The patient’s seizures were managed with levetiracetam, primidone and lacosamide and she subsequently underwent a stereotactic left temporal craniotomy and resection of the lesion.
Histopathology
Macroscopic description:
Oval-shaped rubbery fawn tissue consistent with low grade astrocytoma/ganglioglioma.
Microscopic description:
The sections show a moderately cellular glioneuronal tumour involving both the cortex and white matter. There is tumour in the subpial region. Increased numbers of abnormal ganglion cells are present. They are unevenly distributed with crowding. They have enlarged nuclei and prominent nucleoli. Bi-nucleated forms are occasionally seen. A second neoplastic astrocytic proliferation is identified. The astrocytes form diffuse sheets in a fibrillary background. They have elongated hyperchromatic nuclei and scanty ill-defined cytoplasm. Eosinophilic granular bodies are not seen. Mitoses are inconspicuous. There is no endothelial cell hyperplasia or necrosis. A small amount of perivascular lymphocytes is seen. The adjacent cerebral cortex shows distortion of the architecture with malorientation of the neurons, in keeping with focal cortical dysplasia. The overall features are those of ganglioglioma. The Ki-67 index is less than 1%. Ganglioglioma with no anaplastic features is considered as Grade I in the 2007 WHO classification.
Diagnosis: Brain tumour: Ganglioglioma (WHO grade I).
Six years post-diagnosis the patient remains seizure-free and with no evidence of disease recurrence.