Suprasellar pleomorphic xanthoastrocytoma: A case report

Area of Science:

• Neuro-oncology
• Neurosurgery
• Pathology

Background:

• Pleomorphic xanthoastrocytoma (PXA) is a rare, World Health Organization Grade II astrocytic neoplasm.
• Typically found in children and young adults, PXA usually occurs in supratentorial cortical regions.
• Seizures are a common initial symptom, and PXA is often not in the initial differential diagnosis for tumors in uncommon locations.

Observation:

• This report details an exceptionally rare case of PXA originating in the suprasellar region.
• The patient, a young adult, presented with progressive peripheral vision loss.
• Initial MRI revealed a heterogeneous suprasellar mass, with craniopharyngioma as the leading differential diagnosis.

Findings:

• Endoscopic endonasal resection was performed, and microscopic and immunohistochemical analysis confirmed the diagnosis of PXA.
• The tumor exhibited glial neoplasm characteristics with variable morphology.
• The patient showed no recurrence at the 1-year follow-up.

Implications:

• PXA, though rare, should be considered in the differential diagnosis of solid-cystic suprasellar tumors in young adults.
• This case expands the known anatomical locations for PXA, which have also been reported in the spinal cord, cerebellum, ventricular system, and pineal region.
• Accurate and timely diagnosis of rare brain tumors like PXA is crucial for appropriate management and favorable outcomes.