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Anaplastic Astrocytoma

Thomas F Gudas, MD
Roman A Klufas, MD

September 15, 1994

Presentation

A 34-year-old man presented with headache and seizures.

Imaging Findings

Noncontrast CT
CT with intravenous contrast
T1-weighted MRI
T2-weighted MRI

Noncontrast head CT shows a 5 cm well-circumscribed round area of low attenuation in the white matter of the right frontal lobe (arrows). A tiny fleck of calcium is evident in the medial aspect of the lesion (arrow). There is minimal mass effect and no enhancement after intravenous contrast.

Coronal T1 and axial T2-weighted MR images show a mass with low T1 (arrows) and homogeneously high T2 (arrows) signal intensity.

Differential Diagnosis

These features are most typical for a low-grade astrocytoma. Oligodendroglioma is usually heterogeneous with nodular or clumped calcifications and mild to moderate enhancement. Ganglioglioma appears as a well-delineated cyst (lower T1 signal than this case) with a partially calcified mural nodule. Lymphoma and abscess would be clinical considerations, but the lack of contrast enhancement excludes them.

Diagnosis

anaplastic astrocytoma

Discussion

This case illustrates the difficulty in differentiating low grade or benign tumors from anaplastic astrocytoma. Both are in the biologic continuum of astrocytoma subtypes, the most common glial cell neoplasm. Anaplastic astrocytomas occupy an intermediate position between low-grade astrocytoma and glioblastoma multiforme. The peak incidence is in the fifth and sixth decades of life. Seizures and focal neurologic deficits are common presenting symptoms. Prognosis is poor with an average 2-year survival.

Imaging studies of anaplastic astrocytoma show an inhomogeneous, mixed attenuation/intensity mass with irregular rim enhancement. Calcification is uncommon; moderate surrounding edema is typical. These tumors occur throughout the cerebral hemispheres but are most common in the frontal and temporal lobes.

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