There is a large intra-axial mainly multiloculated cystic lesion showing two separate solid nodular components (one superiorly and the other inferomedial) in the right parietotemporal region with surrounding vasogenic edema extending to the frontal and occipital lobes and causing midline shift of about 2 cm with subfalcine herniation and compression of the lateral and 3rd ventricle. This causes dilatation of the contralateral ventricle with trans ependymal edema as well as mass-effect on the midbrain and posterior part of the corpus callosum.
The lesion shows peripheral enhancement of the cystic component as well as thick heterogeneous enhancement of the solid component which also shows restricted diffusion.
Impression:
Large intra-axial multiloculated cystic lesion with internal solid nodular components causing significant mass effect, herniation, and obstructive hydrocephalus.
The differential diagnosis includes embryonal tumour with multilayered rosettes (ETMR), atypical teratoid/rhabdoid tumour (AT/RT), desmoplastic infantile ganglioglioma/astrocytoma and supratentorial ependymoma.