Multifocal anaplastic astrocytoma mimicking primary central nervous system lymphoma: A case report

BACKGROUND: Multifocal anaplastic astrocytoma (MAA) is exceedingly rare. The atypical clinical symptoms and imaging characteristics pose significant challenges for accurate clinical diagnosis. CASE PRESENTATION: A 64-year-old woman presented with clinical symptoms persisting for 3 months, characterized by left-sided facial numbness, an unsteady gait that was lateralized, progressive worsening of incomplete closure of the left eye, dysphagia, and episodes of choking. Based on her clinical symptoms and magnetic resonance imaging (MRI), she was misdiagnosed as primary central nervous system lymphoma. Three months later, her clinical symptoms worsened, and she was admitted to neurosurgery where she underwent a stereotactic biopsy of the left cerebellar hemisphere. Histopathological examination and immunohistochemical analysis were consistent with anaplastic astrocytoma, IDH wild-type status, classified as World Health Organization grade 3. CONCLUSION: MAA exhibits a rapid progression and is associated with a poor prognosis. Clinicians must enhance their understanding of the MRI manifestations of MAA. Moreover, when MRI findings are insufficient to establish a definitive diagnosis, brain stereotactic examination becomes essential.