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 hemiparesis followed by loss of consciousness. A computed tomographic scan revealed 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 cells, but neither mitosis nor necrosis was seen. Glial fibrillary acid protein was immunohistochemically positive in a few tumor cells. Retinal soluble antigen was negative. No reticulin network between the tumor cells was observed. A histological diagnosis of atypical pleomorphic astrocytoma was made. CONCLUSION: No signs of recurrence have been observed for 7 years after surgery without adjuvant therapy. Histologically, the tumor resembled pleomorphic xanthoastrocytoma or pleomorphic granular cell astrocytoma, but the immunohistochemical findings were not completely compatible with either diagnosis. This benign astrocytoma in the pineal gland with unique features is the first such case reported.