1. Gerrit Blignaut Diagnostic Radiology UFS17/08/2012

2.  3Y6M girl from Lesotho. 3D history of right hemiparesis, preceded by 3D history of vomiting. No previous hospital admission or any other illnesses. Father passed due to TB 3 years ago. 2 Siblings, both healthy History

3.  Extensive Tinea Capitis CNS: Right hemiparesis with power 4/5. GCS 15/15 CVS, Resp, Abd, ENT: NAD Bloods: FBC, U&E, HIV normal CXR: Normal Examination

4. 

5.  CT

6. 

7. 

8. 

9.  MRI

10. 

11. 

12.   Differential diagnosis Astrocytoma PNET Ependymoma

13.   30% supratentorial tumors in children.  3 Patterns:Cystic with enhancing mural nodule  solid with necrotic centre  Solid with variable enhancement.  Solid part iso- hypodense on CT and hyperintense on T2 Astrocytoma

14.   Mean age 5 years.  Arise from precursor cells of germinal matrix.  Poor prognosis if supratentorial  CT: dense ca++, large heterogenous mass.  Solid and cystic components.  Can be peri/ intraventricular with hydrocephalous.  Necrosis and hemorrhage.  MRI: Solid- Low signal T1 and intermediate to low signal T2 compared to gray matter.  Little peritumoral oedema PNET

15.   From ependymal cells that line ventricular canal.  70% Post fossa  Can originate supratentorially 1/3, intraaxially  CT: heterogenous, solid, cystic, Ca++, hemorrhage MRI; Solid: Isointense T1 and hyperintense on T2 compared to gray matter. More oedema Ependymoma

16.  Rare glial neoplasms, 0.45-2.8% of primary glial tumors. Present as a large well demarcated, supratentorial hemispheric mass. Prefer frontoparietal region. Children, adolescents and young adults. Median age 11 years. Female predominance Astroblastoma

17.  NECT  Solid and cystic lobular mass, solid portion may be mildly hyperattenuated Occasional punctate Ca++ CECT: Heterogeneous enhancement: Rim of cystic Heterogenous solid MRI :  Mixed solid cystic mass.  Solid part has heterogeneous bubbly appearance on T2.  Relatively hypointense to gray matter on T1 and isointense to gray  matter on T2 Little peritumoral edema on T2. Mixed signal after contrast administration. Imaging

18.  Cell of origin has features of both astrocytoma and ependymoma. Tancytes, variety of ependymal cells. Present in the floor of 4th ventricle. Perivascular pseudorosettes : Astrocytic cell processes radiate toward a central, often hyalinized blood vessel  Oval to elongated hyperchromatic nuclei; +/- Ca++  Immunohistochemistry: GFAP +, vimentin+, S-100 + Pathology

19. 

20. 

21.  GFAP +

22.   Low grade astroblastomas may have long term survival.  Anaplastic histology is associated with recurrence and progression.  Surgical excision mainstay of treatment with postoperative adjuvant radiation and chemotherapy. Treatment

23.  1: Astroblastoma: A Radio-histological diagnosis J Pediatrc Neurosci Vol 3 2008. 2: Astroblastoma: A Rare Glial Tumor International Journal of Pathology; 2004; 2(2):100-102 3: Astroblastoma: Radiologic-Pathologic Correlation and Distinction from Ependymoma AJNR Am J Neuroradiol 23:243–247, February 2002 4: References