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Imaging Conundrum of Granular Cell Astrocytoma: A Case Report

Volume 6, Issue 1, February 2021    |    PP. 61-75    |PDF (1260 K)|    Pub. Date: January 26, 2021
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Author(s)
Fan Zhu, Department of Radiation Oncology, New York - Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
Sonal Paul, Department of Hematology and Oncology, New York - Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
Eric Miller, Department of Radiology, Ohio State University, Columbus, OH, USA
Chathula Kumarasinghe, Department of Medicine, New York - Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
Bahaa Mokhtar, Department of Radiation Oncology, New York - Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
Madhumathi Kalavar, Department of Hematology and Oncology, New York - Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA

Abstract
Introduction: Granular cell astrocytoma (GCA) does not have defined radiological criteria/appearance for diagnosis. Here we present a case of GCA that was initially diagnosed as primary CNS lymphoma before pathologic diagnosis was available.
Case Description: We report a 73 year old male patient who presented to our ED with tonic-clonic seizures with additional seizures at ED. Initial CT showed no intracranial hemorrhages and MRI brain showed T2 intense lesions in the left inferior basal ganglia, left temporal stem and left amygdala. CT abdomen and pelvis showed thickened rectosigmoid junction, enlarged prostate and no lymphadenopathy in the chest, abdomen or pelvis. MRI brain spectroscopy showed increased choline peak, decrease of NAA peak and no appreciable lactate peak and it also showed that the lesion was homogeneously enhancing with rapid growth rate. Considering all these appearances, a diagnosis of primary CNS lymphoma was considered. Patient then had a left temporal stereotactic craniotomy and microsurgical subtotal resection of the left temporal mass. A gross total resection was not possible due to the location of the lesion. Pathology showed cells with abundant granular cytoplasm, perivascular lymphocytic and histiocytic infiltrates with strong nuclear activity for Olig2 and nonreactivity for CD 163 or MNDA. A final pathological diagnosis of granular cell astrocytoma was made. Patient was treated with 60Gy radiation to his post-surgical area with concurrent temozolomide. Patient received 2 cycles of temozolomide, which was stopped due to transaminitis. Patient’s mental status and neurological status further declined after the treatment and was placed on hospice.
Conclusion: Granular cell astrocytoma can show unusual radiological appearances that can mimic primary CNS lymphoma. Pathological verification of the diagnosis is important. It should be treated as high grade glioma.

Keywords
case report, granular cell astrocytoma, MRI spectroscopy, MRI brain, radiation

Cite this paper
Fan Zhu, Sonal Paul, Eric Miller, Chathula Kumarasinghe, Bahaa Mokhtar, Madhumathi Kalavar, Imaging Conundrum of Granular Cell Astrocytoma: A Case Report, SCIREA Journal of Clinical Medicine. Vol. 6 , No. 1 , 2021 , pp. 61 - 75 .

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