Keith was 16 yrs old when he hit his head and had a seizure
Three weeks later he experienced another seizure. An MRI and CT scan performed at the time were negative.
He also complained of having several years of episodes of "deja vu" with nausea each time
Seven months later he experienced a blank staring episode followed by tonic clonic activity with left eye deviation. He was started on dilantin and another MRI was obtained which showed a right temoral lobe mass
3-dimensional rendering of a tumor located in the precentral gyrus. Functional data from magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) for the motor (MEF and MEA) and sensory (SEF, SEA) cortex clearly depict the laclisation of the central sulcus
Leftsided oligodendroglioma, which could be removed without any speech deficits, because functional navigation clearly depicted the loacalization of the motor-speecha rea, which could beprserved during surgery (a / b).
This 38 year old right handed male presented at age 35 with a generalized seizure.
A CT scan performed at a community hospital showed a focal, high left parietal mass lesion.
A subsequent stereotactic biopsy showed the lesion to be an oligodendroglioma.
The patient has been followed with annual neuroimaging and clinical exams, and has been stable with rare focal seizures.
A recent increase in seizure frequency prompted consideration of surgical resection of the mass.
A 3D reconstruction was performed to aid in the overall surgical plan.
A. shows the 3D outline of the skin and face in a dot rendering. The tumor (green), ventricular system (blue), major venous drainage (red) and a segment of brain around the tumor (gray) are shown B. shows the models with the brain segment removed. C. shows the tumor at the brain surface impinging on primary motor cortex. D. the brain segment removed to allow an understanding of the volume of tumor underlying normal brain.
This saggital section of the posterior fossa shows an ependymoma filling much of the fourth ventricle. Ependymomas are more common in children and arise in or near the ventricles because they arise from ependymal cells
The anterior choroidal artery is elevated (shown by the arrow). This confirms that the tumor is located in the inferior portion of the temporal lobe; it probably arose from the floor of the temporal horn to grow within the ventricle.
Tumor composed of small cells with a regular nucleus, forming small chains and islands disseminated throughout an abundant fibrillary framework, spongy in certain areas. The vessels may be of large caliber and their wall is sometimes very fibrous. Several calcifications are visible. A subependymoma is grossly visible in a brain section (IV.01.g1) that also contains a glioblastoma.
Demographics: Children > Adults. 40-50% papillomas seen in first year of life, 85% < 5 yrs. Carcinomas usually seen only in pediatric age group.
Clinical Presentation: Hydrocephalus
Histology: Papillomas have characteristic lobulated gross appearance. Most are well-differentiated and may resemble normal choroid plexus, however, anaplastic transformation may occur. Parenchymal invasion suggests carcinoma, but can be seen with benign .
Special Stains : Cytokeratin distinguishes from ependymoma; Prealbumin (transthyretin) may be helpful (although metastases may also stain positive)
Progression: CSF seeding may occur in both papillomas and carcinomas.
Radiology: Well-demarcated intraventricular (or cerebellopontine angle) mass with hydrocephalus. Calcification especially frequent in fourth ventricular tumors. In adult patients the fourth ventricle is more common. The tumor is attached to the choroid plexus.
Comments: Hydrocephalus may reflect multiple factors, including CSF over-production, ventricular obstruction, and impaired CSF reabsorption. Can present as a congenital neoplasm.
Cell of Origin: Cerebellar neurons (hamartomatous?)
Synonyms: Ganglioneuroma, Purkinjioma, Granular cell hypertrophy of the cerebellum, Gangliocytoma dysplasticum, Hamartoma of the cerebellum
Common Locations: Cerebellar hemispheres
Demographics: Early adulthood
Clinical Presentation: Hydrocephalus; may also be found as an incidental lesion
Histology: Derangement of normal laminar cellular organization of cerebellum: 1) Thickening of outer molecular cell layer, 2) Loss of middle Purkinje cell layer, 3) Infiltration of inner granular cell layer with dysplastic ganglion cells
Special Stains: Synaptophysin positive
Progression: Good prognosis with surgical excision. Recurrence rare.
Radiology: Non-enhancing cerebellar hemisphere mass with characteristic striated MR appearance. Occasionally contains calcifications.
Comments: Association with Cowden's disease (mucosal neuromas and breast cancer)
Billy was 8 yrs old when in the spring of 1998 his parents noticed that he would occasionally vomit in the mornings, he seemed to lack energy, and he would fall aspleep at odd times-at his desk in school, or on the bench during his little league game.
In August, Billy was brought to the ophthalmologist for a routine eye exam before school started for the year.
Note the large gray mass occupying much of the vermis of the cerebellum. This is a medulloblastoma which is a tumor of children, is very fast growing and very malignant. Fortunately, the tumor is also radiosensitive
Recurrence of a medulloblastoma. Image fusion (c) of a sagittally oriented contrast enhanced T1-weighted MR image (a) with an F-18 DG SPECT image (b) . (d) Image fusion after chemotherapy.