Adult Pilomyxoid Astrocytoma Mimicking a Craniopharyngioma: An Unusual Suprasellar Presentation

ABSTRACT: Pilomyxoid astrocytoma (PMA) is an uncommon variant of pilocytic astrocytoma, distinguished by unique histological features and a relatively aggressive clinical course. While classically seen in infants and young children, PMA in adults, especially in the suprasellar region, is exceedingly rare. We report a 42-year-old woman presenting with progressive visual decline and headaches. Imaging suggested a craniopharyngioma. Endoscopic endonasal transsphenoidal resection achieved gross total excision. Histopathology confirmed PMA, central nervous system World Health Organization Grade 1. Postoperatively, the patient experienced significant visual improvement with no new deficits. Follow-up magnetic resonance imaging demonstrated complete tumor removal and no evidence of recurrence at early surveillance. This case highlights the diagnostic challenge of adult suprasellar PMA, which may mimic craniopharyngioma radiologically. Recognition of PMA in adults is crucial, as advances in molecular diagnostics and minimally invasive surgery support tailored management and favorable outcomes.