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Radiologically typical pilocytic astrocytoma with histopathological signs of atypia
Roshanak Daneshzadeh Tabrizi1, Michel Mittelbronn, Gerhard Marquardt
1Institute of Neuroradiology, Department of Neurosurgery, Goethe University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany.
Insights
Pilocytic astrocytoma (PCA), a common pediatric brain tumor, can present with atypical features. Neuroimaging is crucial for diagnosing these atypical cases, even without signs of anaplastic transformation.
Area of Science:
- Pediatric neuro-oncology
- Neuroradiology
- Pediatric neuropathology
Background:
- Pilocytic astrocytoma (PCA) is the most common central nervous system (CNS) tumor in children.
- Early diagnosis and accurate classification are critical for effective treatment and prognosis.
Observation:
- A 7-month-old infant presented with a large cerebellar tumor.
- Neuroimaging revealed features consistent with pilocytic astrocytoma, including cystic and solid components with ring-like enhancement.
- Histopathology showed atypical features such as high cellularity and proliferation, but no anaplastic transformation.
Findings:
- The tumor was classified as pilocytic astrocytoma with atypia, distinct from typical WHO grade I PCA.
- Atypical histological findings were noted, including high proliferation rate, hypercellularity, and focal diffuse infiltration.
Implications:
- This case highlights the importance of integrating neuroimaging findings with histopathology for diagnosing atypical pediatric brain tumors.
- Neuroimaging can provide critical diagnostic clues for pilocytic astrocytomas exhibiting unusual pathological features.
- Accurate classification of atypical pilocytic astrocytoma is essential for guiding patient management and predicting outcomes.
Abstract:
Pilocytic astrocytoma (PCA) is the most common CNS tumor in primary school-aged children. Herein, we report the case of a 7-month-old female child with a large cerebellar hypodense tumor on computer tomography occupying nearly the whole cerebellar hemisphere. Magnetic resonance imaging revealed characteristic features of a PCA, depicting a mass with hyperintense solid and cystic areas on T2-weighted images and with marked solid and ring-like enhancement pattern. Histopathological and immunohistochemical analysis showed partially typical features of a PCA, but also atypical features such as a high proliferation rate, hypercellularity, and focally diffuse infiltration pattern were present. However, definite signs of transformation to an anaplastic PCA were not observed. We therefore classified the tumor as pilocytic astrocytoma with signs of atypia instead of simple WHO grade I pilocytic astrocytoma. The case illustrates that neuroimaging features may give very important clues for the definite diagnosis in histopathologically atypical PCA.
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