Answer for CoW 16 April 2017
Central neurocytoma
Findings:
Complex cystic and solid T1 / T2 intense lesion can arise from the septum pellucidum with univentricular hydrocephalus – obstruction noted at foramen at munro. Minimal contrast enhancement noted.
Discussion:
Central neurocytoma first was described in 1982 by Hassoun et al. as a midline neuronal tumor characterized by its intraventricular location, greater frequency among young adults, specific radiologic features, and good postoperative prognosis due to its benign clinical course . Neurocytoma can arise from the septum pellucidum, fornix, or the walls of the lateral ventricles (subependymal layer). It may derive from bipotential precursor cells of the periventricular germinal matrix, which are capable of both neuronal and glial differentiation, but maintain a low proliferative potential after birth . Central neurocytoma has a long clinical course. Patients frequently present with headache and visual changes, and the duration of clinical symptoms and signs typically is less than 6 months. Most of these symptoms are attributed to increased intracranial pressure secondary to obstructive hydrocephalus. CT demonstrate an iso- or slightly hyperdense mass within the body of the lateral ventricles near the foramen of Monro. Areas of hypodensity represent cystic degeneration. Approximately 51% of central neurocytomas demonstrate calcification on CT images . As these tumors are thought to arise from septal nuclei, they are centered at the midline. The tumors usually have a broad-based attachment to the superior and lateral wall of the ventricle. Obstruction of the interventricular foramen of Monro by the tumor mass usually results in hydrocephalus. MR imaging isointense in T1-weighted images, T2-weighted images, most central neurocytomas are relatively isointense with cortex. There is usually moderate enhancement after the administration of gadolinium. Contrast enhancement is mild to moderate for most central neurocytomas. Based on radiological images, differential diagnosis of central neurocytoma depends on the exact tumor location and age of the patient. Tumors in the lateral ventricle in young adults include oligodendrogliomas, subependymal giant cell astrocytomas, ependymomas, and low grade or pilocytic astrocytomas. Astrocytomas and ependymomas may occur anywhere within the ventricular system, but usually lack intratumoral cysts and calcifications. The intraventricular oligodendroglioma is usually located within the body of the lateral ventricle. However, intratumoral calcifications in oligodendrogliomas are typically large and irregular . A typical central neurocytoma is located in the supratentorial ventricular system of which the anterior half of the lateral ventricle is the most frequent location . Extension into the third ventricle occurs in 26% of central neurocytomas.
Findings:
Complex cystic and solid T1 / T2 intense lesion can arise from the septum pellucidum with univentricular hydrocephalus – obstruction noted at foramen at munro. Minimal contrast enhancement noted.
Discussion:
Central neurocytoma first was described in 1982 by Hassoun et al. as a midline neuronal tumor characterized by its intraventricular location, greater frequency among young adults, specific radiologic features, and good postoperative prognosis due to its benign clinical course . Neurocytoma can arise from the septum pellucidum, fornix, or the walls of the lateral ventricles (subependymal layer). It may derive from bipotential precursor cells of the periventricular germinal matrix, which are capable of both neuronal and glial differentiation, but maintain a low proliferative potential after birth . Central neurocytoma has a long clinical course. Patients frequently present with headache and visual changes, and the duration of clinical symptoms and signs typically is less than 6 months. Most of these symptoms are attributed to increased intracranial pressure secondary to obstructive hydrocephalus. CT demonstrate an iso- or slightly hyperdense mass within the body of the lateral ventricles near the foramen of Monro. Areas of hypodensity represent cystic degeneration. Approximately 51% of central neurocytomas demonstrate calcification on CT images . As these tumors are thought to arise from septal nuclei, they are centered at the midline. The tumors usually have a broad-based attachment to the superior and lateral wall of the ventricle. Obstruction of the interventricular foramen of Monro by the tumor mass usually results in hydrocephalus. MR imaging isointense in T1-weighted images, T2-weighted images, most central neurocytomas are relatively isointense with cortex. There is usually moderate enhancement after the administration of gadolinium. Contrast enhancement is mild to moderate for most central neurocytomas. Based on radiological images, differential diagnosis of central neurocytoma depends on the exact tumor location and age of the patient. Tumors in the lateral ventricle in young adults include oligodendrogliomas, subependymal giant cell astrocytomas, ependymomas, and low grade or pilocytic astrocytomas. Astrocytomas and ependymomas may occur anywhere within the ventricular system, but usually lack intratumoral cysts and calcifications. The intraventricular oligodendroglioma is usually located within the body of the lateral ventricle. However, intratumoral calcifications in oligodendrogliomas are typically large and irregular . A typical central neurocytoma is located in the supratentorial ventricular system of which the anterior half of the lateral ventricle is the most frequent location . Extension into the third ventricle occurs in 26% of central neurocytomas.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!