Glioblastoma multiforme versus pleomorphic xanthoastrocytoma with anaplastic features in the pathological diagnosis: a c
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CASE REPORT
Open Access
Glioblastoma multiforme versus pleomorphic xanthoastrocytoma with anaplastic features in the pathological diagnosis: a case report Shoko M. Yamada1*, Hideki Murakami1, Yusuke Tomita1, Makoto Nakane1, Soichiro Shibui1, Mikiko Takahashi2 and Masashi Kawamoto2
Abstract Background: Pleomorphic xanthoastrocytoma (PXA) with anaplastic features should be strictly distinguished from glioblastoma multiforme (GBM). Case presentation: A case of PXA that was initially diagnosed as GBM is presented. A 42-year-old man visited our clinic because of right hemiparesis and total aphasia. Head magnetic resonance imaging demonstrated enhanced multiple cystic lesions in the left temporal lobe suggesting an intra-parenchymal brain tumor. The lesion was partially removed and GBM with a Ki-67 index of 20 % was diagnosed by pathological examination of the resected specimen. Despite receiving radiation and chemotherapy, the patient died 6 months after the first admission. At autopsy, the boundary between the tumor and normal brain tissue was clear. Large parts of the tumor demonstrated typical features of PXA, including pleomorphism, clear xanthomatous cells with foamy cytoplasm, positive silver staining, and a Ki-67 index of less than 1 %. Discussion and conclusions: GBM should be diagnosed only when the majority of the tumor cells are undifferentiated. Although the operative specimen appeared typical GBM histologically, the diagnosis of GBM was subsequently excluded by the autopsy finding that much of the tumor had the characteristic features of a benign PXA. Therefore, the final diagnosis in this case was PXA with anaplastic features. PXA with anaplastic features should be carefully distinguished from GBM to facilitate appropriate decisions concerning treatment. Keywords: Pleomorphic xanthoastrocytoma, Glioblastoma, Anaplastic features, Ki-67 index
Background The characteristic histological features of pleomorphic xanthoastrocytoma (PXA) include strong pleomorphism resembling that of glioblastoma multiforme (GBM); however, according to the WHO classification, failure to identify mitosis and necrosis should result in a diagnosis of PXA, which is classified as a grade II glial tumor [1]. The prognosis of PXA is relatively favorable; however, malignant transformation with aggressive clinical behavior has been reported in some recurrences [2, 3];
transformation to GBM has also been described [4]. When anaplastic components are identified in a tumor, the diagnosis is PXA with anaplastic features [5, 6]. We here present a case in which we believe the diagnoses of malignant transformation of PXA or PXA with anaplastic features were both inappropriate, because only the characteristic features of GBM were found on histological examination of the initial specimen, a partially resected tumor, whereas PXA was diagnosed at autopsy, when the entire tumor could be carefully examined.
* Correspondence: [email protected] 1 Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, 3-8-3 Mizonokuchi, Takats
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