Journal of Neuropathy and Experimental Neurology
Patient is a 57 yo man who presented with periodic headaches and lower back pain, initially attributed to lifting heavy weights but symptoms persisted. Eventual imaging was performed and revealed a 4 cm heterogeneously enhancing left cerebellar mass, 1 cm enhancing lateral right frontal subcortical lesion, and enhancing T12-L1 spinal cord lesion and multiple smaller spinal cord lesions suggestive of drop metastasis. The cerebellar lesion was first resected and final results, including methylome profiling, were consistent with high grade astrocytoma with piloid features (HGAP). The T12-L1 spinal lesion was later resected and had somewhat distinct histology although intraoperatively surgeon felt it appeared similar but was also sent off for methylome profiling, the results of which are currently pending. The subcortical lesion was not resected but was treated with radiation. HGAP is generally solitary and this case is of interest due to possible drop met, or just the presence of multiple CNS tumors.
Fullmer J. 57 yo man with high grade astrocytoma with piloid features and 2 other CNS lesions. J Neuropathol Exp Neurol. 2023 Jun;82(6):535. doi:10.1093/jnen/nlad029