Presentation
Chronic headache, raised intracranial pressure clinically.
Patient Data
Large lesion measuring approx. 61 x 55 x 62mm (AP x TD x CC) is seen in right frontoparietal lobes and reaching upto body of right lateral ventricle. It is compressing surrounding brain parenchyma, right basal ganglia, thalamus, right lateral, 3 rd ventricles and corpus callosum with midline shift of approx. 13mm towards left side. Mild descending transtentorial herniation is also seen. Left lateral ventricle is mildly dilated with periventricular seepage.
Lesion shows areas of diffusion restriction, calcification at posterior aspects, necrosis / cystic change and heterogeneous enhancement on post contrast study.
Possible peritumoral cyst, measuring approx. 19 x 32 x 21mm is seen at posterior aspect of the lesion.
Brainstem is mildly deviated to left side. It is otherwise unremarkable.
Tiny suprasellar lesion, measuring approx. 6.5 x 5.6 x 4.4mm is seen in suprasellar region, possibly involving right lateral aspects of optic chiasma. This is possibly possibly a synchronous lesion or a metastasis.
CT shows the periwinkle sign- centripetal calcification reminiscent of a periwinkle flower with surrounding peripheral cyst, likened to a leaf.
Case Discussion
In view of above findings, first differential is supratentorial ependymoma. Other differentials include atypical teratoid rhabdoid tumor (AT / RT) and embryonal tumor with multilayered rosettes. Histopathology confirmed the presence of supratentorial ependymoma.