A case of pleomorphic xanthoastrocytoma presenting with massive tumoral hemorrhage

Abstract

Pleomorphic xanthoastrocytoma has been generally conceived to be in a benign nature, showing a relatively favorable prognosis. Apoplectic attack attributable by massive hemorrhage in this distinct form of the supratentorial glioma is an exceedingly rare event. A 61-year-old female presented with a sudden onset of generalized tonic--clonic convulsion. CT and MRI disclosed the presence of a tumor composing of massive intra-tumoral hemorrhage filling the cyst associated with mural nodule in the left frontotemporal lobe. At surgery, the subpial mass involving hematoma was well marginated and slightly adherent to the dura mater. It could be removed totally and proved to be a pleomorphic xanthoastrocytoma. The unusual hemorrhagic presentation of this typically benign entity is extremely rare and is thought to be intra-tumoral bleeding in this case, since subarachnoid hemorrhage was absent.

Massive Intracranial Hemorrhage Associated With Pleomorphic Xanthoastrocytoma -Case Report-

“…11) Two other case reports described pleomorphic xanthoastrocytoma presenting with intratumoral bleeding. 22,23) An unknown microscopic vascular anomaly within the tumor parenchyma was proposed to induce massive bleeding, whereas leptomeningeal invasion was unlikely because of the absence of subarachnoid hemorrhage.…”

“…3,8) Hemorrhage associated with low-grade astrocytoma is unusual, with few reports of hemorrhage associated with pleomorphic xanthoastrocytoma. 11,22,23) Leptomeningeal involvement is a frequent finding in pleomorphic xanthoastrocytoma, but arterial invasion is unknown.…”

A Rare Brain Tumour- Hypothalamic Pleomorphic Xanthoastrocytoma in a 11 Year Old Child.

“…To the best of our knowledge, only one case of pleomorphic xanthoastrocytoma involving hypothalamus has been reported in the literature 4 .Location outside the supratentorial compartment has been reported in cerebellum and spinal cord. 5 Patients typically presents in the second or third decades of life, with the median age of 14 years. Both sexes are affected equally.…”

Pleomorphic Xanthoastrocytoma with an Intracystic Hemorrhage : A Case Report and Literature Review

“…Pleomorphic xanthoastrocytoma (PXA) is an uncommon neoplasm and is considered as a low-grade tumor of adolescents and young adults with a favorable prognosis 2,5,6,11) . Although over 200 PXAs have been reported so far, the intracranial or intratumoral bleeding is an extremely rare clinical situation, and only a few English-written literatures have been found 2,8,11) .…”

“…Although over 200 PXAs have been reported so far, the intracranial or intratumoral bleeding is an extremely rare clinical situation, and only a few English-written literatures have been found 2,8,11) . Erosion of cortical artery by the tumor, thin-walled tumor vessel or unknown microvascular anomaly within the tumor were thought to be contributing factors for the bleeding episode 8,11) . When bleeding occurr, prognosis is usually poor as three of 4 reported patients died from bleeding 2,8,11) .…”