An atypical presentation of a pleomorphic xanthoastrocytoma in a 66-year-old woman, a case report

Pleomorphic xanthoastrocytoma (PXA) is a rare astrocytic tumour, typically affecting young patients and most often located in the temporal lobe. We report an unusual case in a 66-year-old woman presenting with memory disturbance, dysphasia, headache, right-sided hemianopsia, and unilateral blindness. MRI imaging revealed a haemorrhagic, multiloculated, predominantly cystic lesion with extensive perilesional oedema in the left occipital lobe. Due to its atypical and non-specific appearance, the lesion could not be confidently diagnosed pre-operatively. Complete surgical resection was performed, and histopathology confirmed PXA, CNS WHO grade 2, with BRAF V600E mutation. The patient recovered without postoperative complications and remains disease-free at 1-year follow-up without adjuvant therapy. This case expands the known clinical and radiological spectrum of PXA, highlighting that it can occur in older patients, in uncommon locations, and with atypical imaging features. It underscores the importance of histopathological and molecular analysis for definitive diagnosis and supports gross total resection as the mainstay of treatment.