Cerebellar astrocytoma with extensive lipidization mimicking adipose tissue

We report the case of an elderly woman with a history of headache, vomiting and dizziness while walking. On CT scans a mass was identified in the right cerebellar hemisphere exhibiting radiological characteristics of lipomatous tissue. Surgery revealed a compact lesion consisting of whitish-yellow tissue with a fatty aspect and texture. Smears of tissue samples and paraffin sections showed features suggestive of tissue mainly composed of fully differentiated lipocytes. Lipid-specific stainings on fresh frozen material confirmed univacuolar intracytoplasmic fat accumulation. However, immunohistochemistry for glial fibrillary acidic protein and electron microscopy clearly demonstrated the glial lineage of these lipid-laden cells. Therefore, the tumor was diagnosed as a highly lipidized astrocytoma. In our view, this case represents a variant of lipidized gliomas that has not been described previously and that differs phenotypically from the entities documented earlier.