Angiocentric Glioma in an Elderly Patient: Case Report and Review of the Literature

• Published in: World neurosurgery Vol. 97; pp. 755.e5 - 755.e10
• Main Authors: Gonzalez-Quarante, Lain Hermes, Fernández Carballal, Carlos, Agarwal, Vijay, Vargas Lopez, Antonio J, Gil de Sagredo del Corral, Oscar Lucas, Sola Vendrell, Emma
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2017
• Subjects: Aged, 80 and over; Angiocentric glioma; Brain Neoplasms - classification; Brain Neoplasms - pathology; Brain Neoplasms - surgery; Diagnosis, Differential; Elderly patient; Evidence-Based Medicine; Glioma - classification; Glioma - pathology; Glioma - surgery; Grade I glioma; Humans; Intractable seizures; Low-grade glioma; Male; Neurosurgery; Rare Diseases - pathology; Rare Diseases - surgery; Treatment Outcome; Elderly patient; Grade I glioma; Magnetic resonance imaging; MRI; Low-grade glioma; Central nervous system; EMA; CNS; Epithelial membrane antigen; Angiocentric glioma; Intractable seizures
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.10.034

Background Angiocentric glioma is a very uncommon low-grade tumor, predominantly occurring in pediatric patients, that was first described in 2005 and was codified 2 years later as a new central nervous system primary tumor. We herein report an exceptionally rare case of an elderly patient with angiocentric glioma. Only one additional case of angiocentric glioma in a patient older than 65 years has been hitherto reported. Case Description An 83-year-old male patient presented at our institution complaining of a 1-month history of progressive weakness of his right hand and difficulty performing fine movements. Magnetic resonance imaging of the brain was performed, and fluid-attenuated inversion recovery and T2-hyperintense diffuse cortico-subcortical lesion were reported. A neuronavigation-guided frontal craniotomy was performed to expose the premotor cortex, motor cortex, Rolandic sulcus, and postcentral gyrus. Intraoperative mapping showed that the tumor was close to the shoulder area. Therefore, only partial resection was safely feasible. Pathology report described astrocytic neoplastic cells affecting mainly the cortex and piamater with the classic finding of subpial palisading, with no endothelial invasion or atypia. Neoplastic cells were positive for glial fibrillary acidic protein, epithelial membrane antigen, Wilms tumor protein-1, P16, and P53. Low proliferative activity was seen (Ki-67 < 2%). Abundant gliovascular structures were also reported. Conclusions Considering the morphologic and immunohistochemical data, the final pathologic diagnosis was angiocentric glioma. Furthermore, a thorough review of the literature was performed with the purpose of updating and summarizing the main clinical, radiologic, and pathologic features of this rare tumor.