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A case of recurrent pleomorphic xanthoastrocytoma (PXA) was reported. A 46-year-old male underwent total removal of mural nodule from cystic tumor in the left temporal lobe in 1986. Histological diagnosis was astrocytoma. There were no abnormal neurological signs or symptoms after the operation. However, 6 years after the operation he complained of strong unpleasant smell as of rotten onions and was admitted to our hospital. MRI revealed a cystic tumor with a mural nodule which was enhanced markedly by Gd-DTPA in the same location as previous tumor site. He was operated upon again and tumor was removed with the cyst wall. Histological diagnosis was PXA. Surgical procedures for removal of cystic PXA has been controversial; removal of tumor only, tumor removal with biopsy of cyst wall, or tumor removal with resection of cyst wall. Real reason for recurrence of this tumor in our case is unknown. However, since astrocytoma cells were found in the biopsy specimen of the cyst wall at time of the first operation, the tumor might have recurred from these cells. Therefore, this time we removed not only the mural nodule but also the cyst wall, because the cyst wall peeled off easily. We would like to propose that PXA cyst walls should be resected, whenever possible, in order to accomplish total removal of tumor.
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