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Brain Tumor Brain Tumor Neuroimaging Neuroimaging - 4 - 4 Dr Deb Dr Deb
Brain Tumor Brain Tumor Neuroimaging - 4Neuroimaging - 4
Dr DebDr Deb
Others tumorsOthers tumors
II. Tumors of nervesII. Tumors of nerves III. Tumors of the coverings of the brain III. Tumors of the coverings of the brain
(meninges)(meninges) IV. Germ cell tumorsIV. Germ cell tumors V. Other malformative tumors and tumor-like lesionsV. Other malformative tumors and tumor-like lesions
VI. Tumors of the pituitary glandVI. Tumors of the pituitary gland
VII. Metastatic tumors to brain from elsewhere in the VII. Metastatic tumors to brain from elsewhere in the
bodybody
II. Tumors of nervesII. Tumors of nerves
1.1. Schwannoma Schwannoma
2.2. NeurofibromaNeurofibroma
Vestibular schwannomaVestibular schwannoma
Vestibular schwannoma Vestibular schwannoma arises on the eighth cranial arises on the eighth cranial nerve.nerve.
usually unilateral, but in usually unilateral, but in 9% of cases is bilateral9% of cases is bilateral
Commonly asymptomaticCommonly asymptomatic
hearing loss and tinnitus hearing loss and tinnitus are early symptoms are early symptoms produced by involvement produced by involvement of the cochlear division of of the cochlear division of the nervethe nerve
In the later stages vertigo In the later stages vertigo with abnormal caloric and with abnormal caloric and electronystagmographic electronystagmographic responses develop from responses develop from damage to the vestibular damage to the vestibular division itself.division itself.
CT Scan in SchwanomaCT Scan in Schwanoma
Plain CT, most Plain CT, most schwannomas are schwannomas are isodense with brain isodense with brain parenchyma. parenchyma.
Calcification or areas of Calcification or areas of hemorrhage are rare.hemorrhage are rare.
On contrast-enhanced CT, On contrast-enhanced CT, the enhancement pattern the enhancement pattern typically is homogeneoustypically is homogeneous
On contrast-enhanced CT, the On contrast-enhanced CT, the enhancement pattern typically is enhancement pattern typically is homogeneous. homogeneous.
Bone window images can Bone window images can demonstrate remodeling of the demonstrate remodeling of the adjacent skull base, such as adjacent skull base, such as expansion of the IAC by expansion of the IAC by vestibular schwannomas and vestibular schwannomas and the facial canal by facial the facial canal by facial schwannomasschwannomas
Expansion of the jugular Expansion of the jugular foramen by CN IX, CN X, or CN foramen by CN IX, CN X, or CN XI schwannomas also can be XI schwannomas also can be seen. seen.
Thin-collimation CT Thin-collimation CT imaging of the skull imaging of the skull base can be helpful for base can be helpful for evaluating bone evaluating bone destruction, which is destruction, which is useful for useful for differentiating jugular differentiating jugular foramen foramen schwannomas from schwannomas from paragangliomasparagangliomas
MRI in SchwannomasMRI in Schwannomas
isointense or slightly isointense or slightly hypointense to gray matter on hypointense to gray matter on T1-weighted images and slightly T1-weighted images and slightly hypointense to CSFhypointense to CSF
on T2-weighted images. on T2-weighted images. Enhancement following Enhancement following
gadolinium administration gadolinium administration typically is homogeneous, typically is homogeneous, although larger schwannomas although larger schwannomas can show areas of cystic can show areas of cystic degeneration and signal degeneration and signal heterogeneity,heterogeneity,
often on the bases of increased often on the bases of increased areas of Antoni type B histology. areas of Antoni type B histology.
high-resolution thin-section high-resolution thin-section heavily T2-weighted 3-heavily T2-weighted 3-dimensional sequences, dimensional sequences, individual nerves within the individual nerves within the cistern and IAC can be cistern and IAC can be visualized as linear filling visualized as linear filling defects within the bright CSFdefects within the bright CSF
Small masses can be identified Small masses can be identified without the use of an without the use of an intravenous contrast agentintravenous contrast agent
Typically, the masses are Typically, the masses are located in the cerebellopontine located in the cerebellopontine angle (CPA) and are centered at angle (CPA) and are centered at the porus, with extension into the porus, with extension into the IAC. Their appearance has the IAC. Their appearance has been termed comet tail or ice been termed comet tail or ice cream conecream cone
The long axis of the tumors lies The long axis of the tumors lies parallel to the petrous surface. parallel to the petrous surface. Occasionally, tumors can be Occasionally, tumors can be entirely intracanicular, in which entirely intracanicular, in which case, the primary differential case, the primary differential diagnosis is a meningioma of diagnosis is a meningioma of the CPAthe CPA
Unlike vestibular schwannomas, Unlike vestibular schwannomas, meningiomas tend to form meningiomas tend to form obtuse angles with the adjacent obtuse angles with the adjacent petrous bone, typically are petrous bone, typically are hemispherical in appearance, hemispherical in appearance, and often extend into the middle and often extend into the middle fossa via herniationfossa via herniation
Contrast-enhanced T1-Contrast-enhanced T1-weighted image at the weighted image at the level of the internal level of the internal auditory canal shows a auditory canal shows a densely enhancing densely enhancing cisternal vestibular cisternal vestibular schwannoma (white arrow) schwannoma (white arrow) compressing the adjacent compressing the adjacent pons and cerebellum and pons and cerebellum and distorting the fourth distorting the fourth ventricle. ventricle.
Contrast-enhanced T1-Contrast-enhanced T1-weighted axial image weighted axial image through the internal through the internal auditory canal shows a auditory canal shows a heterogeneously heterogeneously enhancing enhancing intracanalicular/cisternal intracanalicular/cisternal vestibular schwannoma vestibular schwannoma (white arrow). Anterior to (white arrow). Anterior to the schwannoma a tumor-the schwannoma a tumor-related cyst is noted (black related cyst is noted (black arrow). arrow).
Intracanalicular vestibular Intracanalicular vestibular schwannoma. Axial CISS schwannoma. Axial CISS (constructive interference (constructive interference in the steady state) image in the steady state) image shows a 3-mm mass in the shows a 3-mm mass in the internal auditory canal as a internal auditory canal as a filling defect within the filling defect within the bright cerebrospinal fluid. bright cerebrospinal fluid.
Vestibular schwannoma. Vestibular schwannoma. Axial contrast-enhanced Axial contrast-enhanced T1-weighted image T1-weighted image confirms the confirms the intracanalicular mass seen intracanalicular mass seen in Image 3. . in Image 3. .
68 year old male with left sided hearing loss68 year old male with left sided hearing loss
44-year-old male with progressive right-44-year-old male with progressive right-sided sensorineural hearing losssided sensorineural hearing loss
Female, 55 years, complaining of a right Female, 55 years, complaining of a right hearing loss and facial hemispasmhearing loss and facial hemispasm
(1) Enhancing small tumor at the right cerebellopontine angle(2) Tumoral component inside the right internal acoustic meatus(3) Membranous labyrinth(4) Pons(5) Cerebellar hemisphere(6) Normal left internal acoustic meatus
Facial nerve: SchwannomasFacial nerve: Schwannomas
can occur along any segment but frequently involve the geniculate can occur along any segment but frequently involve the geniculate ganglion and extend proximally or distally from there. ganglion and extend proximally or distally from there.
MRI and CT imaging characteristics are similar to those for vestibular MRI and CT imaging characteristics are similar to those for vestibular schwannomas. schwannomas.
The location of the mass results in variable growth patterns. The location of the mass results in variable growth patterns. In the IAC, facial schwannomas are indistinguishable from vestibular In the IAC, facial schwannomas are indistinguishable from vestibular
lesions. lesions. When crossing the petrous bone to involve both the middle and posterior When crossing the petrous bone to involve both the middle and posterior
fossa, facial schwannomas cross in the mid portion of the petrous bone fossa, facial schwannomas cross in the mid portion of the petrous bone as opposed to trigeminal schwannomas, which cross near the petrous as opposed to trigeminal schwannomas, which cross near the petrous apex.apex.
Lesions in the geniculate ganglion can be mistaken for temporal lobe Lesions in the geniculate ganglion can be mistaken for temporal lobe lesions, and imaging in the coronal plane is useful in evaluating the lesions, and imaging in the coronal plane is useful in evaluating the lesionslesions
Facial schwannoma. Facial schwannoma. Axial T1-weighted Axial T1-weighted image at the level of image at the level of the internal auditory the internal auditory canal shows a soft canal shows a soft tissue mass along the tissue mass along the course of the tympanic course of the tympanic segment of the facial segment of the facial nerve. nerve.
Facial schwannoma. Facial schwannoma. Coronal contrast-Coronal contrast-enhanced T1-weighted enhanced T1-weighted image shows the image shows the schwannoma involving schwannoma involving the mastoid segment the mastoid segment of cranial nerve VII. of cranial nerve VII.
Facial neuritis. Axial Facial neuritis. Axial contrast-enhanced T1-contrast-enhanced T1-weighted image shows weighted image shows swelling and swelling and enhancement of the enhancement of the labyrinthine, labyrinthine, geniculate, and geniculate, and tympanic segments of tympanic segments of cranial nerve VII. cranial nerve VII.
Facial neuritis. Coronal Facial neuritis. Coronal contrast-enhanced T1-contrast-enhanced T1-weighted image shows weighted image shows swelling and marked swelling and marked enhancement of the enhancement of the mastoid segment of mastoid segment of cranial nerve VII. cranial nerve VII.
Trigeminal schwannomasTrigeminal schwannomas
Trigeminal schwannomas can arise in the Meckel Trigeminal schwannomas can arise in the Meckel cave or in the cistern along the course of the cave or in the cistern along the course of the nerve. nerve.
Extension and expansion of the foramen rotundum Extension and expansion of the foramen rotundum or ovale is common, and the masses can have a or ovale is common, and the masses can have a bilobed appearance. bilobed appearance.
Tumors also can grow posteriorly to involve the Tumors also can grow posteriorly to involve the posterior fossa or anteriorly into the cavernous posterior fossa or anteriorly into the cavernous sinus. sinus.
Trigeminal schwannomas tend to have a more Trigeminal schwannomas tend to have a more cystic component than do other schwannomascystic component than do other schwannomas
Trigeminal Trigeminal schwannoma. Coronal schwannoma. Coronal T2-weighted image T2-weighted image shows a hyperintense shows a hyperintense mass in the right mass in the right cavernous sinus. cavernous sinus.
Trigeminal schwannoma. Trigeminal schwannoma. Axial contrast-enhanced Axial contrast-enhanced T1-weighted image at the T1-weighted image at the level of the mid pons level of the mid pons shows a densely shows a densely enhancing mass involving enhancing mass involving the left cranial nerve V the left cranial nerve V within the cistern (black within the cistern (black arrow) and Meckel cave arrow) and Meckel cave (white arrow). (white arrow).
Trigeminal schwannoma. Trigeminal schwannoma. Axial CISS (constructive Axial CISS (constructive interference in the steady interference in the steady state) image shows a state) image shows a mass in the region of the mass in the region of the cisternal segment of the cisternal segment of the right cranial nerve V (white right cranial nerve V (white arrow). The left cranial arrow). The left cranial nerve V (without tumor) nerve V (without tumor) also is visualized (white also is visualized (white arrow). arrow).
Trigeminal schwannoma. Trigeminal schwannoma. Coronal contrast-Coronal contrast-enhanced T1-weighted enhanced T1-weighted image (same patient as image (same patient as Picture 12) shows the Picture 12) shows the mass arising from the mass arising from the cisternal segment of the cisternal segment of the right cranial nerve V. The right cranial nerve V. The left cranial nerve V left cranial nerve V (without tumor) also is (without tumor) also is visualized (white arrow). visualized (white arrow).
Glossopharyngeal, vagus, or Glossopharyngeal, vagus, or accessory nerve schwannomasaccessory nerve schwannomas
Glossopharyngeal, vagus, or accessory nerve Glossopharyngeal, vagus, or accessory nerve schwannomas are rare and are difficult to distinguish from schwannomas are rare and are difficult to distinguish from each other. each other.
The tumors are classified based on their growth patterns, The tumors are classified based on their growth patterns, with with – type A lesions growing predominantly intracranially,type A lesions growing predominantly intracranially,– type B lesions growing predominantly at the jugular foramen, and type B lesions growing predominantly at the jugular foramen, and – type C lesions growing predominantly extracranially.type C lesions growing predominantly extracranially.
CT and MRI characteristics are similar to those seen in CT and MRI characteristics are similar to those seen in other schwannomas. In contrast to the more common other schwannomas. In contrast to the more common paraganglioma in this region, schwannomas expand but do paraganglioma in this region, schwannomas expand but do not infiltrate the adjacent bonenot infiltrate the adjacent bone
Glossopharyngeal Glossopharyngeal schwannoma. Axial schwannoma. Axial contrast-enhanced T1-contrast-enhanced T1-weighted image shows weighted image shows a large extraaxial mass a large extraaxial mass compressing the compressing the brainstem (black brainstem (black arrows) and extending arrows) and extending into the skull base into the skull base (white arrows). (white arrows).
Glossopharyngeal Glossopharyngeal schwannoma. Coronal schwannoma. Coronal contrast-enhanced T1-contrast-enhanced T1-weighted image (same weighted image (same patient as Picture 17) patient as Picture 17) shows a mass shows a mass extending through the extending through the skull base via the skull base via the jugular foramen. jugular foramen.
Glossopharyngeal Glossopharyngeal schwannoma. Digital schwannoma. Digital subtraction angiogram subtraction angiogram from an ascending from an ascending pharyngeal artery injection pharyngeal artery injection reveals a moderately reveals a moderately hypervascular hypervascular schwannoma, which is schwannoma, which is atypical for schwannomas atypical for schwannomas (same patient as Pictures (same patient as Pictures 17-19). 17-19).
Hypoglossal schwannomasHypoglossal schwannomas
Hypoglossal schwannomas are similar in Hypoglossal schwannomas are similar in growth patterns and imaging characteristics growth patterns and imaging characteristics to jugular foramen schwannomas. to jugular foramen schwannomas.
When large enough, the tumors can erode When large enough, the tumors can erode the hypoglossal canal to such an extent that the hypoglossal canal to such an extent that differentiation from jugular foramen differentiation from jugular foramen schwannomas can be difficult. schwannomas can be difficult.
Schwannomas of CN VISchwannomas of CN VI
Schwannomas of CN VI are rare. Schwannomas of CN VI are rare. They have been reported to occur in the They have been reported to occur in the
prepontine cistern, with a heterogeneous prepontine cistern, with a heterogeneous appearance on CT and MRI imaging and appearance on CT and MRI imaging and extension into the adjacent cavernous sinus. extension into the adjacent cavernous sinus.
Similar to other schwannomas, meningioma is the Similar to other schwannomas, meningioma is the primary differential diagnosis, and the presence of primary differential diagnosis, and the presence of areas of cystic change (manifesting as high T2 areas of cystic change (manifesting as high T2 signal) can sway the likelihood of a diagnosis to signal) can sway the likelihood of a diagnosis to schwannoma over meningioma. CN IV schwannoma over meningioma. CN IV schwannomas similarly are rare (see Image 17). schwannomas similarly are rare (see Image 17).
Cranial nerve IV Cranial nerve IV schwannoma. Axial schwannoma. Axial and coronal contrast-and coronal contrast-enhanced T1-weighted enhanced T1-weighted images demonstrate a images demonstrate a small mass involving small mass involving the cisternal segment the cisternal segment of cranial nerve IV of cranial nerve IV adjacent to the adjacent to the midbrain. midbrain.
Oculomotor nerve SchwannomasOculomotor nerve Schwannomas
Schwannomas of the oculomotor nerve Schwannomas of the oculomotor nerve have been reported in the literature but are have been reported in the literature but are exceedingly rare. exceedingly rare.
The tumors can present as masses in the The tumors can present as masses in the suprasellar cistern and can be difficult to suprasellar cistern and can be difficult to distinguish from meningiomas in this region.distinguish from meningiomas in this region.
Notice the whirly swirly pattern and how the cell nuclei are closely bunched together... almost Notice the whirly swirly pattern and how the cell nuclei are closely bunched together... almost as if they're forming a fence (Verocay bodies). Schwannomas are benign spindle cell as if they're forming a fence (Verocay bodies). Schwannomas are benign spindle cell tumors that occur along the edges of peripheral nerves. They can usually be removed tumors that occur along the edges of peripheral nerves. They can usually be removed without damaging the nerve itself. without damaging the nerve itself.
A high power view of A high power view of the Schwannoma, the Schwannoma, emphasizing the emphasizing the slenderness of the slenderness of the spindle cells and their spindle cells and their elongate nuclei.elongate nuclei.
Compare them with Compare them with the much plumper the much plumper spindle cells of the spindle cells of the meningioma. meningioma.
NeurofibromatosisNeurofibromatosis
NF-1 and NF-2 chromosome 17 and 22NF-1 and NF-2 chromosome 17 and 22 NF-1 NF-1
– 1) six or more café-au-lait spots, 1) six or more café-au-lait spots, – 2) two or more hemartomas of the iris (Lisch nodules), 2) two or more hemartomas of the iris (Lisch nodules), – 3) two or more neurofibromas, 3) two or more neurofibromas, – 4) one or more plexiform neurofibromas, 4) one or more plexiform neurofibromas, – 5) axillary freckling, 5) axillary freckling, – 6) one or more bone dysplasias, 6) one or more bone dysplasias, – 7) psuedoarthrosis of a long bone,7) psuedoarthrosis of a long bone,– 8) optic glioma, or 8) optic glioma, or – 9) a first-degree relative with the diagnosis of NF-19) a first-degree relative with the diagnosis of NF-1
Neurofibromatosis - RadiologyNeurofibromatosis - Radiology
cerebellar, brain stem, and cerebral astrocytomas cerebellar, brain stem, and cerebral astrocytomas are seen with NF-1. are seen with NF-1.
On MR T2 weighted images, patients may have On MR T2 weighted images, patients may have high signal intensity foci in the peduncles or deep high signal intensity foci in the peduncles or deep gray matter of the cerebellum, brain stem or basal gray matter of the cerebellum, brain stem or basal gangliaganglia
These features are believed to represent These features are believed to represent hamartomas, focal areas of gliosis, wallerian hamartomas, focal areas of gliosis, wallerian degeneration, neuronal migrational disorders, or degeneration, neuronal migrational disorders, or possibly neoplasms.possibly neoplasms.
9-year-old male with a history of headaches x 9-year-old male with a history of headaches x two months and hyperreflexia.two months and hyperreflexia.
Multiple rounded foci of abnormally bright signal are seen in the lentiform nuclei bilaterally, the thalami bilaterally, mesencephalon, and dentate nuclei bilaterally (left greater than right), on FLAIR and T2 weighted images. No abnormal enhancement is seen.
Neurofibromatosis 2Neurofibromatosis 2
37 year old man with a well established family history of 37 year old man with a well established family history of neurofibromatosis type 2. Of 4 older siblings, all four had in the past neurofibromatosis type 2. Of 4 older siblings, all four had in the past been treated with surgery for bilateral acoustic neuromas and a variety been treated with surgery for bilateral acoustic neuromas and a variety of other CNS tumors of other CNS tumors
Coronal T1 weighted MRI with contrast demonstrating a falx meningioma
Neurofibromatosis 2Neurofibromatosis 2
Axial MRI with contrast demonstrating a very large acoustic neuroma and two meningiomas of the posterior cranial fossa.
Neurofibromatosis 2Neurofibromatosis 2
Coronal MRI demonstrating a falx meningioma, a meningioma of the tentorium and an acoustic neuroma on the right side.
Neurofibromatosis 2Neurofibromatosis 2
Sagital contrast T1 Sagital contrast T1 MRI of the same MRI of the same patient demonstrating patient demonstrating the extent of the the extent of the tentorial meningioma tentorial meningioma
Neurofibromatosis 2Neurofibromatosis 2
T1 axial, non contrast T1 axial, non contrast MRI demonstrating an MRI demonstrating an
optic nerve glioma.optic nerve glioma.
Neurofibromatosis 2Neurofibromatosis 2
Axial T1-weighted Axial T1-weighted postcontrast image postcontrast image demonstrates bilateral demonstrates bilateral internal auditory canal-internal auditory canal-enhancing masses enhancing masses diagnostic for diagnostic for neurofibromatosis type 2. neurofibromatosis type 2. No biopsy is necessary for No biopsy is necessary for the diagnosis. Notice the the diagnosis. Notice the en-plaque meningioma en-plaque meningioma anterior to the brainstem. anterior to the brainstem.
Neurofibromatosis 2Neurofibromatosis 2 Axial postcontrast T1-weighted Axial postcontrast T1-weighted
image demonstrates a large image demonstrates a large enhancing sellar meningioma enhancing sellar meningioma surrounding both internal carotid surrounding both internal carotid arteries in this case of arteries in this case of neurofibromatosis type 2 (NF-2) neurofibromatosis type 2 (NF-2) (black arrows). Enhancing tissue in (black arrows). Enhancing tissue in the ethmoid air cells also represents the ethmoid air cells also represents meningioma, extending through the meningioma, extending through the cribriform plate. Meningiomas in cribriform plate. Meningiomas in patients with NF-2 can be more patients with NF-2 can be more aggressive and invasive than aggressive and invasive than spontaneous meningiomas. Note spontaneous meningiomas. Note the small round enhancing extra-the small round enhancing extra-axial mass posterior to the tectum axial mass posterior to the tectum (white arrows). While this could (white arrows). While this could represent another meningioma, the represent another meningioma, the shape and location suggest it is a shape and location suggest it is a trochlear schwannoma instead. trochlear schwannoma instead.
Neurofibromatosis 2Neurofibromatosis 2
Sagittal T1-weighted Sagittal T1-weighted postcontrast image in a postcontrast image in a patient with known patient with known neurofibromatosis 2 neurofibromatosis 2 demonstrates two midline demonstrates two midline meningiomas meningiomas (arrowheads), one over the (arrowheads), one over the convexity and one along convexity and one along the vein of Galen. The the vein of Galen. The enhancing mass in the enhancing mass in the medulla (arrow) most likely medulla (arrow) most likely is an ependymoma is an ependymoma
III. Tumors of the coverings of the III. Tumors of the coverings of the
brain - brain - Meningioma Meningioma Meningiomas are the most common non-glial primary tumor Meningiomas are the most common non-glial primary tumor
of the CNS. Meningiomas are also the most common of the CNS. Meningiomas are also the most common extraaxial primary tumor of the CNS. extraaxial primary tumor of the CNS.
They represent 15-25% of all intracranial primary tumors. They represent 15-25% of all intracranial primary tumors. Most patients are in the 5th and 6th decades (40's - 50's). Most patients are in the 5th and 6th decades (40's - 50's).
The 2x-4x female predilection is most likely due to hormone The 2x-4x female predilection is most likely due to hormone receptors for progesterone and estrogen. receptors for progesterone and estrogen.
The tumor arises from the arachnoid cap cells and is usually The tumor arises from the arachnoid cap cells and is usually a slowly growing intradural intracranial mass, with a broad a slowly growing intradural intracranial mass, with a broad base of attachment to the overlying dura. base of attachment to the overlying dura.
Hyperostosis of the overlying skull occurs in 15-25% of Hyperostosis of the overlying skull occurs in 15-25% of cases and may be a "sympathetic reaction" - or - can cases and may be a "sympathetic reaction" - or - can indicate invasion of the skull. indicate invasion of the skull.
MeningiomaMeningioma Note that arachnoid villi are Note that arachnoid villi are
composed of an outer layer of composed of an outer layer of thick dura invaginated by thick dura invaginated by arachnoid membrane. arachnoid membrane.
Meningiomas are composed of Meningiomas are composed of arachnoid cap cells (outer layer) arachnoid cap cells (outer layer) but they arise from the dura. but they arise from the dura.
Throughout the dura there are Throughout the dura there are rests of arachnoid cap cells and rests of arachnoid cap cells and this is most common in the dura this is most common in the dura of the superior sagittal sinus of the superior sagittal sinus because of the arachnoid villi because of the arachnoid villi naturally invaginating the dura in naturally invaginating the dura in this location (Pacchionian this location (Pacchionian granules). granules).
Because this phenomena is most Because this phenomena is most common in this location this is common in this location this is the region where meningiomas the region where meningiomas are most commonare most common
Meningiomas are the 4H Plus tumor: H - hemispheric H - homogeneous H - homogeneously enhancing H - hyperdense (CT) H - hyperostosis H - hormonally reactive (progesterone/estrogen)
Meningioma - GrossMeningioma - Gross
This is a meningioma that This is a meningioma that arose from an arachnoid arose from an arachnoid villus in the superior villus in the superior sagittal sinus. Note that sagittal sinus. Note that unlike a glial tumor, it does unlike a glial tumor, it does not infiltrate surrounding not infiltrate surrounding brain but rather pushes brain but rather pushes against it; this usually against it; this usually makes meningiomas makes meningiomas easier to remove than easier to remove than gliomasgliomas
MeningiomaMeningioma
MeningiomaMeningioma
MeningiomaMeningioma
MeningiomaMeningioma
This patient is a 27-year-old female who presented from a referring This patient is a 27-year-old female who presented from a referring hospital secondary to a mass seen on CT exam. She had been hospital secondary to a mass seen on CT exam. She had been complaining of double vision and intermittent headache for five monthscomplaining of double vision and intermittent headache for five months
MeningiomaMeningioma
IV. Germ cell tumorsIV. Germ cell tumors
A. Germinoma A. Germinoma B. Others: embryonal carcinoma, B. Others: embryonal carcinoma,
choriocarcinoma, teratomachoriocarcinoma, teratoma
A: GerminomaA: Germinoma
These tumors arise from These tumors arise from germ cells and are most germ cells and are most common in the region of common in the region of the pineal gland. the pineal gland.
They are thought to arise They are thought to arise from cells that should have from cells that should have migrated to the gonads migrated to the gonads during development. during development.
They are highly infiltrative They are highly infiltrative and rapidly growing and rapidly growing
GerminomaGerminoma
The tumor is The tumor is composed of primitive composed of primitive germ cells distributed germ cells distributed in a lobular array in a lobular array separated by a separated by a lymphocytic-rich lymphocytic-rich stroma. stroma.
V. Other malformative tumors and V. Other malformative tumors and tumor-like lesionstumor-like lesions
A. Craniopharyngioma A. Craniopharyngioma B. Rathke's cleft cyst B. Rathke's cleft cyst C. Epidermoid and Dermoid cyst C. Epidermoid and Dermoid cyst D. Colloid cyst of the third ventricle D. Colloid cyst of the third ventricle E. Lipoma E. Lipoma F. Hamartoma F. Hamartoma
A. CraniopharyngiomaA. Craniopharyngioma
A. CraniopharyngiomaA. Craniopharyngioma
A. CraniopharyngiomaA. Craniopharyngioma
A. CraniopharyngiomaA. Craniopharyngioma
A. CraniopharyngiomaA. Craniopharyngioma
A 45 year old male presented with history of severe A 45 year old male presented with history of severe headaches of 2 years duration. headaches of 2 years duration.
CT scan was done and it showed a well defined, mildly CT scan was done and it showed a well defined, mildly hyperdense, non enhancing lesion in the Foramen of hyperdense, non enhancing lesion in the Foramen of Monro, with obstructive hydrocephalus, this was reported Monro, with obstructive hydrocephalus, this was reported as a colloid cyst. as a colloid cyst.
Bilateral ventriculo-peritoneal shunts were introduced, and Bilateral ventriculo-peritoneal shunts were introduced, and subsequent scan showed regression of the hydrocephalus.subsequent scan showed regression of the hydrocephalus.
A year later, patient developed a progressive loss of A year later, patient developed a progressive loss of memory; an MRI scan of the brain was performed.memory; an MRI scan of the brain was performed.
A. CraniopharyngiomaA. Craniopharyngioma
A. CraniopharyngiomaA. Craniopharyngioma
This photograph of a This photograph of a lateral X-ray of the lateral X-ray of the skull shows the skull shows the expansion of the sella expansion of the sella turcica and turcica and calcification in mass calcification in mass (look between arrows).(look between arrows).
A. CraniopharyngiomaA. Craniopharyngioma
A sagittal section of A sagittal section of the brain shows a the brain shows a large large craniopharyngioma craniopharyngioma below the cerebral below the cerebral ventricle. Note the ventricle. Note the stippled pattern of the stippled pattern of the tumor tumor
A. CraniopharyngiomaA. Craniopharyngioma
This low power view of a This low power view of a section of section of craniopharyngioma shows craniopharyngioma shows a cystic area on the left, in a cystic area on the left, in the zones to the center, the zones to the center, and lower right epithelia and lower right epithelia producing acellular producing acellular substance, and a loose substance, and a loose mesenchyme filling the mesenchyme filling the rest of the field.rest of the field.
A. CraniopharyngiomaA. Craniopharyngioma
A. CraniopharyngiomaA. Craniopharyngioma
A. CraniopharyngiomaA. Craniopharyngioma
A. CraniopharyngiomaA. Craniopharyngioma
A. CraniopharyngiomaA. Craniopharyngioma
year-old who year-old who presented with presented with headache, vomiting, headache, vomiting, visual defects, and visual defects, and polyuria.polyuria.Head MRI: midline Head MRI: midline tumor mass and tumor mass and obstructive obstructive hydrocephalus. hydrocephalus.
A. CraniopharyngiomaA. Craniopharyngioma
51-year-old male with unspecified neurological symptoms four months status post head trauma
Rathke's cleft cyst
Rathke's cleft cystRathke's cleft cyst
Dermoid cyst: These are benign tumors that arise from epithelial cells misplaced during development. The cysts are smooth and encapsulated. Dermoid cysts occur most often in the posterior fossa
Colloid Cyst of Third VentricleColloid Cyst of Third Ventricle
Colloid Cyst of Third VentricleColloid Cyst of Third Ventricle
Female, 79 years, complaining Female, 79 years, complaining of recent disorientation and of recent disorientation and memory loss. memory loss.
On CT and MR images : small, On CT and MR images : small, round, non-enhancing, round, non-enhancing, hyperdense, hypointense (T2), hyperdense, hypointense (T2), hyperintense (T1) tumour hyperintense (T1) tumour located in the anterior part of the located in the anterior part of the third ventricle, near the Monro's third ventricle, near the Monro's foramina. foramina.
This lesion leads to obstruction This lesion leads to obstruction of the Monro's foramina and of the Monro's foramina and therefore to lateral ventricles therefore to lateral ventricles dilatation. We read this lesion as dilatation. We read this lesion as a typical colloid cyst. a typical colloid cyst.
HarmatomaHarmatoma
VI. Tumors of the pituitary glandVI. Tumors of the pituitary gland
HX: 71 y/o RHM developed a HX: 71 y/o RHM developed a cataclysmic headache on cataclysmic headache on 11/5/92 associated with a 11/5/92 associated with a violent sneeze. The headache violent sneeze. The headache lasted 3-4 days. On 11/7/92, he lasted 3-4 days. On 11/7/92, he had acute pain and loss of had acute pain and loss of vision in the left eye. Over the vision in the left eye. Over the following day his left pupil following day his left pupil enlarged and his left upper enlarged and his left upper eyelid began to droop. He was eyelid began to droop. He was seen locally and a brain CT seen locally and a brain CT showed no sign of bleeding, but showed no sign of bleeding, but a tortuous left middle cerebral a tortuous left middle cerebral artery was visualized. The artery was visualized. The patient was transferred to UIHC patient was transferred to UIHC 11/12/92.11/12/92.
HX: This 47 y/o RHM presented HX: This 47 y/o RHM presented to his local optometrist in 9/92 to his local optometrist in 9/92 for routine evaluation. He had for routine evaluation. He had no complaint of visual loss, HA, no complaint of visual loss, HA, nausea/vomiting, nausea/vomiting, lymphadenopathy, weight lymphadenopathy, weight change, galactorrhea, change, galactorrhea, impotence, temperature impotence, temperature intolerance, hot or cold flashes, intolerance, hot or cold flashes, or personality change. Visual or personality change. Visual field testing revealed a superior field testing revealed a superior bitemporal incongruous bitemporal incongruous hemianopia and he was referred hemianopia and he was referred to NeuroOpthalmology at UIHC.to NeuroOpthalmology at UIHC.
VII. Metastatic tumors to brain VII. Metastatic tumors to brain from elsewhere in the bodyfrom elsewhere in the body
Note that there are at Note that there are at least five multiple foci least five multiple foci of tumor which usually of tumor which usually indicates metastases indicates metastases rather than primary rather than primary tumor. In this case the tumor. In this case the metastatic nodules are metastatic nodules are also hemorrhagic and also hemorrhagic and they arose from the they arose from the lunglung
VII. Metastatic tumors to brain VII. Metastatic tumors to brain from elsewhere in the bodyfrom elsewhere in the body
VII. Metastatic tumors to brainVII. Metastatic tumors to brain
VII. Metastatic tumors to brainVII. Metastatic tumors to brain
Bronchogenic Carsinoma
Breast MetastasisBreast Metastasis
Brain MetastasisBrain Metastasis
