Presentation on theme: "UNC Neuroradiology-Neuropathology Conference"— Presentation transcript:
1 UNC Neuroradiology-Neuropathology Conference November 2012 Stephen Bagg, MD Fellow in Neuroradiology
2 Case 1- 57 y/o female with no sig PMHx 1 month hx of progressive DizzinessDiplopiaFallsPhysical ExamCN 6 palsyR facial droop and R tongue deviationL facial numbnessR sided dysmetriaNeurology localized abnormality toMedulla, pons, cerebellum
5 Brainstem Gliomas in Adults In a series of 48 adults with a brainstem glioma by clinical and radiologic findings, most of the tumors fit into one of three categories:50% of patients had diffuse intrinsic low-grade gliomas (WHO I or II). Ppatients were typically young adults with a long clinical history and no tumor enhancement. Patients treated by radiotherapy and had a 7.3 year median survival. Anaplastic change (as determined by MRI) developed in 50% of and was the most common cause of death.33% patients had malignant gliomas (WHO grade III or IV). Patients were typically older adults, presented with a short clinical history, and had enhancement and signs of necrosis. Patients were refractory to therapy and had a 11.2 month median survival.10% of patients had focal tectal gliomas. These were young and often presented with hydrocephalus. These tumors had an indolent course.Guillamo J-S, et al. Brain 124: , 2001.
6 Case 2- 21 month old male Previously healthy Recently noted by PCP to have macrocephalyDeveloped Ataxia and N/V
9 Atypical teratoid rhabdoid tumor (ATRT) ATRTs are rare tumors that comprise approximately 1-2% of all pediatric brain tumors; however, in patients less than 3 years of age this tumor accounts for up to 20% of cases.ATRT usually occurs in posterior fossa or supratentorial location and are only rarely in spinal regionATRT is characterized by loss of the long arm of chromosome 22, which results in loss of the hSNF5/INI-1 gene and loss of INI-1 expression.INI1, a member of the SWI/SNF chromatin remodeling complex, is important in maintenance of the mitotic spindle and cell-cycle control.WHO grade IV. Overall survival in ATRT is poor with median survival of around 17 months.Ginn KF, Gajjar A. Front Oncol. 2012;2:114. Epub 2012 Sep 12.
10 Imaging Features, ATRT Heterogeneous mass/enhancement Commonly contains cysts & hemorrhageLeptomeningeal enhancement is commonRestricted Diffusion is commonImaging Diff Dx = medulloblastomaATRT are generally more heterogeneous than medulloblastomaMedulloblastoma is more commmon
11 Common neoplasms associated with intracranial tumoral hemorrhage Yuguang L, et al. Journal of Clinical Neuroscience(2002); 9(6),Common neoplasms associated with intracranial tumoral hemorrhage
12 1 year history of R hand and foot numbness Otherwise healthy- Case y/o male1 year history of R hand and foot numbnessOtherwise healthy-No significant past medial history
15 Carney EM, et al. Am J Surg Pathol 2011;35:262–267. HemangioblastomaHemangioblastoma is a benign CNS neoplasm (WHO grade I), representing 1.5%–2.5% of all intracranial tumors and 7%–12% of posterior fossa tumors. It most commonly arises in the cerebellum but may also arise in the cerebral hemispheres, medulla, and spinal cord. Peak incidence is 3rd to 6th decades.75% of hemangioblastomas are associated with sporadic mutations involving the Von Hippel-Lindau (vHL) gene located at the short arm of chromosome 3, whereas the remaining 25% occur in the setting of the Von Hippel-Lindau syndrome. This is an autosomal dominant syndrome caused by a germline mutation in the vHL tumor suppressor gene.Individuals with the VHL syndrome are at risk of developing renal cell carcinoma and hemangioblastoma in addition to pancreatic and renal cysts, cystadenomas of the epididymis, and endolymphatic sac tumors.The stromal cells stain for Inhibin A, which is a glycoprotein normally secreted by ovarian granulosa cells and testicular Sertoli and Leydig cells to inhibit pituitary follicle-stimulating hormone.Carney EM, et al. Am J Surg Pathol 2011;35:262–267.
16 Imaging Features, Hemangioblastoma Cystic mass with enhancing mural noduleAssociated flow voidsThoracic > Cervical > LumbarEvaluate posterior fossa for additional lesionsDifferential diagnosis: Astrocytoma, Ependymoma, AVF/AVM
17 Presented to outside institution with altered mental status Case y/o FPresented to outside institution with altered mental statusPossible complaint of blurry visionPMHxDiabetes, Hypertension
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