Synchronous multicentric pleomorphic xanthoastrocytoma with anaplastic features: Comparative pathological study between conventional and anaplastic types

Pleomorphic xanthoastrocytoma (PXA) has been considered an astrocytic tumor with a relatively favorable prognosis. However, PXA cases having several recurrent patterns with poor prognosis have been reported in recent years, and a new concept of “PXA with anaplastic features” has been proposed. We present one such case in a 55-year-old male who presented with weakness and numbness of right upper and lower limbs since 3 months along with difficulty in walking as well as difficulty in speaking since then. He also complained of headache since 9 months. Th e magnetic resonance imaging study revealed two well demarcated, hypointense, enhancing lesions in the left parietal and posterior frontal lobes. Clinical and radiological examinations were suggestive of a metastatic neoplasm. A left parietal craniotomy was performed with total excision of the bigger lesion. Th e histopathological findings were of PXA with strong pleomorphic, xanthomatous changes, extensive areas of tumor necrosis and increased mitotic activity. Because of these characteristic findings, a histopathological diagnosis of “PXA with anaplastic features” was given. Synchronous multicentric PXA presents unique challenges since total resection of multifocal tumors can cause significant surgical morbidity. In addition, histological homogeneity among the lesions cannot be confirmed and the welldescribed potential for anaplastic transformation may be increased with multiple lesions. The pathological findings of this case is compared with the two conventional cases of PXA diagnosed in our department in the last 10 years.