ESPECTROSCOPIA DE PRÓTONS POR RESSONÂNCIA

NEURORADIOLOGY-NEUROPATHOLOGY CONFERENCE
Claudia da Costa Leite, MD, PhD
Thomas Bouldin, MD
CASE 1
 21 y-o female
 Partial epilepsy since 6 years old with poor seizure
control in the last 5 months
 Frontal mass diagnosed for 6 years, unchanged on
imaging studies
Ganglioglioma, WHO grade I (not large bi nucleus
neuroons (arrow) and glial cells (arrow).
Ganglioglioma
 Intracranial tumor composed of dysplastic neurons and
neoplastic glial cells
 Most of them are WHO grade I and located in the
temporal lobe
 Often circunscribed, cortical or cortico/subcortical lesion
 Classical imaging: combination of intracortical cysts, and
hyperintensity on FLAIR with enhancement.
Calcifications can occur in 1/3 of cases.
Urbach H. Seminars in Ultrasound CT and MRI 2008; 29: 40-46.
CASE 2
 13 y-o female with diabetes insipidus,
panhypopituitarism, hypocortisolism, growth hormone
deficiency and hypothyroidism
Xanthogranuloma
Tumors of pituitary and sellar region
 Pituitary adenoma
 Atypical adenoma
 Pituitary carcinoma
 Craniopharyngioma
 Adamantinomatous
 Papillary
 Rathke’s cyst
 Meningioma
 Chordoma
 Metastasis
 Lymphocytic hypophysitis
 Other lesions
82%
3.0
0.1
3.2
2.9
0.3
2.0
1.0
0.5
0.6
0.3
4.1
Saeger W, Ludecke DK, Buchfelder M, Fahlbusch R, Quabbe H-J, and Petersenn S.
Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary
Tumor Registry. European Journal of Endocrinology (2007) 156 203–216
Xanthogranuloma of sellar region
 Rare, also know as cholesterol granuloma
 Relatively more common in childhood but seen at all
ages
 May have suprasellar extension
 Better prognosis than craniopharyngioma or Rathke cleft
cyst
 Etiology unclear—from craniopharyngioma, Rathke cleft
cyst, or de novo
Amano K, et al. Brain Tumor Pathol. 2013;30(4):233-41.
Jung CS, et al. Acta Neurochir (Wien) (2006) 148: 473–477.
Muller HL, et al. J Clin Endocrinol Metab 97: 3935–3943, 2012.
CASE 3
 79 y-o female, progressive altered mental status for 3
months
 Diabetes mellitus and high blood pressure
Gliomatosis
Gliomatosis
 Rare, diffuse infiltrative glioma involving at least 3
cerebral lobes, usually bilateral involving cerebral
hemispheres and/or deep gray matter and extending to
brain stem, cerebellum and even spinal cord
 Can be de novo or secondary. It is a heterogenous
disease
 Can occur in any age
 Imaging ill infiltrative lesion, mass effect and variable
enhancement
Rudà et al. Curr Treat Options Neurol 2014; 16:273
CASE 4
 64 y-o male with back pain and lower extremity
weakness for 4-5 months
 Symptoms have been progressing lately
Ependymoma grade II
102 intramedullary tumors at Duke between 1998-2009
Ependymal tumors
54%
Ependymoma
42%
Myxopapillary ependymoma
9
Subependymoma
3
Astrocytic tumors
23
Pilocytic astrocytoma
12
Astrocytoma, grade 2
5
Anaplastic Astrocytoma
3
GBM
1
Other gliomas
2
Ganglioglioma
2
Hemangioblastoma
12
Epidermoid
5
Dermoid
2
Melanocytoma
2
Adenal cortical adenoma
1
Karikari, IO et al. Neurosurgery
68:188–197, 2011.
TABLE 3: Histological type of 430 primary tumors of the spinal
cord, spinal meninges, or cauda equina
Histological Type
astrocytoma*
glioblastoma
oligodendroglioma & mixed oligoastrocytoma
other glioma
ependymoma
lymphoma & plasmacytoma
PNET
schwannoma
chordoma
neurofibroma & other nerve sheath tumor
meningioma
hemangioblastoma
teratoma, dermoid, lipoma & other benign
other and unclassified
No. of Tumors (%)
41 (9.5)
8 (1.9)
4 (0.9)
14 (3.3)
102 (23.7)
18 (4.2)
4 (0.9)
91 (21.2)
7 (1.6)
6 (1.4)
105 (24.4)
7 (1.6)
8 (1.9)
15 (3.5)
* WHO Grades I–III.
Engelhard HH, et al. J Neurosurg Spine 13:67–77, 2010
Case 5
 45 y-o male with right side hearing loss. He also recently
developed headaches, double and blurry vision, and
balance and gait difficulties
Plasmacytoma
Cranial plasmacytoma
 Plasma cell tumors include solitary plasmacytoma,




multiple plasmacytoma and multiple myeloma (MM).
Plasmacytoma may convert to MM.
Plasmacytoma may be intramedullary or extramedullary
Bone or soft tissue mass arising from cranial vault skull
base, orbits, paranasal sinus
Meningeal involvement is usually due to extension of
bone/soft tissue lesions
Intraaxial brain lesions without osseous or dural contact
have been sporadicaly described
Cerase A, et al. Neuroradiology 2008; 50: 665-674.
Cranial plasmacytoma
 CT: hyperdense mass, with bone erosions
 MRI: iso to hyperintense on T1-WI and iso-hypointense
on T2-WI
 Restricted diffusion is described in some cases
Cerase A, et al. Neuroradiology 2008; 50: 665-674.