JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
CLINICAL PRESENTATION RADIOLOGICAL FEATURES PATHOLOGICAL PROGNOSIS
DIAGNOSIS
CENTRAL NEUROCYTOMA
• Young patients • Headache • Features of raised ICP • Rarely, cognitive dysfunction, seizures, etc.
• Intraventricular • Midline • MRI: T1 iso, T2 hyper
• Necrosis and cyst formation common • Diffuse synaptophysin reactivity • GFAP+ in ≈ 50% of cases
• Higher recurrence rate • Requires adjuvent radiotherapy or radiosurgery
• Contrast enhancement + • Heterogenous solid cystic • Calcifications +
LOW GRADE ASTROCYTOMA
• Any age • Headache • Features of raised ICP • Memory dysfunction (with involvement of fornix and corpus callosum)
• Ill-defined outline • Paramedian or assymetric • MRI: T1 iso to hypo, T2-Hyper • Contrast enhancement + • May show edema and mass effect • Heterogenous • MRI: Iso on T1 and iso to hyper on T2 • Contrast enhancement + • Calcifications+ • MRI: Isointence on T1, iso to hyperintense on T2 • Variable contrast enhancement • Calcification ± • Mixed solid cystic • Typical lesion is characterized by a cystic lesion with mural nodule that enhances with contrast • Wall of lateral ventricle near foramen of Monro • MRI: T1 hypo and T2 hyper • Homogenous contrast enhancement
• Glial tumor without neuronal component • GFAP+
• Recurrence occurs without total excision • Requires post of radiotherapy
OLIGODENDROGLIOMA
• Middle aged • Raised ICP due to hydrocephalus
• Perinuclear satellosis • Involves white matter • Larger and varied nuclei
• Recurrence occurs without total excision • Requires post of radiotherapy
GANGLIOGLIOMA
• Neoplastic ganglion and glial cells in reticulin network • Glial cells major cell type • Perivascular lymphocytic infiltration • May show atypia • GFAP+
• In childrem and young adult • Male preponderance • Seizure is the most common presentation
• Good prognosis with rare recurrence • Adjucant therapy usually not required with total excision
PILOCYTIC ASTROCYTOMA
• Intratumoral rosental fibres • Eosinophilic granular bodies • Glial cells without mature neurons
• Young children • Headache • Raised ICP due to hydrocephalus
• Complete resection carries good prognosis • Radiotherapy needed for incomplete resections
SUBEPENDYMAL GIANT CELL ASTROCYTOMA
• Large polyconal cells resembling astrocytes or ganglion cells • Pervascular pseudorosette • No neurons
• Young age • Associated with tuberous sclerosis • Present with raised ICP due to HCP
• Total excision leads to cure • Recurrence rare • Radiotherapy not needed
SUBEPENDYMOMA
• Midline location • Heterogenous with cystic areas
• Glial tumor cells in clusters in an abundant fibrillary matrix • No mature neurons
• 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
• Lobulated appearance • T1 hypo and T2 hyper • Minimal contrast enhancement in septum pellucidum lesions
DYSEMBROPLASTIC NEUROEPITHELIAL TUMOR
• Small round oligodendroglia like cells with floating neurons • Microcystic or alvelolar pattern • May express synaptophysin but not GFAP
• Midline location • Homogenous • T1 hypo, T2 hyperintense • Does not enhance with contrast • Higher ADC value
• Excellent prognosis • Rare recurrence even if in subtotal excision • Radiotherapy not needed
• Young age • Seizure, headache • Raised ICP due to HCP
Table 2: Differentiating features of various tumors of septum pellucidum
126 J La State Med Soc VOL 169 SEPTEMBER/OCTOBER 2017
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