Atypical pleomorphic astrocytoma in the pineal gland: Case report

OBJECTIVE AND IMPORTANCE: We report a rare case of pleomorphic astrocytoma in the pineal region that took a benign course despite pleomorphism. CLINICAL PRESENTATION: A 30-year-old woman suddenly developed right hemipar esis followed by loss of consciousness. A computed tomographic scan reveale d a mass in the pineal region accompanied by obstructive hydrocephalus. Her symptoms improved after ventriculoperitoneal shunt surgery. INTERVENTION: The tumor was totally removed in an en bloc fashion using the occipital interhemispheric transtentorial route. Light microscopy revealed that the tumor had marked pleomorphism and multinucleated, bizarre giant c ells, but neither mitosis nor necrosis was seen. Glial fibrillary acid prot ein was immunohistochemically positive in a few tumor cells. Retinal solubl e antigen was negative. No reticulin network between the tumor cells was ob served. A histological diagnosis of atypical pleomorphic astrocytoma was ma de. CONCLUSION: No signs of recurrence have been observed for 7 years after sur gery without adjuvant therapy. Histologically, the tumor resembled pleomorp hic xanthoastrocytoma or pleomorphic granular cell astrocytoma, but the imm unohistochemical findings were not completely compatible with either diagno sis. This benign astrocytoma in the pineal gland with unique features is th e first such case reported.