank hydrocephalus and the patient was taken to the operating room for placement of a ventriculoperitoneal (VP) shunt He was found to have elevated intracranial pressure. His neurologic status and overall health gradually deteriorated and he expired 11 months after initial symptom presentation and 4 months after surgery
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