Pleomorphic Xanthoastrocytoma Mimicking A Convexity Meningioma

Case Report

Abstract

A 71-year-old male was referred to Kenyatta National Hospital with a background history of right-sided focal onset convulsions with secondary generalization for 2 years. The patient had been optimized on sodium valproate and levetiracetam, but the episodes were recalcitrant. Systemic review was unremarkable. Significant medical history was hypertension that was controlled on hydrochlorothiazide. Physical examination findings were unremarkable in all the systems. The laboratory findings were also unremarkable, including the extended biochemical profile. CT findings: left frontal lobe-wide dural-based lesion with contrast enhancement MRI findings: Extra-axial lesion with significant perilesional edema with no clear cut cerebrospinal fluid cleft noted. Dural enhancement noted. Radiological diagnosis: High-grade left-sided convexity meningioma. Differential diagnosis: Solitary Fibrous tumour, Lymphoma, dural metastasis. Intraoperative Findings: Myocutaneous flap opened in standard fashion and craniotomy done. Dural-based lesion noted to be fibrous but no arachnoid plane noted. Lesion resected. Histology result: Pleomorphic xanthoastrocytoma WHO Grade 2 Densely cellular neoplasm with increased vascularity and no necrotic areas. Pleomorphic with large cells with some multinucleated with no mitotic figures. Microcyst formation noted and eosinophilic granular bodies. Ki  67  less  than  1% BRAF V600E staining negative