case_images: PMC11151406_01
case_images: Series of axial (a, b, c, d upper row) and sagittal (e, f, g, h lower row) MR imaging over 11 years at age 2, age 6 and age 13. White arrow: suprasellar tumour. Blue arrow: leptomeningeal nodule. (a, e) Contrasted MRI brain at age 2 shows a large, solid, enhancing suprasellar mass with small enhancing leptomeningeal nodules at the right interpeduncular cistern (a) and anterior to the cerebellar vermis (e). (b, f) Repeat MRI brain at age 6 after partial tumour resection shows a smaller suprasellar mass causing obstruction of the right lateral ventricle. The leptomeningeal nodule at the right interpeduncular cistern is still present and appears isointense on T2WI (b). Contrast administration was declined at this time. (c, g) Repeat MRI brain at age 13 revealed that the residual suprasellar mass had increased in size and the leptomeningeal nodules increased in size and number in the right interpeduncular cistern (c) and anterior to the cerebellar vermis with new nodules at the craniocervical junction (d). (f, h) Repeat MRI at 8 months post surgery showed a decrease in the size of the suprasellar mass with an increase in the size and number of leptomeningeal nodules.
case_images: SAJR-28-2876-g001.jpg
case_images: PMC11151406_01_SAJR-28-2876-g001.jpg
case_images: F0001
case_images: An MRI of the brain conducted at that time showed a large lobulated suprasellar mass with intense enhancement on post-contrast imaging (Figure 1a & 1e). Post operative MRI of the brain and spine revealed a smaller suprasellar mass with a stable leptomeningeal nodule at the right interpeduncular cistern (Figure 1b & 1f). Repeat MRI brain (Figure 1c & 1g) showed that the residual suprasellar mass had increased in size with a solid-cystic appearance and extension to the right frontotemporal lobe, right midbrain and prepontine region, causing mass effect. At 8 months post-surgery, a repeat MRI of the brain and spine (Figure 1d & 1h and Figure 2c-2f) revealed a reduction in the size of the suprasellar mass with less mass effect.
case_images: Series of MR imaging of the spine at ages 6 and 13 years. Spinal MRI at age 6. (a) Sagittal T1W pre-contrast and (b) T1W post-contrast fat saturated sequence. The imaging does not reveal any spinal lesions. Spinal MRI at age 13. (c) Sagittal and (e) Axial T1W pre-contrast. (d) Sagittal and (f) Axial T1W fat saturated post-contrast. There is an enhancing intraspinal dural lesion (white arrows) at the level of L5 extending to S2, suggestive of leptomeningeal dissemination.
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case_images: PMC11151406_01_SAJR-28-2876-g002.jpg
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case_images: No significant findings were observed in the spine (Figure 2a & 2b). At 8 months post-surgery, a repeat MRI of the brain and spine (Figure 1d & 1h and Figure 2c-2f) revealed a reduction in the size of the suprasellar mass with less mass effect.
case_images: (a) Low magnification histopathological examination showing a moderately cellular tumour with hyaline vessels (black arrows) (H&E x40). (b) High magnification showing tumour cells with oval nuclei and eosinophilic globules (black arrows.) (H&E x400). (c) Higher magnification of the tumour indicating piloid astrocytic tumour cells with long delicate hair-like processes and eosinophilic Rosenthal fibres (black arrows) characteristic of pilocytic astrocytoma (H&E x600). (d) Immunohistochemical (IHC) stain showed brown staining of the tumour cells with GFAP positivity confirming glial tumour differentiation or origin (IHC x 40).
case_images: SAJR-28-2876-g003.jpg
case_images: PMC11151406_01_SAJR-28-2876-g003.jpg
case_images: F0003
case_images: Hyalinized blood vessels were noted (Figure 3a). Eosinophiloc globules (Figure 3b) and Rosenthal fibres (Figure 3c) were noted. The tumour was positive for glial fibrillary acid protein (Figure 3d) that confirmed astrocytic glial differentiation or origin.