Massive Intracranial Hemorrhage Associated With Pleomorphic Xanthoastrocytoma -Case Report-

Abstract

A 60-year-old woman with a history of intermittent headaches and frequent seizures for 30 years presented with a massive intracranial hematoma in the left medial temporal lobe with thick subarachnoid hemorrhage. She had been treated with anticonvulsant medication under a diagnosis of left mesial temporal sclerosis based on magnetic resonance imaging findings. Cerebral angiography on admission revealed occlusion of the P 2 segment of the left posterior cerebral artery (PCA) and extravasation of contrast medium during the procedure. The patient underwent left temporal lobectomy including the lesioned mesial temporal cortex, and the ruptured P 2 segment of the PCA was removed as well. The operative finding of the ruptured aneurysm was pseudoaneurysm. Histological examination of the resected PCA segment demonstrated a pleomorphic xanthoastrocytoma invading the outer wall of the PCA. Presumably the bleeding was caused by the rupture of a pseudoaneurysm secondary to leptomeningeal involvement of this typically benign tumor.

Malignant potential of pleomorphic xanthoastrocytoma

“…59 9/F + + + + Few 11 Tonn et al (1997) 48 3/NR 12 19/F + + + --1/10 HPF 13 Charbel (1998) 62 9/F 14 Leonard et al (1998) 60 11/F -0/10 HPF + + 15 Prayson et al (1998) 63 17 15 17/M 31 Wu et al (2011) 36 7/F + 7/10 HPF 32 1/F + 0/10 HPF 33 6/M + 18/10 HPF 34 Present report 50/M --Few + = Present, À = absent, Ca = calcifications, EGB = eosinophilic granular bodies, EP = endothelial proliferation, F = female, GFAP = glial fibrillary acid protein immunostaining, HPF = high power fields, LC = lymphoid cells, M = male, MIB = -1 = proliferation index, Pleo = pleomorphism, Nec = necrosis, NF = neurofilament immunostaining, NR = not reported, Nucl inc = nuclear inclusions, Ret = reticulin deposits, S100 = S100 immunostaining, Spin = spindle cells, syn = synaptophysin immunostaining, Xanth = xanthomatous cells.…”

“…19,31 Haemorrhage may occasionally be catastrophic where the tumour has eroded intracranial vessels. 12 PXA has distinctive histology. Tumour cells are pleomorphic in size and shape, with spindle cells intermingled with mono-or multinucleated giant cells.…”

Chiasm and optic nerve glioma manifested as hemorrhage (two clinical cases and a literature review)

“…Однако это объяснимо при быстром росте опухоли [17,18,[21][22][23] и остается не вполне понятным при медленной ее прогрессии, имевшей, скорее всего, место у наших пациенток.…”

A Case of Pleomorphic Xanthoastrocytoma with Intracranial Hemorrhage in a Child

“…3,4) Intracranial hemorrhage associated with PXA is extremely rare. So far, only six cases have been reported in the English literature 5–10) (Table 1). PXAs appear as hypovascular masses on angiogram, and histological hypervascularity has been reported in only one case.…”