Disseminated Juvenile Pilomyxoid Astrocytoma of the Hypothalamic-Chiasmatic Region

Pilomyxoid astrocytoma (PMA) is a recently described histological type of pilocytic astrocytoma (PA), but the tumors show histological differences. PMA has more aggressive malignant behavior than PA. Magnetic Resonance Imaging (MRI) may play a crucial role in the preoperative setting and also help to establish an appropriate therapeutic regimen. In this case report, we illustrated MRI findings of a hypothalamic-chiasmatic PMA in a 15-year-old female patient presenting with extensive leptomeningeal seeding. The patient was operated for total tumor resection, but could not survive the second post-operative day. We have comprehensively discussed the clinical, imaging, and histopathological features of these relatively rare tumors and also reviewed the recent literature.