Primary Anaplastic Pleomorphic Xanthoastrocytoma with Brainstem Dissemination: A Case Report from West Africa

Background Anaplastic pleomorphic xanthoastrocytoma (APXA) is a rare primary brain neoplasm with a poor prognosis. Case Description An adult male presented with a sixteen-day history of headaches. His neurologic examination revealed a left upper limb pronator drift. Neuroimaging showed a right frontoparietal tumour for which he had craniotomy and complete tumour excision. Histology revealed features of an APXA. The patient initially declined adjuvant chemoradiotherapy. He presented three months post-surgery with clinical features of raised intracranial pressure. Repeat neuroimaging showed evidence of tumour recurrence. He defaulted follow-up, subsequently re-presenting six months post-operatively with seizures, personality changes and urinary incontinence. Brain magnetic resonance imaging revealed a significant increase in his tumour size, with transcallosal spread to the contralateral frontal lobe. He later had a re-opening craniotomy and subtotal tumour excision. Histopathological evaluation of the resected specimen confirmed recurrence of the initial tumour. He received adjuvant chemoradiotherapy. At his follow-up review sixteen months post-initial diagnosis, he had optimal seizure control and complete resolution of all symptoms. He remained well until eighteen months post-diagnosis, when he developed a gait imbalance with a neuroimaging correlation of medullary tumour dissemination. He progressively deteriorated until his demise twenty-three months post-diagnosis. Conclusion We have described a rare APXA (adult-onset) in a Nigerian man with an aggressive clinical course and brainstem dissemination. The lack of timely adjuvant therapy may have contributed significantly to his poor treatment outcome. It is noteworthy that chemoradiotherapy afforded him a brief period of tumour remission. This case further highlights the challenges of neuro-oncological practice in lower- to middle-income countries where ignorance, distrust in healthcare facilities, and unregulated, unorthodox care are pervasive.