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Granular Cell Astrocytoma: A Diagnostic Conundrum.

Rimlee Dutta1, Mehar Chand Sharma1, Vaishali Suri1

  • 1Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

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Summary

Granular cell astrocytoma (GCA) is a rare, aggressive brain tumor that can be misdiagnosed due to its unusual appearance. Early diagnosis of GCA is crucial for effective patient management.

Keywords:
Aggressive gliomasBrain tumorGlial tumorsGranular cell astrocytomaIDH wild type glioma

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Area of Science:

  • Neuro-oncology
  • Pathology

Background:

  • Granular cell astrocytoma (GCA) is an aggressive astrocytoma variant.
  • Characterized by round-to-polygonal cells with granular cytoplasm.
  • Lacks typical astrocytoma features, increasing misdiagnosis risk.

Observation:

  • A 50-year-old male presented with headache, vertigo, and seizures.
  • Imaging revealed multiple intra-axial lesions in the temporal lobe, parietal lobe, thalamus, and cerebellum.
  • Histopathology showed large polygonal cells with granular cytoplasm and specific immunohistochemical markers.

Findings:

  • Immunohistochemistry confirmed GCA with positivity for Olig2, S100, EMA, lysozyme, and CD68.
  • Negative for GFAP, IDH1, and other markers, differentiating it from other gliomas.
  • MIB 1 labeling index was 5%-6%.

Implications:

  • GCAs exhibit aggressive behavior and genetic alterations similar to glioblastoma.
  • Early and accurate diagnosis of GCA is essential for optimal patient outcomes.
  • Highlights the importance of comprehensive immunohistochemical analysis for challenging neuro-oncology cases.