High-grade astrocytoma with piloid features: A case report and review of literature

Background: High-grade astrocytoma with piloid features (HGAP) is a rare, newly recognized brain tumor, typically seen in middle aged to elderly patients, often associated with neurofibromatosis type 1. Case Description: We report the first documented case of HGAP in Pakistan in a 57-year-old woman with tremors, vertigo, and cerebellar signs. Magnetic resonance imaging showed a cerebellar lesion, and after resection, initial pathology suggested a pilocytic astrocytoma. Molecular testing confirmed HGAP with a CDKN2A/B deletion. Despite treatment, including a second surgery, the disease progressed. Conclusion: This case highlights the diagnostic challenges of HGAP and underscores the importance of advanced molecular testing for accurate diagnosis. Given the poor prognosis and limited treatment options, further research is needed to understand this rare tumor entity better and improve patient outcomes.