Synchronous Pediatric Supratentorial Glioblastoma Multiforme with Noncontiguous Infratentorial Pilocytic Astrocytoma: A Rare Event

The patient underwent left temporoparietal craniotomy and near total decompression of the tumor. The lesion was grayish, soft, and friable with moderate vascularity. Histopathology of the temporal lesion showed a densely cellular neoplasm with cells being round‐to‐ovoid, hyperchromatic, and exhibiting high N:C ratio, scanty, clear to eosinophilic cytoplasm with the areas of necrosis, and microvascular proliferation [Figure 3a and b]. The tumor cells showed a high p53 labeling [Figure 3c]. The MIB‐1 labeling was high [40%, Figure 3d]. The tumor cells were positive (strongly) for glial fibrillary acidic protein [Figure 3d1 inset]. These characters were diagnostic of glioblastoma (GBM) (small cell), the WHO grade‐IV. Histopathology of the cerebellar lesion showed a relatively hypocellular neoplasm with bland round vesicular nuclei, abundant piloid fibers, numerous eosinophilic granular bodies and Rosenthal fibers, and vascular proliferation [Figure 3e and f]. These features were characteristic of pilocytic astrocytoma (WHO grade‐I). Subsequently, she underwent midline suboccipital craniectomy and subtotal resection of the posterior fossa lesion. She underwent chemoradiation for the left temporal lesion and has improvement in weakness of limbs compared to preoperative status, without any fresh deficit.