1 / 23

Case Presentation

Case Presentation. Gerrit Blignaut Diagnostic Radiology UFS 17/08/2012. History. 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.

shirin
Download Presentation

Case Presentation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case Presentation GerritBlignaut Diagnostic Radiology UFS 17/08/2012

  2. History 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

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

  4. CT

  5. MRI

  6. Differential diagnosisAstrocytomaPNETEpendymoma

  7. Astrocytoma • 30% supratentorialtumors 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

  8. PNET • 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

  9. Ependymoma • 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

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

  11. Imaging • 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 peritumoraledema on T2. Mixed signal after contrast administration.

  12. Pathology 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 +

  13. GFAP +

  14. Treatment • Low grade astroblastomas may have long term survival. • Anaplastic histology is associated with recurrenceand progression. • Surgical excision mainstay of treatment with postoperative adjuvant radiation and chemotherapy.

  15. References 1: Astroblastoma: A Radio-histological diagnosis J PediatrcNeurosciVol 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 EpendymomaAJNR Am J Neuroradiol23:243–247, February 2002 4:

More Related