Astrocitoma anaplásico do cerebelo: relato de caso / Anaplasic cerebellar astrocytoma: case report

Astrocitomas de alto grau são tumores de apresentação rara na fossa posterior, especialmente na idade adulta. A sobrevida média descrita na literatura é de cerca de 14 a 32 meses. A apresentação clínica mais frequente é na forma de síndrome de hipertensão intracraniana. Tende a evoluir com disseminação leptomeníngea e também pode estender-se ao tronco cerebral e à medula. Apresentamos um caso de astrocitoma anaplásico (grau III) da fossa posterior numa mulher de 62 anos, o único observado num adulto no nosso hospital num período de 10 anos. O diagnóstico foi confirmado com biópsia estereotáxica da lesão. A apresentação clínica está de acordo com o descrito na literatura, contudo a sobrevida observada foi significativamente mais curta.

High grade astrocytomas are rare tumors in posterior fossa, especially in adulthood. The median survival reported in literature is around 14 to 32 months. The most frequent clinical presentation is intracranial hypertension syndrome. It tends to present leptomeningeal dissemination and may also extend to the brainstem and spinal cord. We present a case of anaplastic astrocytoma (grade III) in the posterior fossa in a 62 year-old female, the only adult presentation of this tumor observed in our hospital over a period of 10 years. The diagnosis was confirmed by stereotactic biopsy of the lesion. The clinical presentation is consistent with that described in the literature, however the survival time was significantly shorter.

Clinical Analysis of Posterior Fossa Tumors

We have experienced 56 cases of posterior fossa tumors which were diagnosed with clinical symptoms, angiography, brain computerized tomography scan and/or operative and pathologic findings at the department of neurosurgery of Catholic University Medical College from January 1983 to December 1987. The results were summarized as follows: 1) Cerebellar astrocytomas were the most common posterior fossa tumors(21%). 2) The male to female ratio of posterior fossa tumors was equal. The astrocytoma and hemangioblastoma were frequent in male, but brain stem glioma, acoustic neuroma and meningioma were more frequent in female. 3) The posterior fossa tumors were more frequent in younger persons. 4) The most common duration symptoms were within 3 months(39%) and the common clinical features were headache(73%), nausea and vomiting(48%). In neurological examination, cerebellar signs were present in most cases(63%). 5) In brain computerized tomography scan, low density(46%) and contrast enhancement(63%) were common features and in vertebral angiography, mass effect(93%) in posterior fossa tumors. 6) The most postrior fossa tumors showed relatively good prognosis(61%) but mortality rate was high(30%).

Clinical Analysis of Posterior Fossa Tumors

We have experienced 56 cases of posterior fossa tumors which were diagnosed with clinical symptoms, angiography, brain computerized tomography scan and/or operative and pathologic findings at the department of neurosurgery of Catholic University Medical College from January 1983 to December 1987. The results were summarized as follows: 1) Cerebellar astrocytomas were the most common posterior fossa tumors(21%). 2) The male to female ratio of posterior fossa tumors was equal. The astrocytoma and hemangioblastoma were frequent in male, but brain stem glioma, acoustic neuroma and meningioma were more frequent in female. 3) The posterior fossa tumors were more frequent in younger persons. 4) The most common duration symptoms were within 3 months(39%) and the common clinical features were headache(73%), nausea and vomiting(48%). In neurological examination, cerebellar signs were present in most cases(63%). 5) In brain computerized tomography scan, low density(46%) and contrast enhancement(63%) were common features and in vertebral angiography, mass effect(93%) in posterior fossa tumors. 6) The most postrior fossa tumors showed relatively good prognosis(61%) but mortality rate was high(30%).