Hemorrhagic presentation of intracranial pilocytic astrocytomas: literature review
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Pilocytic astrocytomas (PAs) are seemingly innocuous and benign tumors. However, in recent times, many case series have documented high rates of hemorrhage in these neoplasms. We hereby provide a detailed analysis on hemorrhagic pilocytic astrocytomas (HPA) in adults and report one such case managed at our institute. In addition, salient differences between adult and pediatric hemorrhagic PA have been briefed. Hospital records were retrieved for our case. Literature review was conducted by searching online databases for the following keywords—pilocytic astrocytoma, hemorrhage, cranial, pediatric, and adults. A 22-year-old male with neurofibromatosis-1 presented with sudden onset headache and vomiting of 3-day duration. Imaging revealed a lobulated suprasellar lesion with obstructive hydrocephalus. Pterional transsylvian approach and subtotal resection were performed. Histopathology showed features of PA with bleed. Including current report, a total of 26 cases have been reported. Mean age was 37 years (21–75 years) and they are mostly found in the third decade. The male:female ratio was 2.1:1. Sudden headache with vomiting was the most common symptoms. Tumors were mostly located in cerebral hemispheres (n = 9/34.6%), hypothalamus/suprasellar region (n = 7/27%), and cerebellum (n = 6/23%). Two-thirds underwent gross total excision. There were two deaths and except one case, no recurrences were reported in those with available follow-ups. Hemorrhagic presentation of a PA is rare, although more commonly seen in adults and most commonly located in cerebral hemispheres. Maximal safe resection is the standard treatment and recurrences are rare.
KeywordsPilocytic astrocytoma Hemorrhage Hemorrhagic onset Suprasellar Chiasmatic hypothalamic Cerebellum
No funding was obtained for this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval was felt not necessary as it was a single case operated in standard manner and a review of existing world literature was done.
Informed consent was taken from the patient.
- 10.Byard RW, Bourne AJ, Hanieh A (1991–1992) Sudden and unexpected death due to hemorrhage from occult central nervous system lesions. A pediatric autopsy study. Pediatr Neurosurg 17:88–94Google Scholar
- 35.Shibao S, Kimura T, Sasaki H, Fujiwara H, Akiyama T, Ueno M (2012) Hemorrhagic onset of cerebellar pilocytic astrocytoma in an adult: a case report and review of the literature implying a possible relation of degenerative vascular changes to the massive intratumoral hemorrhage. Brain Tumor Pathol 29:96–102CrossRefPubMedGoogle Scholar
- 45.Scheithauer BW, Hawkins C, Tihan T, VandenBerg SR, Burger PC (2007) Pilocytic astrocytoma. In: David NL, Ohgaki H, Otmar DW (eds) WHO Classification of tumours of the central nervous system. IARC, Lyon, pp 14–21Google Scholar
- 50.Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (2007) WHO classification of tumours of the central nervous system. IARC, Lyon, pp 14–21Google Scholar
- 57.Brown PD, Buckner JC, O'Fallon JR, O’Neill BP, Gianini C, Galanis E, Shah SA, et al (2015) Adult patients with supratentorial pilocytic astrocytomas: long-term follow-up of prospective multicenter clinical trial NCCTG-867251 (Alliance). Neurooncol Pract 2:199–204Google Scholar