Haemorrhage into a Pilocytic Astrocytoma

pilocystic astrocytoma with haemorrhage

This 12-year-old boy presented acutely obtunded, and was found to have a haemorrhage into a cystic posterior fossa mass, which was confirmed to be a pilocytic astrocytoma. Haemorrhage is a rare, but recognised complication.

Pilocytic astrocytomas (also known as polar spongioblastoma or juvenile pilocytic astrocytoma (JPA) ) are low grade astrocytoma (WHO Grade I) found in young patients. Indeed they are the most common primary brain tumour of childhood, accounting for 5 – 10% of all gliomas. They are slow-growing well-circumscribed tumours with a good prognosis following treatment (>70% 20 year survival).

Typically (50%) they have a large cystic component with a brightly enhancing mural nodule. Usually the cyst wall does not enhance much if at all – only the nodule need be resected to effect cure. Up to 20% may demonstrate some calcification. A smaller proportion (40%) demonstrate more hetereogenous enhancement. Only 10% are completely solid.

For more about pilocytic astrocytomas please visit Radiopaedia.org here.

References:
1. Diagnostic Imaging – Brain – Osborn
2. Liana Beni-Adani et al “Cyst Wall Enhancement in Pilocytic Astrocytoma: Neoplastic or Reactive Phenomena” Pediatric Neurosurgery 2000;32:234-239

Credit: Dr Frank Gaillard