Astroblastoma
Updates to Case Attributes
The combination of a hyperdense lesion on CT and an avidly enhancing lesion on MRI is often seen in lymphoma, however, typically there is fairly marked diffusion restriction within the lesion, not seen here. The moderate edge restriction was not thought typical of lymphoma. The imaging appearance in conjunction with the prominent vasogenic oedema raised the possibility of a metastasis. Given the age of the patient metastatic melanoma was suggested in the differential.
At histology, the morphology and immunophenotype were felt to be consistent with an astroblastoma. The histological features were considered low grade (no WHO grading currently exists for these lesions) with a favourable prognosis. Follow up 18 months post surgery shows no residual lesion.
Astroblastoma is an uncommon glial neoplasm (0.45-2.8% brain gliomas) which is almost always supratentorial, occurring most commonly in young adults. The figure of 85% of lesions showing calcification on CT quoted in the literature is based on a series of 7 patients. No overt calcification was seen on CT in this case, although the lesion was hyperdense. The lesion, in this case, was predominantly isointense, with heterogenousheterogeneous features in keeping with the reported solid and cystic components in this pathology.
-<p>The combination of a hyperdense lesion on CT and an avidly enhancing lesion on MRI is often seen in lymphoma, however, typically there is fairly marked diffusion restriction within the lesion, not seen here. The moderate edge restriction was not thought typical of lymphoma. The imaging appearance in conjunction with the prominent vasogenic oedema raised the possibility of a metastasis. Given the age of the patient metastatic melanoma was suggested in the differential. </p><p>At histology, the morphology and immunophenotype were felt to be consistent with an astroblastoma. The histological features were considered low grade (no WHO grading currently exists for these lesions) with a favourable prognosis. Follow up 18 months post surgery shows no residual lesion. </p><p><a href="/articles/astroblastoma">Astroblastoma</a> is an uncommon glial neoplasm (0.45-2.8% brain gliomas) which is almost always supratentorial, occurring most commonly in young adults. The figure of 85% of lesions showing calcification on CT quoted in the literature is based on a series of 7 patients. No overt calcification was seen on CT in this case, although the lesion was hyperdense. The lesion, in this case, was predominantly isointense, with heterogenous features in keeping with the reported solid and cystic components in this pathology.</p>- +<p>The combination of a hyperdense lesion on CT and an avidly enhancing lesion on MRI is often seen in lymphoma, however, typically there is fairly marked diffusion restriction within the lesion, not seen here. The moderate edge restriction was not thought typical of lymphoma. The imaging appearance in conjunction with the prominent vasogenic oedema raised the possibility of a metastasis. Given the age of the patient metastatic melanoma was suggested in the differential. </p><p>At histology, the morphology and immunophenotype were felt to be consistent with an astroblastoma. The histological features were considered low grade (no WHO grading currently exists for these lesions) with a favourable prognosis. Follow up 18 months post surgery shows no residual lesion. </p><p><a href="/articles/astroblastoma">Astroblastoma</a> is an uncommon glial neoplasm (0.45-2.8% brain gliomas) which is almost always supratentorial, occurring most commonly in young adults. The figure of 85% of lesions showing calcification on CT quoted in the literature is based on a series of 7 patients. No overt calcification was seen on CT in this case, although the lesion was hyperdense. The lesion, in this case, was predominantly isointense, with heterogeneous features in keeping with the reported solid and cystic components in this pathology.</p>
References changed:
- 1. Bell JW, Osborn AG, Salzman KL et-al. Neuroradiologic characteristics of astroblastoma. Neuroradiology. 2007;49 (3): 203-9. <a href="http://dx.doi.org/10.1007/s00234-006-0182-0">doi:10.1007/s00234-006-0182-0</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/17216265">Pubmed citation</a><span class="auto"></span>
- 2. Port JD, Brat DJ, Burger PC et-al. Astroblastoma: radiologic-pathologic correlation and distinction from ependymoma. AJNR Am J Neuroradiol. 2002;23 (2): 243-7. <a href="http://www.ajnr.org/content/23/2/243.full">AJNR Am J Neuroradiol (full text)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/11847049">Pubmed citation</a><span class="auto"></span>
- Bell JW, Osborn AG, Salzman KL et-al. Neuroradiologic characteristics of astroblastoma. Neuroradiology. 2007;49 (3): 203-9. <a href="http://dx.doi.org/10.1007/s00234-006-0182-0">doi:10.1007/s00234-006-0182-0</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/17216265">Pubmed citation</a><span class="auto"></span>
- Port JD, Brat DJ, Burger PC et-al. Astroblastoma: radiologic-pathologic correlation and distinction from ependymoma. AJNR Am J Neuroradiol. 2002;23 (2): 243-7. <a href="http://www.ajnr.org/content/23/2/243.full">AJNR Am J Neuroradiol (full text)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/11847049">Pubmed citation</a><span class="auto"></span>
Updates to Study Attributes
Mass lesion predominantly T1 isointense to white matter, with focal hypointense areas. Adjacent white matter T1 hypointensity.
On T2 there are areas of marked hypointensity and small areas of hyperintensity, with marked vasogenic oedema. The lesion appears cortically based-based, and is heterogeneous on FLAIR, with foci of marked hypointensity.
B1000b1000 images suggest some marginal diffusion restriction. ADC confirms some minimal marginal diffusion restriction.
Postcontrast images show prominent enhancement, with a few small areas of non-enhancement. The enhanced lesion appearsis well defined.
Updates to Study Attributes
Contrast-enhanced T1 MRI MRI acquired 18 months post excision shows a small area of encephalomalacia at the operative site, but no evidence of residual or recurrent tumour.
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