Boukobza M, Goutagny S, Cazals-Hatem D, Laissy J-P
Department of radiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, 46, rue Henri-Huchard, 75018, Paris, France.
Department of neurosurgery, hôpital Beaujon, Assistance publique-Hôpitaux de Paris, 92100 Clichy, France.
Neurochirurgie. 2019 Feb;65(1):32-35. doi: 10.1016/j.neuchi.2018.12.002. Epub 2019 Jan 30.
We report an unusual case of a frontal partially calcified pilocytic astrocytoma (PA) (WHO grade 1) in an 18-year-old woman who presented with acute, spontaneous intracerebral hemorrhage. Histopathology revealed the PA was mixed with psammoma bodies and areas of vascular proliferation responsible for a hypervascular pattern. The patient underwent a total gross resection. MRI showed no residual tumor at the 18-month follow-up and her neurological deficits improved after rehabilitation. Only 20 cases, including ours, of hemorrhagic presentation of PA in adults have been reported to date with enough radiological data. Furthermore, hemorrhagic presentation of a calcified PA is extremely rare. To date only two other cases of calcified PA with hemorrhagic presentation have been reported, one in an adult and one in an infant as described by Shibao et al. (2012) and Kapoor et al. (2015) respectively. Endothelial proliferation may be the main cause of bleeding in these lesions. In our case, a hypervascular pattern was exhibited by histopathological findings. A diagnosis of PA should be considered, especially when calcifications are present within a hemorrhagic tumor lesion.
我们报告了一例罕见病例，一名18岁女性患有额叶部分钙化的毛细胞型星形细胞瘤（PA，世界卫生组织1级），表现为急性自发性脑出血。组织病理学显示，该PA混合有砂粒体和血管增生区域，形成了血管丰富的模式。患者接受了全瘤切除。MRI显示，18个月随访时无残留肿瘤，康复后神经功能缺损有所改善。迄今为止，包括我们的病例在内，仅有20例成人PA出血表现的病例报告有足够的影像学资料。此外，钙化PA的出血表现极为罕见。迄今为止，仅另有两例钙化PA出血表现的病例报告，分别由Shibao等人（2012年）和Kapoor等人（2015年）描述，一例为成人，一例为婴儿。内皮细胞增生可能是这些病变出血的主要原因。在我们的病例中，组织病理学结果显示为血管丰富的模式。当出血性肿瘤病变内存在钙化时，应考虑PA的诊断。
