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Neuroradiology

, Volume 49, Issue 4, pp 307–315 | Cite as

MR and CT imaging of 24 pleomorphic xanthoastrocytomas (PXA) and a review of the literature

  • Ana M. Crespo-RodríguezEmail author
  • James G. Smirniotopoulos
  • Elisabeth J. Rushing
Diagnostic Neuroradiology

Abstract

Introduction

The aim of our study was to review the imaging appearance of PXA, a rare and usually low-grade, astrocytic tumor that typically occurs in young adults.

Methods

The clinical presentation, location and imaging findings on CT (n = 15) and MR (n = 18) of 24 pathologically confirmed PXA were retrospectively reviewed. Two morphologic patterns were defined according to imaging features. The Mann-Whitney U-test was used for statistical analysis of the data.

Results

All the neoplasms were supratentorial and superficial in location with obvious leptomeningeal contact in 22 patients, although leptomeningeal enhancement was demonstrated in only 3. Common locations were temporal (42%), frontal (33%) and parietal (21%), and more than one lobe was involved in 21% of patients. On CT without contrast enhancement, PXA was an iso- or hypoattenuating mass, and calcification was seen in six tumors and inner table remodeling was seen in three patients younger than 12 years. On MR, the solid component of PXA was isointense relative to gray matter on T1-weighted images, hyperintense on T2-weighted images in more than 90% and enhanced intensely following intravenous contrast material administration. Cystic areas showed hyperintensity relative to CSF. Two imaging patterns were differentiated: first a cystic mass containing a mural nodule (70%) and second a predominantly solid mass that may show cystic changes (30%).

Conclusion

The most consistent imaging features of PXA were a superficial location, leptomeningeal contact, and enhancement of the solid component. Apart from the classical PXA appearance of a cystic lesion with an enhancing mural nodule, a second pattern consisting of a predominantly solid mass was recognized.

Keywords

Pleomorphic xanthoastrocytoma Brain neoplasms Supratentorial neoplasms Glioma Imaging pattern 

Notes

Acknowledgements

The authors gratefully acknowledge Angela Levy, LTC, MC, USA, and the Department of Radiologic Pathology of the Armed Forces Institute of Pathology in Washington, DC, for providing the human and material assistance during preparation of this article.

Conflict of interest statement

We declare that we have no conflict of interest.

References

  1. 1.
    Kepes JJ, Kepes M, Slowik F (1973) Fibrous xanthomas and xanthosarcomas of the meninges and the brain. Acta Neuropathol (Berl) 23:187–199CrossRefGoogle Scholar
  2. 2.
    Kepes JJ, Rubinstein LJ, Eng LF (1979) Pleomorphic xanthoastrocytoma: a distinctive meningocerebral glioma of young subjects with relatively favorable prognosis. A study of 12 cases. Cancer 44:1839–1852PubMedCrossRefGoogle Scholar
  3. 3.
    Kepes JJ (1993) Pleomorphic xanthoastrocytoma: the birth of a diagnosis and a concept. Brain Pathology 3:269–274PubMedGoogle Scholar
  4. 4.
    Giannini C, Scheithauer BW, Brat DJ, Wollan PC, Lach B, O’Neill BP (1999) Pleomorphic xanthoastrocytoma: what do we really know about it?. Cancer 85:2033–2045PubMedGoogle Scholar
  5. 5.
    Malacaulay RJB, Jay V, Hoffman HJ, Becker LE (1993) Increased mitotic activity as a negative prognostic indicator in pleomorphic xanthoastrocytoma. Case report. J Neurosurg 79:761–768Google Scholar
  6. 6.
    Pahapill PA, Ramsay DA, Del Maestro RF (1996) Pleomorphic xanthoastrocytoma: case report and analysis of the literature concerning the efficacy of resection and the significance of necrosis. Neurosurgery 38:822–829PubMedCrossRefGoogle Scholar
  7. 7.
    Fouladi M, Jenkins J, Burger P, Langston J, Merchant T, Heideman R, Thompson S, Sanford A, Kun L, Gajjar A (2001) Pleomorphic xanthoastrocytoma: favorable outcome after complete surgical resection. Neuro-oncology 3:184–192PubMedCrossRefGoogle Scholar
  8. 8.
    Koeller KK, Henry JM (2001) From the archives of the AFIP: superficial gliomas: radiologic-pathologic correlation. Radiographics 21:1533–1556PubMedGoogle Scholar
  9. 9.
    Lipper MH, Eberhard DA, Philips CD, Vezina L-G, Cail WS (1993) Pleomorphic xanthoastrocytoma, a distinctive astroglial tumor: neuroradiologic and pathologic features. AJNR Am J Neuroradiol 14:1397–1404PubMedGoogle Scholar
  10. 10.
    MacKenzie JM (1993) Pleomorphic xanthoastrocytoma in a 62-year-old male. Neuropathol Appl Neurobiol 13:481–487Google Scholar
  11. 11.
    Bucciero A, De Caro M, De Stefano V, Tedeschi E, Monticelli A, Siciliano A, Cappabianca P, Vizioli L, Cerillo A (1997) Pleomorphic xanthoastrocytoma: clinical, imaging and pathological features of four cases. Clin Neurol Neurosurg 99:40–45PubMedCrossRefGoogle Scholar
  12. 12.
    Wasdahl DA, Scheithauer BW, Andrews BT, Jeffrey RA Jr (1994) Cerebellar pleomorphic xanthoastrocytoma: case report. Neurosurgery 35:947–950PubMedCrossRefGoogle Scholar
  13. 13.
    Herpers MJ, Freling G, Beuls EA (1994) Pleomorphic xanthoastrocytoma in the spinal cord. Case report. J Neurosurg 80:564–569PubMedCrossRefGoogle Scholar
  14. 14.
    Zarate JO, Sampaolesi R (1999) Pleomorphic xanthoastrocytoma of the retina. Am J Surg Pathol 23:79–81PubMedCrossRefGoogle Scholar
  15. 15.
    Nitta J, Tada T, Kyoshima K, Goto T, Ishii K, Hongo K, Kobayshi S (2001) Atypical pleomorphic xanthoastrocytoma in the pineal gland: case report. Neurosurgery 49:1458–1461PubMedCrossRefGoogle Scholar
  16. 16.
    Arita K, Kurisu K, Tominafa A, Sugiyma K, Sumida M, Hirose T (2002) Intrasellar pleomorphic xanthoastrocytoma: case report. Neurosurgery 51:1079–1082PubMedCrossRefGoogle Scholar
  17. 17.
    Furuta A, Takahashi H, Ikuta F, Onda K, Takeda N, Tanaka R (1992) Temporal lobe tumor demonstrating ganglioglioma and pleomorphic xanthoastrocytoma components. Case report. J Neurosurg 77:143–147PubMedGoogle Scholar
  18. 18.
    Lindboe CF, Cappelen J, Kepes JJ (1992) Pleomorphic xanthoastrocytoma as a component of a cerebellar ganglioglioma: case report. Neurosurgery 31:353–355PubMedCrossRefGoogle Scholar
  19. 19.
    Perry A, Giannini C, Scheithauer BW, Rojiani AM, Yachnis AT, Seo IS, Johnson PC, Kho J, Shapiro S (1997) Composite pleomorphic xanthoastrocytoma and ganglioglioma: report of four cases and review of the literature. Am J Surg Pathol 21:763–771PubMedCrossRefGoogle Scholar
  20. 20.
    Evans AJ, Fayaz I, Cusimano MD, Laperriere N, Bilbao JM (2000) Combined pleomorphic xanthoastrocytoma-ganglioglioma of the cerebellum. Arch Pathol Lab Med 124:1707–1709PubMedGoogle Scholar
  21. 21.
    Perry A, Scheithauer BW, Szczesniak DM, Atkinson JL, Wald JT, Hammak JE (2001) Combined oligodendroglioma/pleomorphic xanthoastrocytoma: a probable collision tumor: case report. Neurosurgery 48:1358–1361PubMedCrossRefGoogle Scholar
  22. 22.
    Yeh DJ, Hessler RB, Stevens EA, Lee MR (2003) Composite pleomorphic xanthoastrocytoma-ganglioglioma presenting as a suprasellar mass: case report. Neurosurgery 52:1465–1469PubMedCrossRefGoogle Scholar
  23. 23.
    Saikali S, Le Strat A, Heckly A, Stock N, Scarabin J-M, Hamlat A (2005) Multicentric pleomorphic xanthoastrocytoma in a patient with neurofibromatosis type 1. J Neurosurg 102:376–381PubMedGoogle Scholar
  24. 24.
    McNatt SA, Gonzalez-Gomez I, Nelson MD, McComb JG (2005) Synchronous multicentric pleomorphic xanthoastrocytoma: case report. Neurosurgery 57:E191PubMedCrossRefGoogle Scholar
  25. 25.
    Özek MM, Sav A, Pamir MN, Özer AF, Özek E, Erzen C (1993) Pleomorphic xanthoastrocytoma associated with von Recklinghausen neurofibromatosis. Childs Nerv Syst 9:39–42PubMedCrossRefGoogle Scholar
  26. 26.
    Kubo O, Sasahara A, Tajika Y, Kawamura H, Kawabatake H, Takakura K (1996) Pleomorphic xanthoastrocytoma with neurofibromatosis type 1: case report. Noshuyo Byori 13:79–83PubMedGoogle Scholar
  27. 27.
    Ohta S, Ryu H, Miura K (1999) Eighteen-year survival of a patient with malignant pleomorphic xanthoastrocytoma associated with von Recklinghausen neurofibromatosis. Br J Neurosurg 13:420–422PubMedCrossRefGoogle Scholar
  28. 28.
    Naidich MJ, Walker MT, Gottardi-Littell NR, Han G, Chandler JP (2004) Cerebellar pleomorphic xanthoastrocytoma in a patient with neurofibromatosis type 1. Neuroradiology 46:825–829PubMedCrossRefGoogle Scholar
  29. 29.
    Lee TT, Landy HJ, Bruce JH (1996) Arteriovenous malformation associated with pleomorphic xanthoastrocytoma. Acta Neurochir (Wien) 138:590–591CrossRefGoogle Scholar
  30. 30.
    Yoshino MT, Lucio R (1992) Pleomorphic xanthoastrocytoma. AJNR Am J Neuroradiol 13:1330–1332PubMedGoogle Scholar
  31. 31.
    Petropoulou K, Whiteman ML, Altman NR, Bruce J, Morrison G (1995) CT and MR of pleomorphic xanthoastrocytoma: unusual biologic behavior. J Comput Assist Tomogr 19:860–865PubMedCrossRefGoogle Scholar
  32. 32.
    Nakajima T, Kumabe T, Shamoto H, Watanabe M, Suzuki H, Tominaga T (2005) Malignant transformation of pleomorphic xanthoastrocytoma. Acta Neurochir (Wien) 148:67–71CrossRefGoogle Scholar
  33. 33.
    Lubansu A, Rorive S, David P, Sariban E, Seligmann R, Brotchi J, Pirotte B (2004) Cerebral anaplastic pleomorphic xanthoastrocytoma with meningeal dissemination at first presentation. Childs Nerv Syst 20:119–122PubMedCrossRefGoogle Scholar
  34. 34.
    Blom RJ (1998) Pleomorphic xanthoastrocytoma: CT appearance. J Comput Assist Tomogr 12:351–352CrossRefGoogle Scholar
  35. 35.
    Maleki M, Robitaille Y, Bertrand G (1983) Atypical xanthoastrocytoma presenting as a meningioma. Surg Neurol 20:235–238PubMedCrossRefGoogle Scholar
  36. 36.
    Jea A, Ragheb J, Morrison G (2002) Unique presentation of pleomorphic xanthoastrocytoma as a lytic skull lesion in an eight-year-old girl. Pediatr Neurosurg 37:254–257PubMedCrossRefGoogle Scholar
  37. 37.
    Tien RD, Cardena CA, Rajagopalan S (1992) Pleomorphic xanthoastrocytoma of the brain: MR findings in six patients. AJR Am J Roentgenol 159:1287–1290PubMedGoogle Scholar
  38. 38.
    Brown JH, Chew FS (1993) Pleomorphic xanthoastrocytoma. AJR Am J Roentgenol 160:1272PubMedGoogle Scholar
  39. 39.
    Rippe DJ, Boyko OB, Radi M, Worth R, Fuller GN (1992) MRI of temporal lobe pleomorphic xanthoastrocytoma. J Comput Assist Tomogr 16:856–859PubMedCrossRefGoogle Scholar
  40. 40.
    Levy RA, Allen R, McKeever P (2005) Pleomorphic xanthoastrocytoma presenting with massive intracranial hemorrhage. AJNR Am J Neuroradiol 17:154–156Google Scholar
  41. 41.
    Yoshida D, Kogiku M, Noha M, Takahashi H, Teramoto A (2005) A case of pleomorphic xanthoastrocytoma presenting with tumoral hemorrhage. J Neurooncol 71:169–171PubMedCrossRefGoogle Scholar
  42. 42.
    Osborn AG, Blaser S, Salzman KL (2004) Diagnostic imaging: brain. WB Saunders/Amirsys, Philadelphia. pp 34–37Google Scholar
  43. 43.
    Mascalchi M, Muscas GC, Galli C, Bartolozzi C (1994) MRI of pleomorphic xanthoastrocytoma: case report. Neuroradiology 36:446–447PubMedCrossRefGoogle Scholar
  44. 44.
    Pierallini A, Bonamini M, Di Stefano D, Siciliano P, Bozzao L (1999) Pleomorphic xanthoastrocytoma with CT and MRI appearance of meningioma. Neuroradiology 41:30–34PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Ana M. Crespo-Rodríguez
    • 1
    Email author
  • James G. Smirniotopoulos
    • 2
  • Elisabeth J. Rushing
    • 3
  1. 1.Servicio de RadiodiagnósticoHospital Universitario Clínica Puerta de HierroMadridSpain
  2. 2.Department of Radiology and Nuclear MedicineUniformed Services UniversityBethesdaUSA
  3. 3.Department of Neuropathology and Ophthalmic PathologyArmed Forces Institute of PathologyWashington DCUSA

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