JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Clinical Presentation
Radiological Features
Pathological Features
Prognosis
• Intraventricular • Midline • MRI: T1 iso, T2 hyper
• Necrosis and cyst formation common • Diffuse synaptophysin reactivity • GFAP+ in ~ 50% of cases
• Higher recurrence rate • Requires adjuvant radiotherapy or radiosurgery
• Young patients • Headache • Features of raised ICP • Rarely, cognitive dysfunction, seizures, etc
Central Neurocytoma
• MRI- Isointense on T1, iso to hyperintense on T2 • Variable contract enhancement • Calcification ± • Heterogenous • MRI- Iso on T1 and Iso to hyper on T2 • Contrast enhancement + • Calcifications + • Ill-defined outline • Paramedian or assymetric • MRI: T1 iso to hypo, T2- Hyper • Contrast enhancement + • May show edema and mass effect • Contrast enhancement + • Heterogenous solid cystic • Calcifications +
• Glial tumor without neuronal component • GFAP+
• Recurrence occurs without total excision • Requires post of radiotherapy
• Any age • Headache • Features of raised ICP
Low grade astrocytoma
• Memory dysfunction (with involvement of fornix and corpus callosum)
• Perinuclear satellosis • Involves white matter • Larger and varied nuclei
• Recurrence occurs without total excision • Requires post of radiotherapy
• Middle aged • Raised ICP due to hydrocephalus
Oligodendroglioma
• Large polygonal cells resembling astrocytes or ganglion cells • Perivascular pseudorosette • No neurons • Glial tumor cells in clusters in an abundant fibrillary matrix • No mature neurons • Intratumoral rosental fibres • Eosinophillic granular bodies • Glial cells without mature neurons • Glial cells major cell type • Perivascular lymphocytic infiltration • May show atypia • GFAP+ • Neoplastic ganglion and glial cells in reticulin network
• Good prognosis with rare recurrence • Adjucant therapy usually not required with total excision
• In children and yong adult • Male preponderence • Seizure is the most common presentation
Ganglioglioma
• Mixed solid cystic • Typical lesion is
• Complete resection carries good prognosis • Radiotherapy needed for incomplete resections
• Young children • Headache • Raised ICP due to hydrocephalus
Pilocytic astrocytoma
• Wall of lateral ventricle near foramen of Monro • MRI- T1 hypo and T2 hyper • Homogenous contrast enhancement characterized by a cystic lesion with mural nodule that enhances with contract • Midline location • Heterogenous with cystic areas • Lobulated apprance • T1 hypo and T2 hyper • Minimal contrast enhancement in septum pellucidum lesions
• Young age • Associated with tuberous sclerosis • Present with raised ICP due to HCP • Middle aged and elderly males • More common in 4 th ventricle • Present with raised ICP due to HCP
• Total excision leads to cure • Recurrence rare • Radiotherapy not needed • Total excision leads to cure • Recurrence rare • Radiotherapy not needed
Subependymal Giant cell astrocytoma
Subependymoma
• Young age • Seizures, headache • Raised ICP due to HCP
• Midline location • Homogenous
• Small round oligodendroglia like cells with floating neurons • Microcystic or alvelolar pattern • May express synaptophysic but not GFAP
• Excellent prognosis • Rare recurrence even if in subtotal excision • Radiotherapy not needed
Dysembroplastic neuroepithelial tumor
• T1 hypo, T2 hyperintense • Does not enhance with contrast • Higher ADC value
Table 2: Differentiating features of various tumors of septum pellucidum
J La State Med Soc VOL 170 JANUARY/FEBRUARY 2018 13
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