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Ray Peeples, MD. Case 1  50 y/o F with NF1  hx of meningioma debulking (2/10) and cervical neurofibroma removal (7/09)  MRI studies showed an enhancing.

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Presentation on theme: "Ray Peeples, MD. Case 1  50 y/o F with NF1  hx of meningioma debulking (2/10) and cervical neurofibroma removal (7/09)  MRI studies showed an enhancing."— Presentation transcript:

1 Ray Peeples, MD

2 Case 1  50 y/o F with NF1  hx of meningioma debulking (2/10) and cervical neurofibroma removal (7/09)  MRI studies showed an enhancing superior cerebellar lesion growing over time and eventually causing obstructive hydrocephalus, the lesion was biopsied

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8 Pilocytic astrocytoma

9 In one series of 100 NF1 patients with biopsied tumors, there were… 50 pilocytic astrocytomas (PA) 28 diffuse astrocytomas (Grades II—5%, III—15%, IV—7%) 17 low- grade astrocytomas, subtype indeterminate 2 pilomyxoid astrocytomas 1 desmoplastic infantile ganglioglioma 1 conventional ganglioglioma 24 tumors arose in the optic pathways (14 PAs, 4 low-grade astrocytomas of indeterminate type, 4 anaplastic astrocytomas, 1 pilomyxoid astrocytoma, and 1 ganglioglioma). Most tumors arising in setting of NF1 are pilocytic astrocytomas (PAs) and, unlike their sporadic counterparts, have a distinctive predilection to involve the optic nerve, chiasm, and hypothalamus. NF1-related optic gliomas are typically in young children and afflict 15% to 20% of NF1 patients. NF-1 related optic gliomas seem to have a more indolent behavior than their sporadic counterparts and may even regress without treatment. Rodriguez FJ, et al. J Neuropathol Exp Neurol. 67:240–249, 2008.

10 Case 2  26 y/o M with 2 yr hx of back pain and lower extremity paresthesias  MRI showed and intradural lesion in the L spine  MRI brain showed multiple enhancing cerebellar lesions  Spinal lesion was resected

11 T2T1 T2

12 T1 C+

13 T2

14 T1 +C FLAIR

15 Myxopapillary ependymoma, metastatic

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17 Case 3  35 y/o M with 1 year hx of back pain and RLE weakness  sent from outside institution with presumptive diagnosis of L3 schwannoma with MRI performed without contrast  EMG showed L3 and S1 radiculopathy  L3 mass was resected

18 T2 T1 L3 S1 T2 T1 T2

19 Sarcoidosis

20 Spinal syndromes are reported at clinical presentation in 6% to 8% of patients with neurosarcoidosis Spinal sarcoidosis can be intramedullary, intradural extramedullary, epidural, or in vertebral bodies. Most cases are intramedullary. Intradural, extramedullary spinal sarcoidosis is extremely rare, with only 8 cases reported in the literature as of Schaller B, et al. The Spine Journal 6:204–210, 2006.

21 Case 4  26 y/o M who presented in 10/2012 with seizure  CT/MRI showed L frontal low density lesion in white matter with no enhancement, this lesion was biopsied

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23 FLAIR T2 T1 T1 C+ T1

24 Gliomatosis cerebri


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