Unpredictable Evolution of Pilocytic Astrocytoma in Adults - A Case Series and Diagnostic Challenges

Sep 28, 2026

Unpredictable clinical evolution and nonspecific symptoms complicate diagnosis and prognosis of pilocytic astrocytoma in adults. This case series reports four female patients aged 58–76 years, managed over 15 years, with final diagnosis confirmed by histopathology. Imaging was misleading in three cases, suggesting stroke or metastases, while immunohistochemistry supported diagnosis using IDH1, Ki-67, Nestin, p53, MGMT, and PTEN. Tumor progression occurred in one case and death in another; two patients had favorable outcomes without disability after 5 years. The report highlights the diagnostic and prognostic value of immunohistochemistry.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Case series

Patients and final diagnosis

Clinical presentation and diagnostic approach

Immunohistochemistry and outcomes

Conclusions

Diagnostic difficulties and prognostic role of immunohistochemistry

Need for standardized protocols and molecular evidence

e-ISSN 1941-5923 © Am J Case Rep, 2025; 26: e947774 DOI: 10. 12659/AJCR.947774 Received: 2024.12.20 Accepted: 2025.10.23 Available online: 2025.11.07 Published: 2025.12.12 Unpredictable Evolution of Pilocytic Astrocytoma in Adults: A Case Series and Diagnostic Challenges Authors’ Contribution: Study Design A Data Collection B Statistical Analysis C Data Interpretation D Manuscript Preparation E Literature Search F Funds Collection G ABEF 1 ACDE 1-3 BDFG 1-3 DEG 1,2 BCD 1,2 BDG 1 CEF 1,2 CDE 1,2 Anamaria Sincu Cristian-Ionut Orasanu Raluca Ioana Voda Madalina Bosoteanu Manuela Enciu Sorin Vamesu Sinziana Andra Ghitoi Mariana Deacu 1 Department of Pathology, Clinical Service of Pathology,“Sf. Apostol Andrei”Emergency County Hospital, Constanta, Romania 2 Faculty of Medicine,“Ovidius” University of Constanta, Constanta, Romania 3 Department of Histopathology, Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), Constanta, Romania Corresponding Author: Cristian Ionut Orasanu, e-mail: [critian.ionut@gmail.com](critian.ionut@gmail.com)[ ](critian.ionut@gmail.com)[Financial support:](Financial support: None declared)[ None declared](Financial support: None declared) [Conflict of interest:](Conflict of interest: None declared)[ None declared](Conflict of interest: None declared) Case series Patients: Female, 58-year-old • Female, 63-year-old • Female, 63-year-old • Female, 76-year-old Final Diagnosis: Pilocytic astrocytoma Symptoms: Headache • nausea • vomiting Clinical Procedure: — Specialty: Pathology Objective: Rare disease Background: Pilocytic astrocytomas are WHO grade 1 tumors frequently identified in children and young adults, with a male predominance. This pathology is uncommon in adults, representing 0.8% of central nervous system tumors. The significance of these tumors is underscored by their recurrence rates, which are 38.9% following subtotal resection and 4% after complete resection. This study presents 4 cases of female patients, aged between 58 and 76 years, managed in our service in the last 15 years. Case Reports: Clinical manifestations (headache, nausea, and vomiting) were nonspecific. Imaging helped in 1 case. In 3 cases, imaging caused confusion by indicating either a stroke (1 case) or metastases (2 cases). Diagnosis was determined through histopathological examination. Immunohistochemical assays were conducted to confirm the diagnosis (IDH1, Ki-67, Nestin, and p53) and to evaluate the prognosis and risk of progression/recurrence of the cases (MGMT and PTEN). Of the 4 cases, there was 1 case of tumor progression and 1 of death. Two cases presented a favorable evolution, surviving without disabilities 5 years after diagnosis. We compared our results with other studies and observed similarities and differences between patients, including variations in age and sex. Conclusions: This rare tumor’s nonspecific symptomatology and imaging make diagnosis and prognosis difficult. The cases illustrate the significant role of immunohistochemical assays in diagnosing and evaluating patient prognosis. The clinical applicability of these tests must be corroborated with clinical presentation and neurosurgical resection to highlight progression and recurrence rates. Standardized protocols and molecular-based evidence are essential for optimizing patient management and outcomes. Keywords: Astrocytoma • Brain Neoplasms • Prognosis • Survival Full-text PDF: [https://www.amjcaserep.com/abstract/index/idArt/947774](https://www.amjcaserep.com/abstract/index/idArt/947774) 4761 1 4 51 Publisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guarant

FAQs

Why is diagnosing pilocytic astrocytoma in adults challenging in this case series?

Symptoms were nonspecific, and imaging led to confusion in three of four cases by mimicking stroke or metastases. Definitive diagnosis required histopathological examination and immunohistochemistry.

What immunohistochemical markers were used to confirm diagnosis and assess prognosis?

IDH1, Ki-67, Nestin, and p53 were used to support diagnosis, and MGMT and PTEN were used to evaluate prognosis and risk of progression or recurrence.

What outcomes were observed among the four adult female patients?

There was one tumor progression and one death. Two cases showed favorable evolution, with survival without disabilities five years after diagnosis.

Sep 28, 2026

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