Cerebellar pilocytic astrocytomas with spontaneous intratumoral hemorrhage in adult

Abstract

Cerebellar pilocytic astrocytomas (PAs) are benign gliomas predominantly found in the pediatric population. Intracranial hemorrhages are extremely rare in initial presentations of cerebellar PAs. There are no reports in the medical literature of adult cerebellar PA cases presenting with intratumoral hemorrhage. We report 2 cases of adult cerebellar pilocytic astrocytomas with intratumoral hemorrhage. The first case is a 37-year-old woman presenting with severe headache, nausea, and vomitting. Computed tomography demonstrated an acute hemorrhage adjacent to the right cerebellar hemisphere and hydrocephalus. Magnetic resonance imaging (MRI) revealed a cerebellar vermian tumor with the hemorrhage as a mixed isointense area in the T2-weighted image, and as a mixed hyperintense area in the contrast-enhanced T1-weighted image. The second case is a 53-year-old man presenting with headache for 3 weeks. MRI revealed a cerebellar hemispheric tumor with the hemorrhage as a mixed hyperintense area. It had a cystic mass with a heterogeneous enhanced mural nodule in the gadolinium-enhanced T1-weighted image and a fluid-fluid level within the cyst in the T2-weighted image. Both of them underwent radical resections of their respective lesions. Histological examination of the specimens revealed typical astrocytoma, including a hemorrhagic portion. Both patients recovered postoperatively and continue to do well at present. The medical literature on hemorrhagic cerebellar PAs is also reviewed.

Keywords: Adult; Cerebellum; Hemorrhage; Pilocytic astrocytoma.

Fig. 1

A : Brain non-enhanced computed tomography scan at admission showing a hyperdense mass adjacent to the right cerebellar hemisphere. B : Preoperative axial T2-weighted brain magnetic resonance imaging (MRI) scan showing a cerebellar mass with central mixed-signal intensity and peripheral low-signal intensity. C and D : The mass shows mixed, iso- and high-signal intensity in the T1-weighted axial image and peripheral enhancement in the axial gadolinium-enhanced T1-weighted image. E : Axial gadolinium-enhanced T1-weighted MRI obtained three months after operation showing no residual or recurred lesions.

Fig. 2

A : Histopathological examination shows astrocytic tumor cells with numerous Rosenthal fibers and hyalinized blood vessels (H&E staining, ×100). B : Immunohistochemical staining for glial fibrillary acidic protein shows very positive (×200).

Fig. 3

A : Preoperative axial T2-weighted brain magnetic resonance imaging (MRI) scan showing a left cerebellar hemispheric cystic mass with fluid-fluid level. B : Preoperative axial gadolinium-enhanced T1-weighted MRI showing heterogeneous enhanced mural nodule and peripheral enhanced cystic mass. C : Axial gadolinium-enhanced T1-weighted MRI obtained three months after operation showing no residual or recurred lesions.

Fig. 4

A : Histopathological examination shows hemorrhage and compact portions consisting of astrocytic tumor cells (H&E staining, ×40). B : Neoplastic astrocytes with eosinophilic granular bodies and Rosenthal fibers in the glial fibrillary background are shown (H&E staining, ×100).