Pilomyxoid astrocytoma of the cerebellar vermis in an elderly patient.
BACKGROUND
Pilomyxoid astrocytoma (PMA) has recently been accepted as an aggressive variant of pilocytic astrocytoma with distinct histopathological features. PMAs have been frequently described in the pediatric population with a predilection for the hypothalamic/chiasmatic region.


METHODS
A 72-year-old African American male presented with 6 months of memory loss, difficulty expressing himself, and a progressively worsening gait. Magnetic resonance imaging of the brain demonstrated a heterogeneously enhancing cystic mass centered within the cerebellar vermis with mass effect on the fourth ventricle and ventriculomegaly. The patient underwent placement of a ventriculoperitoneal shunt followed by a surgical resection of the lesion, which after immunohistopathologic evaluation, was diagnosed as a World Health Organization grade II PMA. The patient refused further treatment of the lesion and expired 11 months after initial symptom presentation and 4 months after surgery.


CONCLUSIONS
To our knowledge, this is the first report of PMA of the cerebellar vermis in a previously unreported age group. This case report describes the natural history of this type of tumor in a patient who refused adjuvant therapy following surgical resection.
Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA.
Branko
B
Skovrlj
Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA.
Margaret
M
Pain
Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA.
Joshua B
JB
Bederson
Department of Pathology, Mount Sinai School of Medicine, New York, NY, USA.
Mary
M
Fowkes
Cerebellar vermis; elderly patient; natural history; pilomyxoid astrocytoma