Subependymal giant cell astrocytoma incidentally found in an elderly patient: Report of an autopsy case

Abstract

Background: Subependymal giant cell astrocytoma (SEGA) is a benign, slowly growing tumor typically occurring in the first two decades of life. SEGA usually occurs in the setting of tuberous sclerosis complex (TSC), however there are several reported cases in which patients with solitary SEGA had no other stigmata of TSC. These lesions are generally considered to be forme fruste of TSC. We report such a case of SEGA in the oldest patient reported to date.Case report: The patient was a 75‐year‐old woman who had a history of radical vulvectomy for malignant melanoma and died of widespread systemic metastasis, which was confirmed at autopsy. Postmortem examination of the brain revealed a single intraventricular nodule in the left lateral ventricle, measuring 2.1×1.0×0.8cm. Histologically, the tumor was composed of interlacing bundles of spindle shaped tumor cells with thin delicate processes admixed with relatively large atypical cells with abundant glassy eosinophilic cytoplasm, as seen in SEGA. Ultrastructural study supported the diagnosis. Autopsy study showed no manifestations of TSC systemically or intracranially.Discussion: This is a very rare case of solitary SEGA incidentally found at autopsy in an elderly patient lacking any other findings of TSC. This is the second reported case of SEGA found in an elderly patient. This autopsy case showed that SEGA can occur outside the setting of TSC.