Brain Tumor Res Treat.  2017 Apr;5(1):37-41. 10.14791/btrt.2017.5.1.37.

Subependymal Giant Cell Astrocytoma Presenting with Tumoral Bleeding: A Case Report

• Kim JY
• Jung TY
• Lee KH
• Kim SK

• KMID: 2378304
• DOI: http://doi.org/10.14791/btrt.2017.5.1.37

Abstract

We report a rare case of subependymal giant cell astrocytoma (SEGA) associated with tumoral bleeding in a pediatric patient without tuberous sclerosis complex (TSC). A 10-year-old girl presented with a 2-week history of an increasingly aggravating headache. Brain magnetic resonance imaging revealed an approximately 3.6-cm, well-defined, heterogeneously enhancing mass with multistage hemorrhages on the right-sided foramen of Monro. The tumor was completely resected using a transcallosal approach. Intraoperatively, the mass presented as a gray-colored firm tumor associated with acute and subacute hemorrhages. The origin of the mass was identified as the ventricular septum adjacent to the foramen of Monro. A pathological analysis revealed pleomorphic multinucleated eosinophilic tumor cells with abundant cytoplasm. These cells showed positive staining for the glial fibrillary acidic protein and S100 protein. A diagnosis of SEGA was established. The patient recovered without any neurological symptoms. There was no evidence of TSC. The radiological follow-up showed no recurrence for 2 years. This was a case of SEGA with intratumoral hemorrhage, for which a favorable outcome was achieved, without any neurological deficit after tumoral resection.

Keyword

Hemorrhage; Astrocytoma; Tuberous sclerosis; Surgery

MeSH Terms

Astrocytoma*
Brain
Cerebral Ventricles
Child
Cytoplasm
Diagnosis
Eosinophils
Female
Follow-Up Studies
Glial Fibrillary Acidic Protein
Headache
Hemorrhage*
Humans
Magnetic Resonance Imaging
Recurrence
Tuberous Sclerosis
Ventricular Septum
Glial Fibrillary Acidic Protein

Figure

• 

  Fig. 1 Preoperative and postoperative radiological findings of subependymal giant cell astrocytoma with bleeding. A: A brain computed tomography scan showing acute hemorrhage on the right lateral ventricle. B: A brain magnetic resonance (MR) image showing an approximately 3.6-cm, well-defined mass in the right-sided foramen of Monro. The mass shows mixed low and high signal intensity on T1-weighted MR images. C: The mass shows mixed low and high signal intensity on T2-weighted MR images. D: Following gadolinium administration, the lesion demonstrates heterogeneous enhancement on axial images. E: The lesion is heterogeneously enhanced on peripheral solid area on sagittal images. F: Cerebral blood volume is focally increased on perfusion MR images. G and H: Recurrence is not observed for 2 years, based on T1-weighted enhanced MR images.

• 

  Fig. 2 Pathological findings of subependymal giant cell astrocytoma. A: Pathological analysis revealing tumor cells with many small vessels (hematoxylin and eosin staining, original magnification, ×40). B: The pleomorphic multinucleated eosinophilic tumor cells contain abundant cytoplasm (hematoxylin and eosin staining, original magnification, ×200). C: The tumor cells show focally positive staining for glial fibrillary acidic protein (original magnification, ×200). D: The tumor cells show positive staining for S100 protein (original magnification, ×200).

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