Extraneural metastases of a cerebral astrocytoma.

CASE HISTORY A 4 year old boy was admitted to the Hospital for Sick Children in July 1975 with a history starting in September 1974. At that time, he began having minor seizures in which he stared, and he regressed in speech and motor ability. It is interesting that his mother, who had been concerned about him, was told by a psychic that her son had a brain tumor. At the time of admission, he was neurologically intact with no signs of raised intracranial pressure. A brain scan showed increased uptake in the left temporal region, a CT scan showed a contrast enhancing mass in the left middle fossa, and a left carotid angiogram showed a large avascular mass in the left temporal lobe (Figure 1). On July 24, 1975 through a left temporal craniotomy, 95% of a parenchymal temporal lobe tumor was grossly removed. The portion of the tumor which was adherent medially, in the region of the internal carotid artery, was left. The tumor was described as the size of an orange. Histological examination showed a sparsely cellular tumor in which the nuclei were round to oval in appearance and cytoplasm was abundant and formed prominent cytoplasmic processes. These processes strained positively with the glial fibrillary acidic protein (GFAP) stain and with the phosphotungsic acid hemotoxylin (PTAH) stain (Figure 2). The nuclei showed a mild variation in degree of chromaticity and size. The histology of this tumor was that of a fibrillary astrocytoma, low grade. Because some tumor had been left behind together with the mild pleomorphism in the tumor, he was subjected to a course of postoperative radiotherapy at the Princess Margaret Hospital. Seizures continued to be an intermittent problem for which he received anticonvulsant medication. A brain scan in March, 1976 and a CT scan in November 1976 showed no evidence of residual tumor (Figure 3). A psychometric assessment in May 1978 revealed a full scale I.Q. of 79.