Cerebral pleomorphic xanthoastrocytoma mimicking inflammatory granuloma: Two case reports

Pleomorphic xanthoastrocytoma (PXA) is a rare low-grade glial neoplasm of the central nervous system, which is difficult to distinguish from other neoplastic and non-neoplastic entities. Herein, we report 2 cases of PXA that had been misdiagnosed as an inflammatory granuloma.

The first case was a 22-year-old man who originally presented with a generalized seizure 7 years previously. Magnetic resonance imaging (MRI) revealed a lesion in the right parietal lobe, leading to a diagnosis of inflammatory granuloma. The second case was a 43-year-old man who presented with repeated generalized seizures. MRI revealed a nodular lesion in the left temporal lobe. The magnetic resonance spectrum showed elevated Cho and NAA peaks and a decreased Cr peak. An inflammatory granuloma was suspected.

After surgical treatment, histopathological examination revealed PXA.

In the first case, after 10 months of anti-inflammatory treatment, the lesion was significantly reduced in size. During the following 7 years, the patient experienced generalized seizures 3 to 4 times annually. To control intractable epilepsy, the lesion was resected. In the second case, conservative treatment provided no benefit, and then the lesion was resected.

In the first case, during a follow-up period of 14 months, the patient was seizure-free with no tumor recurrence. In the second case, after a 6 months of follow-up, the patient remained seizure-free with no tumor recurrence.

The preoperative differential diagnosis of PXA is challenging due to the nonspecific symptoms and imaging manifestations. Considering the potential risk of malignant transformation of PXA, early surgery should be highlighted, and gross total resection is associated with a favorable prognosis.