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

Shunsuke Shibao, Tokuhiro Kimura, Hikaru Sasaki, Hirokazu Fujiwara, Takenori Akiyama, Mari Ueno, Satoka Shidoh, Kazunari Yoshida

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15 Citations (Scopus)

Abstract

Pilocytic astrocytoma (PA) is a low-grade astrocytic tumor arising predominantly during the first two decades of life. Hemorrhagic onset of PAs is uncommon, and the etiology of hemorrhage remains unclear. Here we report a case of hemorrhagic onset of cerebellar PA in a 29-year-old man who presented with a week-long history of headache and gait instability. Computed tomography and magnetic resonance imaging revealed a hemorrhagic tumor located in the right cerebellar hemisphere, and total resection was performed. Histological examination showed bipolar glial cell proliferation in a biphasic pattern in a compact area and a loose microcystic area with Rosenthal fibers and eosinophilic granular bodies, indicating PA. Prominent changes in tumor vasculature, including aggregation of sclerotic thick-walled and ectatic thin-walled vessels, was observed, and nodules of thrombi containing complex vascular proliferation suggesting recanalized thrombi formed in partially ruptured vessels were also found. Thus, rupture of these abnormal vessels appeared to be the cause of hemorrhage. Review of the literature revealed that age distribution of patients with hemorrhagic PAs tends to be older than that of patients with general PAs. These findings imply a possibility that degenerative changes in blood vessels in long-standing PAs might be related to the mechanisms of spontaneous intratumoral hemorrhage.

Original languageEnglish
Pages (from-to)96-102
Number of pages7
JournalBrain Tumor Pathology
Volume29
Issue number2
DOIs
Publication statusPublished - 2012 Apr

Fingerprint

Astrocytoma
Blood Vessels
Hemorrhage
Thrombosis
Neoplasms
Age Distribution
Gait
Neuroglia
Headache
Rupture
Tomography
Magnetic Resonance Imaging
Cell Proliferation

Keywords

  • Adult
  • Hemorrhage
  • MIB-
  • Pilocytic astrocytoma
  • Vasculature

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Clinical Neurology

Cite this

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title = "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",
abstract = "Pilocytic astrocytoma (PA) is a low-grade astrocytic tumor arising predominantly during the first two decades of life. Hemorrhagic onset of PAs is uncommon, and the etiology of hemorrhage remains unclear. Here we report a case of hemorrhagic onset of cerebellar PA in a 29-year-old man who presented with a week-long history of headache and gait instability. Computed tomography and magnetic resonance imaging revealed a hemorrhagic tumor located in the right cerebellar hemisphere, and total resection was performed. Histological examination showed bipolar glial cell proliferation in a biphasic pattern in a compact area and a loose microcystic area with Rosenthal fibers and eosinophilic granular bodies, indicating PA. Prominent changes in tumor vasculature, including aggregation of sclerotic thick-walled and ectatic thin-walled vessels, was observed, and nodules of thrombi containing complex vascular proliferation suggesting recanalized thrombi formed in partially ruptured vessels were also found. Thus, rupture of these abnormal vessels appeared to be the cause of hemorrhage. Review of the literature revealed that age distribution of patients with hemorrhagic PAs tends to be older than that of patients with general PAs. These findings imply a possibility that degenerative changes in blood vessels in long-standing PAs might be related to the mechanisms of spontaneous intratumoral hemorrhage.",
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T2 - A case report and review of the literature implying a possible relation of degenerative vascular changes to the massive intratumoral hemorrhage

AU - Shibao, Shunsuke

AU - Kimura, Tokuhiro

AU - Sasaki, Hikaru

AU - Fujiwara, Hirokazu

AU - Akiyama, Takenori

AU - Ueno, Mari

AU - Shidoh, Satoka

AU - Yoshida, Kazunari

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AB - Pilocytic astrocytoma (PA) is a low-grade astrocytic tumor arising predominantly during the first two decades of life. Hemorrhagic onset of PAs is uncommon, and the etiology of hemorrhage remains unclear. Here we report a case of hemorrhagic onset of cerebellar PA in a 29-year-old man who presented with a week-long history of headache and gait instability. Computed tomography and magnetic resonance imaging revealed a hemorrhagic tumor located in the right cerebellar hemisphere, and total resection was performed. Histological examination showed bipolar glial cell proliferation in a biphasic pattern in a compact area and a loose microcystic area with Rosenthal fibers and eosinophilic granular bodies, indicating PA. Prominent changes in tumor vasculature, including aggregation of sclerotic thick-walled and ectatic thin-walled vessels, was observed, and nodules of thrombi containing complex vascular proliferation suggesting recanalized thrombi formed in partially ruptured vessels were also found. Thus, rupture of these abnormal vessels appeared to be the cause of hemorrhage. Review of the literature revealed that age distribution of patients with hemorrhagic PAs tends to be older than that of patients with general PAs. These findings imply a possibility that degenerative changes in blood vessels in long-standing PAs might be related to the mechanisms of spontaneous intratumoral hemorrhage.

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