A.SM. Ridzuan, N. Azam, J. Abdullah, A.R. Ariff, SS. Mutum
Neurosurgical Division, Department of Radiology,
Department of Pathology,
School of Medical Sciences, Universiti
Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
A case of pleomorphic Xanthoastrocytoma
(PXA) in a 10 year old Malay boy is reported here. The patient presented
with headache and epilepsy and radiologically a ring-enhancing lower density
lesion was seen in the left fronto-temporal area consistent with brain
abscess. At operation, a cystic tumours containing serous fluid was identified
and sub-total removal of the tumour was done. Histologically, the tumour
exhibited marked pleomorphism of oval and spindle-shaped cells intermixed
with uni and multiucleated giant cells and polygonal Xanthomatous cells
with foamy crytoplasm. High mitotic activity was noted in several foci
and necrosis was mainly confined to the inner lining of the cyst. Though
PXA is considered a low grade glioma with favourable prognosis, the prensence
of high mitotic rate and necrosis may be negative prognostic indicators.
The patient was treated with post-operative radiotherapy because of histological
anaplasia and the presence of residual tumour. The patient was alive after
1 year follow up. Review of the literature has confirmed Xanthoastrocyoma
as a distinct clinoco-pathological entity, generally occuring in young
persons, having a good prognosis, histogenesis from those of diffuse astrocytoma
and surgical resection as the mainstay in the management of PXA.