title: Pleomorphic Xanthoastrocytoma with Anaplastic Features in the Tectal Region in a Young Adult Patient: A Case Report.
abstract: BACKGROUND
  Pleomorphic xanthoastrocytomas (PXAs) in the tectal region are exceedingly rare and have distinctive clinicopathological features.
  
  
  METHODS
  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.
authors: Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors: Yuuto
authors: Y
authors: Suzuki
authors: Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan. Electronic address: akiyuki@sapmed.ac.jp.
authors: Yukinori
authors: Y
authors: Akiyama
authors: Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors: Yuusuke
authors: Y
authors: Kimura
authors: Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors: Shintaro
authors: S
authors: Sugita
authors: Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors: Tadashi
authors: T
authors: Hasegawa
authors: Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors: Nobuhiro
authors: N
authors: Mikuni
mesh_terms: D000293:Adolescent; D001254:Astrocytoma / Q000000981:diagnostic imaging / Q000628:therapy*; D020295:Brain Stem Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D016896:Treatment Outcome
keywords: Anaplastic; Pleomorphic xanthoastrocytoma; Tectal