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Pilomyxoid astrocytoma with high proliferation index

Sonam Kumar Pruthi1, Shrijeet Chakraborti1, Ramadas Naik1

  • 1Department of Pathology, Kasturba Medical College, Lighthouse Hill Road, Mangalore, India.

Journal of Pediatric Neurosciences
|January 29, 2014
PubMed

Insights

Pilomyxoid astrocytomas are rare, aggressive brain tumors. This case highlights a 12-year-old with a temporal lobe tumor, showing high Ki-67 proliferation and recurrence after treatment.

Area of Science:

  • Neuro-oncology
  • Pediatric Pathology

Background:

  • Pilomyxoid astrocytomas (PMAs) are uncommon, aggressive piloid neoplasms.
  • They are closely related to pilocytic astrocytomas and typically affect very young children, but can occur in older children and adults.

Observation:

  • A 12-year-old male presented with focal seizures, headache, and vomiting.
  • Imaging revealed a left temporal lobe lesion with solid-cystic components and peripheral enhancement.
  • Histopathology showed a characteristic tumor with bipolar cells, myxoid background, brisk mitoses, and necrosis.

Findings:

  • The tumor exhibited strong GFAP and scattered p53 positivity, with EMA negativity.
  • Ki-67 proliferation index was notably high, ranging from 30-40%, the highest reported.
  • No Rosenthal fibers or eosinophilic granular bodies were observed.

Implications:

  • This case underscores the aggressive nature of pilomyxoid astrocytomas, even in older pediatric patients.
  • The high Ki-67 index may correlate with tumor aggressiveness and recurrence risk.
  • Despite radiotherapy and temozolamide, the tumor recurred within two years, suggesting the need for further therapeutic strategies.

Keywords:
Ki-67pilomyxoid astrocytomarecurrencetemporal lobe

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