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Introduction: Ependymomas are more common in the pediatric population, in whom they are commonly infratentorial. Extra axial location of a supratentorial ependymoma is extremely rare. Diagnosis: Radiologically these tumors are often misdiagnosed as meningioma or other extra axial lesions owing to their unusual location and lack of any pathognomonic features. Hence, histopathological examination becomes imperative for proper evaluation and an adequate diagnosis. Case: Herein we report a case of a supratentorial extra axial anaplastic ependymoma misdiagnosed as a metastatic tumor on radiological examination and mimicking meningioma intra operatively, located in the frontal and temporal region in a 20 year old man.
ABSTRACT
Glioblastoma multiforme (GBM) is the most frequent and most aggressive primary brain tumor in adults,mainly located in the cerebral hemispheres. In the literature, few cases of primary GBM have been reported to have radiographic and intraoperative features of extra-axial lesions, leading to a diagnostic dilemma. Despite the advances in imaging modalities, the diagnosis of GBM can be challenging, and it is mainly based on the histopathologic confirmation of the excised tumor. We describe the case of a 76- year-old previously healthy female patient who presented to our hospital due to speech disturbances and cognitive impairment. The diagnosis of the tumor type on magnetic resonance imaging (MRI) was difficult, as the findings were suggestive of a malignant meningioma due to the heterogeneous enhancement of a dural-based mass with a dural tail sign. Moreover, the intraoperative findings revealed an extra-axial mass attached to the dura. A histological examination confirmed the diagnosis of glioblastoma with arachnoid infiltration. The patient underwent adjuvant radiotherapy and concomitant temozolomide treatment, she had clinical improvement postoperatively, and was stable during the six months of follow-up. Glioblastoma should be considered in the differential diagnosis of primary extra-axial mass with atypical and malignant features, especially in elderly patients.
Subject(s)
Humans , Female , Aged , Brain Neoplasms/therapy , Glioblastoma/radiotherapy , Glioblastoma/therapy , Arachnoid , Brain Neoplasms/diagnostic imaging , Glioblastoma/pathology , Glioblastoma/diagnostic imaging , Diagnosis, Differential , Temozolomide/therapeutic useABSTRACT
Objective: To investigate the clinical features of extra-axial medulloblastoma (MB) in the cerebellopontine angle (CPA) area and analyze the imaging features and clinical prognosis, and to provide the reference for its clinical diagnosis and treatment. Methods: The clinical data of two patients diagnosed as extra-axial MB in CPA area were collected; the literature review was performed, and the clinical characteristics, diagnostic and treatment methods were analyzed. Results: Two patients were admitted to the hospital due to headache accompanied by hearing loss. The magnetic resonance imaging (MRI) results indicated a mass in the CPA area. All the two patients were treated with the cerebellopontine angle tumor resection. The operation of the two patients was successful, and the tumor located outside the axis seen in the operation, which was confirmed as MB by postoperative pathology. No recurrence or metastasis of tumor was found 15 months after follow-up. Conclusion: The possibility of MB should be considered before operation for the occupying lesions in the extra-axial CPA area. The active operation can improve the prognosis and prolong the survival of the patients.
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Background: Extra-axial tumors are the most common adult intracranial neoplasms. Meningiomas are the most common Extra-axial tumors. Their Clinical presentation, survival rates, and prognosis vary depending on the site and specific type of tumor, hence necessitating a detailed clinical and radiological evaluation. Materials and methods: A prospective observational study on 15 symptomatic subjects who presented to a tertiary care hospital with Supratentorial intracranial tumors confirmed by CT was done. After getting a detailed history, clinical examination and CT (including contrast) were done. Results: In the study population, 73% had meningioma. 13% had a Pituitary Adenoma. 13% had craniopharyngioma. A headache was the most commonly reported symptom (73%). Majority of meningiomas were located in convexity of the brain (36.4%) and parasagittal areas (36.4 %). Conclusions: Neuroradiology plays a key role in the identification of supratentorial extra-axial tumors with CT allowing accurate anatomical description which can go a long way in management and defining prognosis.
ABSTRACT
Glioblastoma multiforme (GBM) is located most frequently in the cerebral hemispheres. Glioblastoma presenting as an extraaxial mass of cerebellopontine angle (CPA) is very rare in adults. We report a rare case of GBM arising in the CPA. The patient was a 71-year-old female, who complained of progressive gait disturbance and poor memory. Initial magnetic resonance imaging (MRI) revealed a 1.4×1.3 cm mass in the left CPA, with broad base to the petrous bone, showing homogenous enhancement. Follow-up MRI showed a rapid increase in size of mass (2.7×2.2 cm) with a necrotic portion. A stereotactic biopsy was done under the guidance of navigation system, and the histopathologic diagnosis was GBM, World Heath Organization grade IV. Further surgical resection was not performed considering her general condition, and the patient underwent concurrent chemotherapy with radiation therapy. Although rare, the possibility of glioblastoma should be included in the differential diagnosis of atypical CPA tumor.
Subject(s)
Adult , Aged , Female , Humans , Biopsy , Cerebellopontine Angle , Cerebrum , Diagnosis , Diagnosis, Differential , Drug Therapy , Follow-Up Studies , Gait , Glioblastoma , Magnetic Resonance Imaging , Memory , Petrous BoneABSTRACT
Objective To explore the value of fluid-attenuated inversion recovery (FLAIR)sequence and gradient echo T2 ?weighted image (GRE-T2 ? WI)in diagnosis of acute traumatic extra-axial hemorrhage.Methods 50 patients who were diagnosed as acute traumatic extra-axial hemorrhage by plain CT underwent FLAIR and GRE-T2 ? WI in acute stage.The diagnosis consistency (Kappa ),detection rate of subarachnoid hemorrhage(SAH),epidural hemorrhage(EDH)and subdural hemorrhage(SDH)were compared.The detection rates of SAH in 8 locations among FLAIR,GRE-T2 ? WI and combination of two sequences were analyzed by Chi-square test.Results 48 patients were enrolled in the study.The diagnosis consistency of SAH between FLAIR and GRE-T2 ? WI was high (k =1.0).The detection rate of SAH was 100% for both FLAIR and GRE-T2 ? WI.Comparing with GRE-T2 ? WI and combi-nation of two sequences,FLAIR tended to misdiagnose SAH in perimesencephalic cistern (P <0.05).The diagnosis consistency of EDH between FLAIR and GRE-T2 ? WI was high (k =1.0).3 patients with EDH were all detected by FLAIR and GRE-T2 ? WI. The diagnosis consistency of SDH between FLAIR and GRE-T2 ? WI was high (k =0.943).The detection rate of 12 patients with SDH was 100% in FLAIR,and 1 patient with SDH was missed by GRE-T2 ? WI.Conclusion The detection rate of acute traumatic extra-axial hemorrhage is high for both FLAIR and GRE-T2 ? WI.Combination of two sequences can improve the accuracy of acute traumatic extra-axial hemorrhage in clinic.
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A 24-year-old female patient presented with a midline extra-axial posterior fossa lesion. We failed to suspect this lesion could be a giant thrombosed aneurysm of PICA(posteior inferior cerebellar artery) preoperatively, and didn't perform preoperative angiogram even after rather typical finding of thrombosed giant aneurysm on MRI. We suggest a giant thrombosed aneurysm should be included in the differantial diagnosis of any round extra-axial mass lesion in the skull base.