Anaplastic astrocytoma (WHO grade III) of the septum pellucidum
About 2 weeks of unsteady gait with falling. No seizures.
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Large minimally enhancing mass arising from the septum pellucidum with edema and possible infiltration into the body of the corpus callosum. Extension down to the foramina of Munro with resultant obstructive hydrocephalus (and periventricular edema). Mass is bright on FLAIR with probable small cystic spaces. Note prominent adjacent vascularity.
Highly unusual intraventricular mass arising from the septum pellucidum. In a younger patient central neurocytoma would be considered, however, it seems too aggressive for this condition with infiltration into the corpus callosum and the patient is old (ie 70 years).
Histology: High grade glioma being GFAP +ve, p53 strongly positive in many enlarged atypical nuclei, Ki-67 proliferation index is ~25% with positive 1p/19q gene deletion.