Case 4 - tmuh.org.tw · perinuclear halo + Variable depending on pathology and age. Higher risk of...

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Case 4 39

Transcript of Case 4 - tmuh.org.tw · perinuclear halo + Variable depending on pathology and age. Higher risk of...

Page 1: Case 4 - tmuh.org.tw · perinuclear halo + Variable depending on pathology and age. Higher risk of relapse than medulloblastoma Variable depending on the other histologic components

Case 4

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Page 2: Case 4 - tmuh.org.tw · perinuclear halo + Variable depending on pathology and age. Higher risk of relapse than medulloblastoma Variable depending on the other histologic components

Patient Profile

• 11 years old girl• Chief complaint

‐ Seizure for years

• Past history‐ nil

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Page 3: Case 4 - tmuh.org.tw · perinuclear halo + Variable depending on pathology and age. Higher risk of relapse than medulloblastoma Variable depending on the other histologic components

Image

• 2018-03-27 Brain MRI

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Page 4: Case 4 - tmuh.org.tw · perinuclear halo + Variable depending on pathology and age. Higher risk of relapse than medulloblastoma Variable depending on the other histologic components

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Page 5: Case 4 - tmuh.org.tw · perinuclear halo + Variable depending on pathology and age. Higher risk of relapse than medulloblastoma Variable depending on the other histologic components

Clinical Course

• Diagnosis‐ Previous diagnosis of dysembryoplastic neuroepithelial tumor in

other hospital

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Page 6: Case 4 - tmuh.org.tw · perinuclear halo + Variable depending on pathology and age. Higher risk of relapse than medulloblastoma Variable depending on the other histologic components

Common Cause of Seizure

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Radiology Assistanthttp://www.radiologyassistant.nl

Page 7: Case 4 - tmuh.org.tw · perinuclear halo + Variable depending on pathology and age. Higher risk of relapse than medulloblastoma Variable depending on the other histologic components

Dysembryoplastic Neuroepithelial Tumor

• Benign mixed glial-neuronal neoplasm• Frequently associated with cortical dysplasia• WHO grade I brain tumor• Clinical symptoms

‐ Longstanding drug-resistant partial complex seizures in child/young adult

‐ Slow growth over years

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Page 8: Case 4 - tmuh.org.tw · perinuclear halo + Variable depending on pathology and age. Higher risk of relapse than medulloblastoma Variable depending on the other histologic components

Image Findings

• May occur in any region of supratentorial cortex‐ Temporal lobe most common, followed by frontal lobe

‐ Mass frequently "points" toward ventricle

• Sharply demarcated, wedge shaped‐ Cystic ("bubbly") intracortical mass

‐ Minimal/no mass effect

‐ No surrounding edema

‐ Usually does not enhance

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Page 10: Case 4 - tmuh.org.tw · perinuclear halo + Variable depending on pathology and age. Higher risk of relapse than medulloblastoma Variable depending on the other histologic components

Differential Diagnosis

• Ganglioglioma‐ Ca++ common

‐ Frequently solid and cystic components

‐ Solid components avidly enhance

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Page 11: Case 4 - tmuh.org.tw · perinuclear halo + Variable depending on pathology and age. Higher risk of relapse than medulloblastoma Variable depending on the other histologic components

Differential Diagnosis

• Pleomorphic Xanthoastrocytoma (PXA)‐ Enhancing nodule abuts pia

‐ May have pial enhancement

‐ Look for dural "tail"

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Seizure Related of Brain Tumor

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Supratentorial Brain Tumor

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Supratentorial Brain Tumor

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