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Quiz Prize Rules Current Rankings DIAGNOSIS:
Pilocytic Astrocytoma
A left cerebellar hemispheric solid-cystic mass lesion is seen, with a rim-enhancing cystic component and an inferiorly located, intensely enhancing solid nodule. This is highly suggestive of a pilocytic astrocytoma.
Pilocytic astrocytoma is the most common pediatric central nervous system glial neoplasm and the most common pediatric cerebellar tumor. The WHO classifies this tumor as a grade I glioma. These tumors are usually discrete, indolent lesions associated with cyst formation. The cysts may be unilocular or multilocular, with an associated tumor nodule.
Four imaging patterns have been described: (a) non-enhancing cyst and an intensely enhancing mural nodule, (b) enhancing cyst wall and an intensely enhancing mural nodule, (c) necrotic mass with a central non-enhancing zone, and (d) a predominantly solid mass with minimal or no cyst-like component (REF). Although it was thought that hemorrhage was rare in a pilocytic astrocytoma, newer studies have found that this is not so uncommon (1).
The main differential for a cystic posterior fossa mass with an enhancing mural nodule is hemangioblastoma. Intralesional hemorrhage is more commonly associated with hemangioblastoma (2).
References
Buschmann U, Gers B, Hildebrandt G. Pilocytic astrocytomas with leptomeningeal dissemination: biological behavior, clinical course, and therapeutical options. Childs Nerv Syst. Jun 2003;19(5-6):298-304.
White JB , Piepgras DG , Scheithauer BW , Parisi JE .Rate of spontaneous hemorrhage in histologically proven cases of pilocytic astrocytoma. J Neurosurg. 2008 Feb;108(2):223-6.
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PubMed References for Pilocytic Astrocytoma
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