Reappraisal of haemorrhagic suprasellar pilocytic astrocytoma during adulthood
Related Experiment Video
Updated: Dec 3, 2025
Full-Endoscopic Surgery for Hypothalamic Hamartoma Resection
Published on: April 12, 2024
Gustavo M Cortez1,2, Andre Monteiro1, Benjamin Ludwig1
1Department of Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA.
Insights
Pilocytic astrocytomas are rare in adults, especially when presenting with hemorrhage. This case highlights diagnostic and management differences from pediatric cases, with a poorer adult prognosis.
Area of Science:
- Neuro-oncology
- Neuropathology
Background:
- Pilocytic astrocytomas are the most common pediatric central nervous system tumors.
- Tumor incidence decreases with age, while aggressiveness increases.
Observation:
- A 55-year-old presented with headaches and dizziness.
- MRI revealed a suprasellar lesion with hemorrhage.
- Histopathology unexpectedly diagnosed a pilocytic astrocytoma.
Findings:
- Hemorrhagic pilocytic astrocytoma is rare in adults.
- Adult pilocytic astrocytomas have a higher rate of progression and recurrence.
Implications:
- Recognizing adult pilocytic astrocytomas requires different diagnostic and management strategies compared to pediatric cases.
- Adult pilocytic astrocytomas are associated with an unfavorable prognosis.
Abstract:
Pilocytic astrocytomas comprise the most common central nervous system tumour during childhood and have an excellent response to surgical treatment in this population. The tumour incidence decreases with age, whereas more aggressive behaviour tends to increase. Haemorrhage as a presenting feature of pilocytic astrocytomas is a rare phenomenon, especially in the adult population. We present a case of a 55-year-old patient with progressive headaches and dizziness. MRI confirmed a sellar and predominantly retrochiasmal suprasellar lesion with heterogeneous signal, enhancement and blood products. Management via transsphenoidal approach was performed, and histopathology revealed the unexpected diagnosis of haemorrhagic pilocytic astrocytoma. Haemorrhagic pilocytic astrocytoma is an infrequent entity in the adult population and it is essential to recognise the peculiarities regarding diagnostic evaluation and management, which differ from the paediatric population. During adulthood, this tumour carries an overall unfavourable prognosis, with higher rates of progression and recurrence.
