Rarely, dense Rosenthal fiber deposition, often perivascular and subpial, may be indicative of Alexander disease, a rare genetic disorder caused by mutations in the glial fibrillary acidic protein (GFAP) gene, which may uncommonly manifest in children and/or adults with a spinal or brain stem mass-like lesion, prompting consideration of a neoplastic process and biopsy. This evidence concerns the gene GFAP and Alexander disease.