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High-grade astrocytoma with piloid features: MRI findings associated with a novel entity
Abd-Ur-Rafay Mughal1, Mohammed Nazir Khan2,3
1McMaster University, Department of Undergraduate Medicine, Hamilton, Canada.
Abstract:
High-grade astrocytoma with piloid features is a newly defined brain tumor that requires DNA methylation profiling for diagnosis. Imaging features specific to this tumor have only recently been described in the radiological literature. We highlight the case of a 34-year-old man who presented with a 4-week history of headaches and light-headedness. Postresection, pathological analysis identified the tumor based on DNA methylation profiling, and the patient was started on adjuvant chemotherapy with Temozolomide. T2-weighted imaging showed a well-circumscribed cerebellar mass, which correlated with the pathology-reported glial tumor cells being elongated and piloid. T1-postgadolinium imaging showed heterogeneous enhancement of linear serpiginous areas, which correlated with regions of high microvascular density and vessels that showed thickening and hyalinization. Diffusion-weighted imaging and apparent diffusion coefficient mapping did not show significant diffusion restriction. Rosenthal fibres were absent. Given the specific imaging-pathology correlation, this report contributes imaging features associated with this novel diagnostic entity.
Insights
High-grade astrocytoma with piloid features, a new brain tumor, shows specific imaging traits. DNA methylation profiling confirms diagnosis, aiding treatment strategies for this rare glial tumor.
Area of Science:
- Neuro-oncology
- Neuroradiology
- Molecular Pathology
Background:
- High-grade astrocytoma with piloid features is a recently defined brain tumor.
- Diagnosis currently requires DNA methylation profiling.
- Specific imaging characteristics are emerging in radiological literature.
Observation:
- A 34-year-old male presented with headaches and light-headedness.
- A well-circumscribed cerebellar mass was identified on T2-weighted imaging.
- T1-postgadolinium imaging revealed heterogeneous, linear, serpiginous enhancement.
Findings:
- Pathology confirmed the tumor as high-grade astrocytoma with piloid features via DNA methylation profiling.
- Imaging findings correlated with elongated, piloid glial tumor cells and high microvascular density.
- No significant diffusion restriction was noted on diffusion-weighted imaging; Rosenthal fibers were absent.
Implications:
- This case highlights key imaging features correlating with histopathology for this novel entity.
- Accurate radiological identification can aid in the diagnosis and management of this rare brain tumor.
- Understanding these imaging-pathology correlations is crucial for advancing diagnostic accuracy in neuro-oncology.
