Diffuse Astrocytoma presenting with Stroke-like Symptoms

A 75‒year‒old man was referred to our hospital following the sudden onset of a speech disorder. The patient’s neurological examination indicated severe motor aphasia and computed tomography(CT)demonstrated a low‒density area with a sharp margin in the left frontal lobe. A magnetic resonance image (MRI)revealed a hemorrhagic change in the center of the lesion with linear and spotty enhancement within the lesion. Working under a preoperative diagnosis of malignant glioma with intratumoral hemorrhage, a craniotomy was performed. The histological diagnosis was diffuse astrocytoma without any evidence of necrosis or endothelial proliferation. It is relatively uncommon for diffuse astrocytoma to manifest intratumoral hemorrhage. In this case, a focal increase in the density of tumor cells and microvessels was observed in the hemorrhagic regions. Such situations are thought to contribute to intratumoral hemorrhage even in cases of diffuse astrocytoma. (Received October 19, 2016;accepted December 13, 2016)