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Washington University Experience | NEOPLASMS (GLIAL) | Astrocytoma, pilocytic - Gross Pathology | 2A0 Case 2 History
Case 2 History ---- The patient was an 8 year old left-handed male who presented at 9 months of age with failure to thrive. A head CT revealed a large hypothalamic neoplasm which proved to be a pilocytic astrocytoma consisting of a biphasic pattern and, unlike the tumor seen at autopsy, showed numerous microcysts. Rosenthal fibers were sparse in the original neurosurgical specimen. He was treated with BCNV chemotherapy. In 1/84 a VP shunt was placed due to obstructive hydrocephalus. In February/March 1984 he received 4960 rads of XRT. In February 1985 he developed periodic blindness. CT revealed increased multicystic nature to the mass. He had surgical aspiration of cysts on several occasions. Radioactive phosphorus was inserted without effect on fluid production. A shunt was placed from one cyst into the right atrium in November 1985 due to worsening vision and right hemiparesis. Over the next 3 years he developed seizures with increased frequency, loss of speech, ataxia and decreased activity. In December 1988 he was admitted to further evaluate growth failure. CT of the head at that time revealed a large cystic mass with irregular enhancement involving the hypothalamus, pituitary sella, left temporal and frontal lobe which was unchanged from 1 year prior. Basal ganglia calcifications and left temporal arachnoid cyst were also described. In December 1989 he was admitted with aspiration pneumonia. At the end of January 1990 he was admitted for G-tube button and Nissan fundoplication; however, the day after surgery he developed respiratory distress requiring emergent intubation. CXR revealed dense consolidation of both lungs. Right thoracentesis was performed with 140cc of straw colored fluid removed. He developed a metabolic acidosis and hypotension but aggressive measures were not taken in keeping with his poor prognosis and parents’ wishes. He died at the end of January 1990.
