Presentation
Vague headaches.
Patient Data
A heterogeneous but mostly T2 bright mass appears to arise from the septum pellucidum and project into the right lateral ventricle. It demonstrates minor enhancement, and regions of susceptibility induced signal drop out, likely representing calcification.
On T2 weighted images the mass (red arrow) is almost the same signal intensity as CSF and you could be excused for at least thinking that it could be flow related artefact. On FLAIR the mass is clearly not CSF as is much more easily seen (yellow dotted line).
The patient went on to have a craniotomy and resection of the mass.
Histology
MICROSCOPIC DESCRIPTION: The sections show somewhat lobulated fragments of moderately cellular glial tumor. The tumor cells show prominent clustering. They have round to ovoid nuclei with no significant nuclear pleomorphism. There is microcystic change in the background. No mitoses, endothelial cell hyperplasia or necrosis is identified. No evidence of metastatic carcinoma is seen. The features are those of a subependymoma.
FINAL DIAGNOSIS: Right frontal horn tumor subependymoma (WHO Grade I).
Case Discussion
Typical appearances of a subependymoma, although a central neurocytoma could have essentially identical appearances.
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