Pleomorphic Xanthoastrocytoma with Anaplastic Features in the Tectal Region in a Young Adult Patient: A Case Report

Background: Pleomorphic xanthoastrocytomas (PXAs) in the tectal region are exceedingly rare and have distinctive clinicopathological features.

Case presentation: A 17-year-old man was admitted to our hospital owing to headache and diplopia. Magnetic resonance imaging showed a mass lesion in the tectal gland accompanied by obstructive hydrocephalus. A biopsy and third ventriculostomy were performed. Pathological examination revealed a PXA. Total excision of the lesion was achieved via an occipital transtentorial procedure performed 6 weeks after the biopsy. A pathological examination at that time showed a PXA with anaplastic features and a high mitotic index in surgical specimens. The patient's symptoms improved after the second operation, and radiation and temozolomide-based chemotherapy were administered. No recurrence was found at 24 months after the second operation.

Conclusions: Maximum resections are recommended in cases with anaplastic features such as a high mitotic index in biopsy specimens because of the likelihood of recurrence and the low overall survival rate. We administered radiotherapy and temozolomide-based chemotherapy because of the high mitotic activity detected in surgical specimens. The postoperative course in this case is currently deemed acceptable.