The document discusses various pediatric brain tumors. It notes that pediatric brain tumors account for 15-20% of all brain tumors and are the second most common pediatric tumor after leukemia. It provides details on the typical locations, imaging appearances, and histological subtypes of different pediatric brain tumors, including tumors of the posterior fossa, supratentorial region, sellar/suprasellar region, pineal region, dural surfaces and ventricles. It also discusses specific tumor types such as craniopharyngioma, astrocytoma, germ cell tumors, and hypothalamic hamartoma.

1. Dr. Prashant Pote
Jr.III
Department of Radiology

2.  Pediatric brain tumors(PBT) are 15-20% of all
brain tumors. Second most common
pediatric tumor next to leukemia.
 Overall, supratentorial and infratentorial
tumors occur in equal frequency.
Supratentorial more common <2yrs;
infratentorial more common 4-10 yrs; equally
common after 10yrs age

3.  Posterior fossa
 Supratentorial
 Intraparenchymal
 Sellar/Suprasellar
 Extra-axial

4.  Astrocytoma
 Ependymoma
 Desmoplastic Infantile Ganglioglioma (DIG)
 Dysembryoplastic neuroepithelial tumor (DNET)
 Teratoma
 Ganglioglioma/Gangliocytoma
 Primitive NeuroectodermalTumor (PNET)
 Atypical teratoid/rhabdoid tumors

5.  Craniopharyngioma
 Astrocytoma
 Rathke cleft cyst
 Germ cell tumors
 Hypothalamic hamartoma
 Langerhans cell histioctyosis
 Pituitary adenoma

6.  Choroid plexus papilloma /carcinoma
 Langerhans cell histiocytosis
 Epidermoid/Dermoid
 Arachnoid cyst
 Metastasis

8. 1. Teratoma.
2. CNS PNET
3. Choroid plexus papilloma
4. Anaplastic astrocytoma
5. DIG

9. Cortically-based tumors
• DNET
• Ganglioglioma
• Oligodendroglioma
• PXA

10. Intraventricular tumors
 Ependymoma, subependymoma
 Central neurocytoma
 Choroid plexus papilloma/carcinoma
Pineal region tumors
• Pineal parenchymal tumors
(pineocytoma/blastoma)
• Germ cell tumors (germinoma, teratoma, etc)

11. Dural-based tumors and mimics
• Meningioma
• Metastasis
• Inflammatory pseudotumor
• Infection (e.g., tuberculosis)
• Extramedullary hematopoiesis

12.  Local intracranial extension from
extracranial neoplasms
• Chordoma
• Paraganglioma
• Carcinomas (e.g., nasopharyngeal squamous
cell),sarcomas (rhabdomyosarcoma)

13.  Neoplasms that often have cyst + nodule
• Pilocytic astrocytoma
• Ganglioglioma
• Hemangioblastoma
• Craniopharyngioma

14.  30% of hemispheric tumors. Most common
cerebral hemispheric tumor
 Peak incidence at 7-8yrs age
 Low grade astrocytomas more common
 Glioblastoma Multiforme (GBM)WHO IV/IV ~
20%
 Typically involve basal ganglia, thalamus
 Can be multi-centric

15.  Cerebellum is most common site followed by in
and around optic nerve/chiasm,
hypothalamus/third ventricle.
 Cerebral hemisphere –uncommon.
 Cerebellum and cerebralTm: cyst with mural
nodule.
 Optic nerve/chiasm/third ventricle: solid
infiltrating.
 Hemorrhage uncommon; if present its
pilomyxoid astrocytoma

16. SagittalT2WI shows a
mixed solid and cystic focal lesion in the
right frontoparietal region (arrows).The
solid component of the lesion has
intermediate
signal, and the cystic component has
high signal.
Sagittal postcontrastT1WI
shows prominent Gd-contrast enhancement
at the solid component of the lesion

17. Post contrast

18.  Differs from PA in clinical course,
presentation and histological appearance.
 60%- suprasellar, 40%cerebral hemisphere
 Cerebellum and fourth ventricle ;rare
 Age: Suprasellar- infants and children <4 yrs
Atypical location – adolescent and in adults
 Imaging: A large H shaped suprasellar mass,
mixed SI, heterogeneous enhancement with
hemorrhage

20.  First two decades of life, mean age 11 yrs
 An enhancing lesion at foramen of Monro
should be considered SEGA until proven
otherwise.
 Calcification,
 TSC other feature; SEN, cortical tubers, white
matter radial migration lines
 SEGA or SEN; progressive enlargement.

21. Tuberous Sclerosis- SEGA
T2
Post contrastT1

22.  Children and young adults, 2/3rd under 18 yr
 Well delineated cortically based mass that
contacts the leptomeninges
 70%; cyst with nodule, 30% solid with
intratumoral cysts
 Calcification 40%, hemorrhage rare
 Moderate enhancement ofTm nodule post
contrast

24.  30% of ependymomas
 Peak incidence between 1-5yrs age
 Histologically similar to infratentorial
ependymomas – fourth ventricle and CPA.
 Differs! typically in periventricular white
matter and cerebral hemisphere
parenchyma.

25. AxialT2WI
shows a lesion with heterogenous high signal
containing a cystic zone in the inferior
right frontal lobe.
Postcontrast axialT1WI
shows irregular peripheral enhancement at
lesion.

26.  Arises from subpial astrocytes
 Found between1-months age w/peak at 3-6
months. Occasionally seen up to 5yrs
 Cortically based tumor nodule.

27. Post contrastT1
Desmoplastic infantile ganglioglioma
T1

28.  Imaging findings:
 Large cyst w/cortically based enhancing tumor
nodule
 Solid component avidly enhances;
leptomeningeal and dural enhancement,
enhancement
 Occupies majority of cerebral hemisphere
 Looks worse than it is!!
 Greater then 75% survival after 15yrs
w/complete resection

29.  Cause of 20% cases of medically refractory
epilepsy
 60% in temporal lobe, 30% frontal lobe
 Solid and cystic tumors
 Scalloping of inner table skull
 Associated w/cortical dysplasia
 Slow to No growth!

30. •Multicystic cortically based
lesion
•25% have calcifications
•20-40% enhancement
•Characteristic “bright
rim”on FLAIR .
•Usually no edema, no
mass effect.

31. FLAIR
T2
T2
Post contrastT1

32. DNET

33.  Found in adolescents
 Associated with mesial temporal sclerosis
Most common in temporal, parietal, frontal
lobes
 Difference betweenGG and GC is histological
 Clinical: Partial complex seizures

34. Imaging findings:
•Solid or cystic or cyst w/mural
nodule
•Variable enhancement
•35% w/calcifications
•If peripheral location, then
scalloping of adjacent calvarium
•Hemorrhage and necrosis absent

35. GRE
Post contrastT1

38. a AxialT2WI shows a large lesion
with heterogeneous high signal in the right
frontal lobe extending across the corpus
callosum to the left frontal lobe
b Postcontrast
sagittalT1WI shows irregular enhancement
in a portion of the lesion.

39.  occur in the paediatric population, usually
during the first 10 years of life,
 Circumscribed or invasive lesions. Low to
intermediate signal onT1WI; intermediate to
high signal onT2WI.
 VariableGd-contrast enhancement.
 Frequent dissemination into the
leptomeninges.
 Highly malignant tumors located in the
cerebrum,pineal gland, and cerebellum.

40.  2-5% of tumors in children less then 15 yrs
 Midline lesion typically in pineal gland, third
ventricle
 Most are benign

41.  Imaging findings:
 Midline mass with calcifications and fat
 Enhancement of soft tissue components
 Malignant teratomas have more vasogenic
edema, irregular, less well defined.

43. Teratoma

45.  Choroid plexus papilloma /carcinoma
 Langerhans cell histiocytosis
 Epidermoid/Dermoid
 Arachnoid cyst
 Metastasis

46.  Arise from epithelium of choroid plexus
 5% of supratentorial tumors
 Typically age 1-5yrs
 Male predominance
 Most common in trigone of left lateral
ventricle
 CPC more irregular and invasive then CPP but
diagnosis is histological
 Clinical: Hydrocephalus

47.  Imaging:
 CPP is lobulated, homogeneous mass with
frond like excrescence.
 Punctate calcifications, hyperdense on CT
 Intense enhancement on CT/MR
 CPC irregular, heterogeneous w/cystic
necrosis, invasive and vasogenic edema

48. T2 Choroid plexus papilloma Post contratT1

49. Choroid plexus papilloma
-CT

50. Choroid plexus papilloma
T2 Post contratT1

51. Choroid plexus carcinoma

52. T2
Post contrast
T1
FLAIR

53. DWI

54.  Craniopharyngioma
 Astrocytoma
 Rathke cleft cyst
 Germ cell tumors
 Hypothalamic hamartoma
 Langerhans cell histioctyosis
 Pituitary adenoma

55.  Hypopituitarism– craniopharyngioma
 Diabetes insipidus – LCH,
 Precocious puberty– hamartoma of tuber
cinereum, hypothalamic glioma
 Amenorrhea– pituitary adenoma, Rathke
cleft cyst

56.  Thought to arise from remnant of
craniopharyngeal duct.
 Adamantinomatous(children) and papillary
(adults) types
 15% supratentorial tumors, 50% suprasellar
tumors
 2 peaks: 10-14 yrs age; 4th to 6th decade of
life

57.  Rim enhancement of cysts; heterogeneous enhancement solid portions

60.  Benign epithelial lined cyst in sella
 Arises from remnants of Rathke pouch in
pituitary gland with frequent suprasellar
extension.
 Rare in children

61. CT: Cystic
nonenhancing,
noncalcified mass
MRI:T1 orT2
hyperintense
No enhancement
T1
Post contrastT1

62.  Suprasellar type arises from optic chiasm or
hypothalamus
 M=F 4yrs age
 30-50% have family history of NF1
 Clinical: Hydrocephalus, decreased vision,
pituitary dysfunction (short stature)

63.  Imaging findings:
 T2, FLAIR hyperintense
 Fusiform or lobulated enlargement optic
nerves with heterogeneous enhancement
 Gliomas in patients without NF1 have cystic
components.

64. POST ContrastT1
T2
T1

65.  Imaging findings:
 MR: Infundibular thickening w/uniform
enhancement
 Iso to hypointense onT1,T2 and FLAIR
 When large, can have areas of cystic necrosis
 REMEMBER: HIGH ASSOCIATION
W/DIABETES INSIPIDUS!!.

67.  Heterotopic gray matter generally located in
tuber cinereum
 Can originate from floor third ventricle,
mamillary bodies.
 Can be sessile or pedunculated
 Large lesions cause gelastic seizures; small
lesions have precocious puberty
 Found in 33% of patients w/precocious
puberty

68. MR: Isointense onT1, slightly hyperintense on
T2, Non enhancing

69. Post contrastT1