glioma grade 3

This is an interesting neoplasm. I assume the CT scans and histopathologic photos are from the recurrent or the new cervical spinal tumor. Since there has been radiation therapy, the necrosis seen in figure 5 may or may not be due directly to tumor. I am not certain what those structures next to necrosis are on figure 5. Figures 6, 7 and 8 clearly show a cellular neoplasm with prominent lymphoplasmacytic infiltration. These neoplastic cells have plump eosinophilic cytoplasm, eccentric or large central oval nuclei, central prominent nucleoli, and occasional binucleation. The cytoplasm suggest glial or astrocytic differentiation, but the nuclei suggest neuronal differentiation. There are not too many primary neuroepithelial neoplasms with such histopathologic appearance and anatomic location. One that comes to my mind is subependymal giant cell astrocytoma, a WHO grade I lesion that may have hypercellularity and focal tumor necrosis but does not behave in an aggressive way with CSF dissemination like this case. Certainly, it is possible to have malignant change in a subependymal giant cell astrocytoma, but multiple synchronous or metachronous tumors may be seen in patients with tuberous sclerosis. I cannot say for sure that this is a case of atypical SEGA or anaplastic/malignant SEGA without seeing more photos of the original and recurrent tumors. Interesting case this is!

  I agree with gemistocytic astrocytoma.  Those fat eosinophilic cells (like plasma cells) are gemistocytes (I learned this from my first year autopsy and medical examiners office rotation.

Thanks a lot.  I dont see brain tumor anymore (only in PIPs) and feel very interesting to see them again.