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Unusual presentation of more common disease/injury
Case report
Reappraisal of haemorrhagic suprasellar pilocytic astrocytoma during adulthood
  1. Gustavo M Cortez1,2,
  2. Andre Monteiro1,
  3. Benjamin Ludwig1 and
  4. Ricardo Hanel1
  1. 1Department of Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA
  2. 2Research Department, Jacksonville University, Jacksonville, Florida, USA
  1. Correspondence to Dr Ricardo Hanel; rhanel{at}lyerlyneuro.com

Abstract

Pilocytic astrocytomas comprise the most common central nervous system tumour during childhood and have an excellent response to surgical treatment in this population. The tumour incidence decreases with age, whereas more aggressive behaviour tends to increase. Haemorrhage as a presenting feature of pilocytic astrocytomas is a rare phenomenon, especially in the adult population. We present a case of a 55-year-old patient with progressive headaches and dizziness. MRI confirmed a sellar and predominantly retrochiasmal suprasellar lesion with heterogeneous signal, enhancement and blood products. Management via transsphenoidal approach was performed, and histopathology revealed the unexpected diagnosis of haemorrhagic pilocytic astrocytoma. Haemorrhagic pilocytic astrocytoma is an infrequent entity in the adult population and it is essential to recognise the peculiarities regarding diagnostic evaluation and management, which differ from the paediatric population. During adulthood, this tumour carries an overall unfavourable prognosis, with higher rates of progression and recurrence.

  • neurosurgery
  • CNS cancer
  • neurooncology
  • neuroimaging
  • neuroendocrinology

https://doi.org/10.1136/bcr-2020-235662

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    Footnotes

    • Contributors GC: substantial contributions to the conceptualisation of the work, data acquisition and interpretation; drafting and revision of the work. AM: substantial contributions to the conceptualisation of the work, data acquisition and interpretation. BL: substantial contributions to the conceptualisation and design of the work. RH: original idea, data supervision and interpretation; revision of the work, approval of the final version; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests RH, senior author of the above-mentioned manuscript, is consultant for Covidien, Stryker, Codman and MicroVention.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.