The clinical characteristics of subependymal giant cell astrocytoma: five cases

Abstract

In this study, we reviewed the clinical characteristics of five cases of subependymal giant cell astrocytoma (SEGA) at our hospital between May 1997 and July 2012. The median age was 18 years old (range, 8 to 26). The clinical symptoms were presented as seizure in two patients and headache in three patients. All the tumors were located near the foramen of Monro. The median size of the tumors was 2.5 cm (range, 1.9-4.0). Two patients showed the solitary lesion, and three had subependymal nodules and cortical tubers. The median follow-up duration was 7.4 years (range, 2.0-14.3). Three patients were associated with the tuberous sclerosis complex (TSC). Four patients showed the SEGA at the first presentation and one patient experienced the 1.9 cm-sized growing mass during 7.7 years follow-up after the diagnosis of the TSC. The mass was totally removed in four patients and subtotally in one. Postoperatively, one patient took the medication for the seizure, which was controllable. The subtotally removed mass showed the recurrence postoperative 4.1 years later, and the recurred mass was stable for 4.5 years after the recurrence. The clinical follow-up study of the SEGA showed an indolent behavior before and after the surgery.

Keywords: Astrocytoma; Follow-up studies; Neurosurgery; Tuberous sclerosis.

Fig. 1. Pathological findings of subependymal giant cell astrocytoma. A: Pathology shows the pleomorphic multinucleated eosinophilic tumor cells with abundant cytoplasm and these elongated tumor cells formed streams (hematoxylin and eosin staining, original magnification ×200). B: The tumor cells with abundant cytoplasm are clustered and arranged in perivascular pseudopalisading pattern (hematoxylin and eosin staining, original magnification ×100). C: The tumor cells are immune-positive for microtubule-associated protein 2 (original magnification ×200).

Fig. 2. Radiological findings of case 2. A: Brain MRI shows 3 cm-sized solitary lesion near to the foramen of Monro with iso-signal intensity on T1-weighted images. B: Brain CT reveals that the mass was associated with cyst and calcification. C: The mass is subtotally removed, because of the adhesion of the hypothalamus. D: The follow-up MRI shows a 0.8 cm nodular enhancing lesion (arrow) in the right side of the septum pellucidum.

Fig. 3. Radiological findings of case 4. A: Brain MRI shows the 1 cm-sized mass (arrow) adjacent to the foramen of Monro with iso-signal intensity on T1-weighted images. B: Brain MRI displays 1.9 cm-sized enlarged lesion with contrast enhancement. C: There was no recurred lesion for two years after the operation.