H. Frimmel (Halle/S.)  

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5 Years  

Female  

Head-Brain and brain nerves  

neoplastic  

5.5 year-old girl with increased vision loss, opticus atrophy on both sides.  

Low malignant astrocytoma. WHO-Grade I, usually in children and adolescents.
It is a brain tumor of the astroglia with solid and cystic parts. Calcifications are rare.
Most often located in: Chiasma opticum, Hypothalamus/3rd ventricle, brain stem, cerebellum/4th ventricle.  

<- view MRI 1

MRI 1: T2 FLAIR transversal: multilobed tumor located in the suprasellar region. High in signals.







<- view MRI 2

MRI 2: T2 TIRM transversal: 4.5 x 3 x 3 cm large, solid part (hyperintense), two cystic areas measuring 2 x 1.5 x 1.5 cm ventrally and 4 x 3 x 2.5 cm dorsally of the solid part.







<- view MRI 3

MRI 3: T1 transversal - no contrast: multilobed tumor located in the suprasellar region. Inhomogenically hypointense







<- view MRI 4

MRI 4: T1 transversal after contrast application: 4.5 x 3 x 3 cm solid content (with enhancement), both cystic areas (2 x 1.5 x 1.5 cm ventrally and 4 x 3 x 2.5 cm dorsally to the solid part) with contrast uptake along the edges.






<- view MRI 5

MRI 5: T1 coronar after contrast application: 4.5 x 3 x 3 cm solid content (with enhancement), both cystic areas (2 x 1.5 x 1.5 cm ventrally and 4 x 3 x 2.5 cm dorsally to the solid part) with contrast uptake along the edges.







<- view MRI 6

MRI 6: T1 sagittal after contrast application: 4.5 x 3 x 3 cm solid content (with enhancement), both cystic areas (2 x 1.5 x 1.5 cm ventrally and 4 x 3 x 2.5 cm dorsally to the solid part) with contrast uptake along the edges.



 

Surgery / Histo  

Craniopharyngeoma - up to 50-57% (other literature 80-90%) calcifications. Typical hypointensity of the cystic parts in the T1-weighted images, as well as iso- or hyperintensity of the solid parts (hypointense with calcifications), in T2-weighted images, inhomogenic hyperintensity of the tumor. After contrast media, strong enhancement of the vital tumor, often variable morphology and signal pattern (depending on the cyst's contents, extent of the calcifications, relation of solid/cystic tumor parts).  

Low-malignancy, slow-growing glioma WHO-grade I.

Seldom malignant transformation in WHO Grade II.
Pilocytic astromcytomas are cause of about 5-10% of all giomas and about 30% of all brain tumors in children. Most children are the age of 10. Often, a radical surgery is not possible. Radiation treatment after histologic diagnosis confirmation.  

The often variable picture of the different cerebral tumors regarding the morphology and signal behavior doesn't alone allow a histologic grading because of imaging. In cystic tumor parts, one should always consider a pilocytic astrocytoma.  

N/A  

1. Medline:
K.Sartor
"Neuroradiologie"
2.Auflage
Georg-Thieme-Verlag 2001

2. Medline:
D.Uhlenbrock
"MRT und MRA des Kopfes"
Georg-Thieme-Verlag 1996  

pilocytic, astrocytoma, brain tumor, pilocytic astrocytoma, low malignant astrocytoma, child, childhood, pediatric radiology  

H Frimmel. Pilocytic astrocytoma. PedRad [serial online] vol 2, no. 8.
URL: www.PedRad.info/?search=20020815184849