Diffuse astrocytoma (WHO Grade II)

Patient referred due investigation for multiple sclerosis.

Age: 30 year-old

Gender: Male

Biopsy was performed: After 2 Years

MICROSCOPIC DESCRIPTION: 1-3. The sections show features of a moderately cellular astrocytic tumour. The tumour cells have mildly enlarged round and hyperchromatic nuclei with short cytoplasmic processes in a fibrillary and focally microcystic background (most likely protoplasmic astrocytes). Occasional tumour cells extend into the cerebral cortex. Mitoses are inconspicuous. No endothelial cell hyperplasia or necrosis is present. There is no oligodendroglial component. The features are those of diffuse astrocytoma. The tumour cells are IDH-1, p53 and p16 positive. The topoisomerase index is 1-2%. MGMT immunostain is negative.

DIAGNOSIS: 1-3. Brain tissue: Diffuse astrocytoma (WHO Grade II).

Left frontal low grade glioma

Discussion:

This case demonstrated the indolent progression of a left lobe low-grade tumour that was histologically proven to be a diffuse astrocytoma (WHO grade II). It is important to emphasise that no enhancement is often the rule for these tumours, but small ill-defined areas of enhancement are not rare; however, when enhancement is seen it should be considered as a warning sign for progression to a higher grade. 

This tumour expressed: IDH1 positive = mutation present = better prognosis