Anaplastic Pleomorphic Xanthoastrocytoma, WHO Grade 3, Located on the Hippocampal Region: A Case Report

CASE REPORT
Serbeze Kabashi-Muçaj, Agon Mekaj, Mentor Petrela, Besim Latifi, Gentian Kaloshi, Flaka Pasha, Kreshnike Dedushi Hoti, Arben Rroji, Labinot Shahini, Fjolla Hyseni, Sefedin Muçaj

 
International Journal of Biomedicine. 2023;13(1):172-176.
DOI: 10.21103/Article13(1)_CR2
Originally published March 3, 2023

Abstract: 

Anaplastic pleomorphic xanthoastrocytoma (APXA) is a rare and aggressive brain tumor that requires a multidisciplinary approach for proper diagnosis and treatment. This case report presents the case of a 15-year-old male patient diagnosed with APXA in the left temporal region. The patient underwent a combination of imaging studies, including MRI, followed by a biopsy of the tumor tissue and surgery. The patient was then closely monitored for recurrence and progression of the tumor, and further received six cycles of chemotherapy and radiation therapy.
This report aims to provide detailed information about the diagnostic process for APXA, which can be challenging due to its similarity to other tumors, such as pilocytic astrocytoma. Additionally, the report highlights the varying treatment options and outcomes for patients with APXA, as well as the importance of close monitoring for the recurrence and progression of the tumor. More research is needed to fully understand the best treatment options for APXA and to improve outcomes for patients diagnosed with this rare and aggressive brain tumor.

Keywords: 
anaplastic pleomorphic xanthoastrocytoma • brain tumor • hippocampus • MRI • biopsy
References: 
  1. Kepes JJ, Rubinstein LJ, Eng LF. Pleomorphic xanthoastrocytoma: a distinctive meningocerebral glioma of young subjects with relatively favorable prognosis. A study of 12 cases. Cancer. 1979 Nov;44(5):1839-52. doi: 10.1002/1097-0142(197911)44:5<1839::aid-cncr2820440543>3.0.co;2-0.
  2. Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, Ohgaki H, Wiestler OD, Kleihues P, Ellison DW. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016 Jun;131(6):803-20. doi: 10.1007/s00401-016-1545-1. 
  3. Giannini C, Scheithauer BW, Burger PC, Brat DJ, Wollan PC, Lach B, et al. Pleomorphic xanthoastrocytoma: what do we really know about it? Cancer. 1999 May 1;85(9):2033-45.
  4. Ronsley R, Dunham C, Yip S, Brown L, Zuccato JA, Karimi S, et al. A case series of pediatric survivors of anaplastic pleomorphic xanthoastrocytoma. Neurooncol Adv. 2021 Jan 30;3(1):vdaa176. doi: 10.1093/noajnl/vdaa176.
  5. She D, Liu J, Xing Z, Zhang Y, Cao D, Zhang Z. MR Imaging Features of Anaplastic Pleomorphic Xanthoastrocytoma Mimicking High-Grade Astrocytoma. AJNR Am J Neuroradiol. 2018 Aug;39(8):1446-1452. doi: 10.3174/ajnr.A5701.
  6. Shao LW, Wang FL. Anaplastic pleomorphic xanthoastrocytoma. Chin J Contemp Neurol Neurosurg. 2017;17:616-625.
  7. Alexandrescu S, Korshunov A, Lai SH, Dabiri S, Patil S, Li R, et al. Epithelioid Glioblastomas and Anaplastic Epithelioid Pleomorphic Xanthoastrocytomas--Same Entity or First Cousins? Brain Pathol. 2016 Mar;26(2):215-23. doi: 10.1111/bpa.12295. 
  8. Broniscer A, Tatevossian RG, Sabin ND, Klimo P Jr, Dalton J, Lee R, et al. Clinical, radiological, histological and molecular characteristics of paediatric epithelioid glioblastoma. Neuropathol Appl Neurobiol. 2014 Apr;40(3):327-36. doi: 10.1111/nan.12093.
  9. Fornasa F. Diffusion-weighted Magnetic Resonance Imaging: What Makes Water Run Fast or Slow? J Clin Imaging Sci. 2011;1:27. doi: 10.4103/2156-7514.81294. 
  10. Wang J, Takashima S, Takayama F, Kawakami S, Saito A, Matsushita T, et al. Head and neck lesions: characterization with diffusion-weighted echo-planar MR imaging. Radiology. 2001 Sep;220(3):621-30. doi: 10.1148/radiol.2202010063. 
  11. Sasaki M, Eida S, Sumi M, Nakamura T. Apparent diffusion coefficient mapping for sinonasal diseases: differentiation of benign and malignant lesions. AJNR Am J Neuroradiol. 2011 Jun-Jul;32(6):1100-6. doi: 10.3174/ajnr.A2434. 
  12. Aronen HJ, Pardo FS, Kennedy DN, Belliveau JW, Packard SD, Hsu DW, et al. High microvascular blood volume is associated with high glucose uptake and tumor angiogenesis in human gliomas. Clin Cancer Res. 2000 Jun;6(6):2189-200. 
  13. Buckley DL. Uncertainty in the analysis of tracer kinetics using dynamic contrast-enhanced T1-weighted MRI. Magn Reson Med. 2002 Mar;47(3):601-6. doi: 10.1002/mrm.10080
  14. Lev MH, Ozsunar Y, Henson JW, Rasheed AA, Barest GD, Harsh GR 4th, et al. Glial tumor grading and outcome prediction using dynamic spin-echo MR susceptibility mapping compared with conventional contrast-enhanced MR: confounding effect of elevated rCBV of oligodendrogliomas [corrected]. AJNR Am J Neuroradiol. 2004 Feb;25(2):214-21. Erratum in: AJNR Am J Neuroradiol. 2004 Mar;25(3):B1. 

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Received January 31, 2023.
Accepted March 1, 2023.
©2023 International Medical Research and Development Corporation.