Pleomorphic xanthoastrocytoma (PXA) has been considered an astrocytic tumor with a relatively favorable prognosis.
However, PXA cases having several recurrent patterns with poor prognosis have been reported in recent years, and a new
concept of �PXA with anaplastic features� has been proposed. We present one such case in a 55-year-old male who presented
with weakness and numbness of right upper and lower limbs since 3 months along with difficulty in walking as well as difficulty
in speaking since then. He also complained of headache since 9 months. The magnetic resonance imaging study revealed two well
demarcated, hypointense, enhancing lesions in the left parietal and posterior frontal lobes. Clinical and radiological examinations
were suggestive of a metastatic neoplasm. A left parietal craniotomy was performed with total excision of the bigger lesion.
The histopathological findings were of PXA with strong pleomorphic, xanthomatous changes, extensive areas of tumor necrosis
and increased mitotic activity. Because of these characteristic findings, a histopathological diagnosis of �PXA with anaplastic
features� was given. Synchronous multicentric PXA presents unique challenges since total resection of multifocal tumors can
cause significant surgical morbidity. In addition, histological homogeneity among the lesions cannot be confirmed and the well-
described potential for anaplastic transformation may be increased with multiple lesions.The pathological findings of this case is
compared with the two conventional cases of PXA diagnosed in our department in the last 10 years.
Dr Kavita Mardi has completed her MBBS at the age of 25 years from Government Medical College, Mysore, Karnataka. She has done MD in Pathology from Indira Gandhi Medical College, Shimla. She has also acquired DNB (Diplomate of National Board) degree in Pathology from National Board of Examinations, Newdelhi. She has 11 years of post PG teaching experience and presently working as Associate Professor in Pathology at Indira Gandhi Medical College, Shimla. She has published more than 75 papers in reputed national and international journals and acted as reviewer for a number of reputed journals.
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