Diffuse astrocytoma NOS ("protoplasmic")

Discussion:

The patient went on to have a craniotomy and resection of the tumor. 

Histology

Paraffin sections show a moderately hypercellular glioma composed

predominantly of protoplasmic astrocytes with lesser numbers of fibrillary and occasional gemistocytic astrocytes. Protoplasmic cells have mildly pleomorphic round and oval hyperchromatic nuclei and delicate processes. No mitotic figures are identified and there is no vascular endothelial cell hyperplasia and no necrosis. The Ki-67/MIB-1 proliferation index is approximately 7%. Prominent microcyst formation is seen. Tumor is seen to infiltrate white matter but is relatively well demarcated from the cortex.

FINAL DIAGNOSIS:  Diffuse astrocytoma of protoplasmic type (WHO Grade II)

 

Note: Until recently, protoplasmic astrocytomas were classified as a subtype low-grade astrocytoma, however, in the latest (2016) update to WHO classification of CNS tumors, protoplasmic astrocytomas no longer exists as a distinct entity, but rather are considered as a pattern of certain gliomas, requiring IDH +/- 1p19q status for classification. 

Note: IDH mutation status is not provided in this case and according to the current (2016) WHO classification of CNS tumors, this tumor would, therefore, be designated as a diffuse astrocytoma NOS.

 

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