Exploring an classical case of Pilomyxoid astrocytoma and its diagnostic challenges: insights from literature

Pilocytic astrocytoma (PA) is the most commonly diagnosed primary brain tumor in children. The majority of documented astrocytic tumors are low-grade, with PA being the most prevalent. Pilomyxoid astrocytoma (PMA), a variant of PA, generally exhibits a more aggressive behavior compared to other variants. Due to its rarity and overlapping features with other entities in the literature, this case has been reported and discussed. This report describes a case involving a 2-year-old boy presenting with a well-defined, lobulated lesion in the suprasellar region, alongside a review of relevant literature. During squash cytology from the frozen section, a low-grade tumor was identified, composed of cells with elongated, fibrillary cytoplasm and round to oval nuclei with dispersed chromatin. Histological examination confirmed the diagnosis, and we will provide a detailed account of the lesion’s histological and radiological features. Additionally, the report discusses the treatment options and the patient’s outcome. The diagnosis is challenging due to histological similarities to classic pilocytic astrocytoma, a difficulty often exacerbated by the limited tissue obtained from small biopsies in unresectable tumors. Squash cytology can only be used as a screening tool. Although classified as low-grade pediatric gliomas, PMA tends to be more aggressive than PA. Surgical resection remains the preferred treatment for effective disease management, although there is a risk of recurrence.