General case of the day. Intraventricular neurocytoma

Cases General Jonas

Case

H. Goldstein,

of the

of the

MD

#{149} Richard

Day1 A. Haas,

MD

#{149} Glenn

.

U HISTORY A 24-yeanld nificant

right-handed medical

history

and

decreased

headache logic

examination

pillary

response

tremity

woman had

revealed to light

weakness.

no sighistory

acuity.

mild

left

right upper

A.

terms:

Brain

pucx-

1mm 02903. accepted

. RSNA.

July

1996

the

neoplasms.

16:9’

1995

RSNA

t)epartmcnt

Front

the

I)ecenther

of

2’.

diagnosis.

16.364

revealed

Proton-density-weighted

material-enhanced

(CT) and magnetic were performed.

1996;

CT

reso-

Neurocytoma.

#{149}

a 6-cm-diameter

enhancing mass in the anterior right triele (Fig 1). No caleifleations were unenhanced CT seams (not shown), effect resulted in hydrocephalus.

of

showed

FIgure 1. Contrast-enhanced CT scan shows a hetenogeneously enhancing mass in the right lateral ventricle. Several small, nonenhancing foci are seen in the periphery of the niass.

RadioGraphics

MD

FINDINGS

MR

a predominantly

tricular

mass

septum

peblucidum

ventricular

Index

Tung,

Contrast-enhanced

Neuno-

a decreased and

Contrast

computed tomography nance (MR) imaging

with

a 6-week

visual

Day

with

lateral yenseen on and mass

imaging

hyperintense

a broad (Fig

dilatation

was

attachment 2).

intraven-

to the

Asymmetric

lateral

noted.

Figure 2. Transaxial proton-density-weighted image (repetition time msec/echo time msec 30) shows a heterogeneous hut predominantly intense mass with a broad base of attachment displaced septum pellucidum (arrowheads).

MR 2,50()/ hyperto the

=

16.364

1 -9’3

I)iagnostic

scientific

Address

intaging. assembly.

reprint

Brown tniversity School of Medicine, Rhode island Received September 26. 1995: revision requested

requests

hospital. October

593 Eddy St. Providence. 1 I and received I)ecemher

RI 2:

toJ.II.G.

1996

GoldsteIn

et al

U

RadioGraphics

U

971

(;ntrast-enlianced imaging mass

into

at the l)tIt

coronal

demonstrated the

third

fonamina

T 1-weighted

caudal ventricle

(Fig

of Monno

nesulted

dilatation

of the

asymmetric

MR

extension

of the

3).

Mass

effect

in bilateral lateral

yen-

tnicles.

DIAGNOSIS:

Intraventricuban

neunocytoma.

U DISCUSSION tumors are uncommon, ac1 0% of all intracranial neoplasms

Intraventriculan counting

for

( I ). Intraventnicular

neurocytoma

commonly

in Iatments

constitutes

nearly

tumors

However,

the

has

before

atice

(2,3).

tnicular

The

seizure.

septum

lateral

duces

fornix,

and

this

advantage

They

also

in which

CT concluded

MR

differential with

many

advantages

masses.

CT

extent

is an

planning

(5).

in detecting streak tic

MR

lesions,

from

of masses and

of calcification. were few cases altered MR

imaging hone,

vascular

mass iniaging

has

is also and

origin

MR

neunosungical more

hemorrhage

allows

malformations

of

attachment

suggests

the

charactercontent,

cys(4).

diagnosis

edema, associated

U

Special

Exhibit

differential hetenoge-

in the

and

age, can

location,

tumor

he valuable alternative

with involves

in 20%

and

imaging

in differentiating (5).

froni Peritumoral

of astnocytomas,

neunocytoma.

the

ch()-

oligodendroglioma

diagnoses

neurocytoma

trigone,

on

menin-

ependymoma,

papilloma,

present

lateral

astrocytonia,

subependyrnoma,

of these

in a young pellucidum

the

mass

includes

intraventricular

972

tumor

(3).

intravemtriculan

several

neo-

of a well-

septum

to neunocytoma,

plexus

are

of this

combination

to the

diagnosis

ventricle

(6). Patient appearance

quently

edema

of a well-circumscribed,

neous

noid

vasogenic

intraventnicular

and

is mild

lntnatu-

appearance the

(69X on vascu-

( 1 ). There

enhancement. the

pre-

of cases),

of cases) and

circumscribed adult

neurobut

calcifications

(85%

is nonspecific,

gioma,

sensitive is free

lipomatous

(62%

( 1 ). Although

third

with

contrast

rare plasm

niass spaces

In addition

completely,

enhancement, with

the

intraventriculan for

voids

moral

intraventriculan

more

solid

Ian flow

intnaventricular

as a heterogeneous

cystic

to moderate

pri-

intraventricular

tool

contrast

artifact

ization

lesion

the

intraventricular

However,

invaluable

appears

of cases). tumors.

that

in imaging

of the

imaging

cytoma doniinantly

detection that there

the

At CT or MR imaging,

pro-

to obstruction

significantly

By showing

in the

often

complementary

of an (4).

horn.

the

lateral

found

reported

imaging

diagnosis

imaged

and

is the

poral

include

neoplasni

of imaging

with

in-

pressure,

intraventriculan

et al (4)

masses

and

nostral

secondary

in characterizing

Figure 3. (ontrast-enhanced coronal T 1-weighted MR image (600/1 1 ) shows caudal extension of the mass into the third ventricle (at-now), deviation of the septum l)elltlCiduni (arrowheads), and asynimetnc dilatation of the lateral ventricles. * dilated tern-

of intraven-

of origin

of the fonamina of Monno. (;T and MR imaging have

mary

it was

appear-

it is coninionly

ventricle,

Mc(oncachie

1982,

microscopic

sites

hydrocephalus

roles

description in

intracranial

Comnion

( 1 ). Since

nostral

initial

increased

l)ellucidtlni,

ventricle

(1). is prob-

oligodendnoglioma,

light

headache,

and

group

symptoms and signs are nonspecific

neunocytoma

elude

with

a similar

and

tumor

neunocytoma

confused

which

age

of this

underestiniated;

most

years

of all supratentorial in this

prevalence

of intraventniculan frequently

occurs 20-40

one-half

intra’entriculan ably

aged

is rarely

frethe

Meningiorna

usually

spares

Volume

16

Number

4

frontal

horn,

and

of 30 years for

is more

(3,6).

The

subependymonia

fourth

(6).

in younger

more

cation

in the

crab

Intraventniculan droglioma can logically

and

distinction

radiographically; because

of these

Intraventricular of neural

origin

has

cur

incomplete

cause

gnee

reported, surgical

tion

therapy

with

may

resection

(7). be

neunologic

bosal

adjuvant

recommended

(8).

Our

resection

patient

and

neunobogic

high

4.

in patients tumor

underwent

at the

3.

de-

is not radia-

partial

a tnanscal-

demonstrated

deficits

neBe-

(2).

value

2.

as

may

therapy However,

after

appropriate

I

Al-

as long

and

of clinical

syniptoms

no

residual

I 2-month

5.

follow-up

visit.

In contrast, neural origin

oligodendroglioma is of nonand may have malignant compo-

nents;

therefore,

tion,

chemotherapy,

section and

(9).

it is often on both

Since

oligodendroglioma

electron

microscopy, between

of intr-aventriculan

ported

by the

reactivity found features

for

1996

(6).

be

The

of axons

7.

mi-

required

neunonal

at silver

im-

of inimuno-

(2).

protein

9.

Ultrastructural

include clear

8.

is sup-

a 38-kd

vesicles

granules,

ne-

bight

neurocytoma

synaptophysin,

microtubules,

synaptic

vesicles,

(6). intnaventriculan

neunocytonia that

and

junctions

In summary,

July

may

them

of meurocytoma

synapselike

a similar

by demonstration

in synaptic

dense-core

surgical neurocytoma

or both

presence

and

6.

radia-

immunohistochemistry,

nature pregnation

after

have

appearance,

distinguish

with

intraventricular

croscopic tO

treated

a benign

tumor

of young

included

in the

differential

adults

diagnosis

to be

evaluation

ealeffleation

pathologic

perform

stir-

tumor

rate

though

appears

overall

of is bet-

diagnosis

If intraventrieular the

neo-

resection

proliferation

of differentiation,

generally

for

a specific

suspected,

a specific

is

neurocytoma

pathologist

should

be

supplemental

is

alerted

to

analyses

to

diagnosis.

should

REFERENCES

U

complete

the

even

imperative.

make

different.

of choice.

survival

been

of a low

which

treatment

recurrence-free

be

is a benign

for

is the

19 years with

glioma,

lat-

treatment

may

neoplasm,

imaging

CT in the

such

the

tumors

neurocytoma

resection

though

1-

of the

however,

is important

plasm

and

horn

MR

than

ten evaluated with CT. Because of the difference in prognosis and treatment between intraventricular neurocytoma and oligodendno-

papilloma

is characterized

posterior

mass.

useful

this

neurocytoma and oligodenbe difficult to distinguish patho-

prognosis

gical

more

intraven-

enhancement

and

ventricular

(6).

ventricle

and

with plexus and

age

is the

choroid

contrast body

the

location

ependymoma

patients

intense

after

common

Compared

neurocytorna,

occurs by

and

ventricle

triculan

common

most

.

Chang KH, Han MH, Kim ance of central neunocytoma. 34:520-526.

DG,

et al. MR appearActa Radiol 1993;

Hassoin J, Soylemezoglu F, Gambanelli D, et al. Central neurocytoma: a synopsis of clinical and histological features. Brain Pathol 1993; 3:297306. Yasangil MG, von Ammon K, von Deimling A, et al. Central neunocytoma: histopathological variants and therapeutic approaches. J Neunosung 1992; 76:32-37. Mc(oncachie NS, Worthington BS, Cornford EJ, et al. Computed tomography and magnetic resonance in the diagnosis of intraventniculan ccnebral masses. BnJ Radiol 1993; 67:223-243. Jelinek J, Smirniotopoubos JG, Parisi JE, et al. Lateral ventricular neoplasms of the brain: diffenential diagnosis based on clinical, CT, and MR findings. AJNR 1990; 11:567-574. Goengen 5K, Gonzales MF, McLean CA. Intraventricular neunocytoma: nadiobogic features and review of the literature. Radiology 1992; 182: 787-792. Hesslen

RB,

Lopes

MBS,

Frankfurter

A, et

al.

Cvtoskeletal immunohistochemistry of central neurocytomas. Am J Sung Pathol 1992; 16:10311038. Nakagawa K, Aoki Y, Sakata K, et al. Radiation therapy of well-differentiated neuroblastoma and central neunoc)’torna. Cancer 1993; 72: 1350-1355. Burger PC, Scheithauer BW. Tumors of the central nervous system. In: Rosai J, Sobin LH, eds. Atlas of tumor pathology, sen 3. Washington, DC: Armed Forces Institute of Pathology, 1993; 119-120.

is be

of an intra-

GoldsteIn

et al

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