Sudden death due to a complicated subependymal giant cell astrocytoma

M. Ceaușu, S. Dermengiu, S. Hostiuc, L. Luca, C. F. Buicu

Abstract: Astrocytic tumors in children, especially subependimal giant cell astrocytoma (SEGA) are slow growing, rare and exotic tumors, with histological similarities, but with distinct evolution. We report a case of a 14 years old female with neurologic deficiency from birth, which developed an intracranial hypertension syndrome and died suddenly at the hospital. During the autopsy an ill-defined, irregular tumor, with invasion into the 3rd and the 4th ventricles was found incidentally, without any associated anomalies. Histologically, the tumor was composed of large, plump, macro-gemistocytic like cells, proliferating in well delineated solid sheets, with small areas of necrobiosis and hemorrhage. The cells had abundant cytoplasm with ground glass aspect and peripherally located nuclei. The nuclear anomalies were minimal and no atypical mitoses were noticed. GFAP, S-100 and vimentin were diffusely positive with strong IHC reaction. Ki-67 was positive in less than 5% of tumor cell nuclei. The underlying cause of death was considered the subependymal giant cell astrocytoma that caused neurological deficits favoring the lung aspiration of gastric contents complicated finally with bronchopneumonia.
Keywords: subependymal giant cell astrocytoma, sudden death, aspiration pneumonia.