Anaplastic ganglioglioma

Case contributed by Dr Amit Chakraborty

Presentation

Headache and vomiting.

Patient Data

Age: 40 years
Gender: Male
CT

Pre and post contrast CT Brain. Findings:

Large lesion in the right temporal lobe with a heterogeneous slightly hyperdense lobulated mass associated with a rounded well-circumscribed low attenuation component in the posterior superior aspect.

Moderate enhancement after administering IV contrast.

Associated white matter oedema, although the amount of associated oedema is less that what would be expected for a tumour this size.

Positive mass effect: near complete effacement of the right lateral ventricle, contralateral midline shift of 3mm with subfalcine herniation

No overlying bony permeative change.

MRI

Selected MR sequences through the brain. Findings:

Confirms the large lesion in the right temporal region with solid and cystic components.

Heterogeneous enhancement of the solid component, rim enhancement of the cystic component.

Large flow void, best appreciated in sagittal projection, consistent with a large vessel travelling through the lesion

Scattered foci of enhancement in the posterior aspect of the right side of the centrum semiovale, suggestive of satellite lesions.

Fiducials are noted in both frontal and occipital regions for operative planning.

Case Discussion

This is a differential diagnosis case of a temporal lobe cystic lesion in a young adult. There are a few relevant entities one must consider when encountering a lesion of this appearance in this age group:

  • ganglioneuroma: fully differentiated neural tumours, 60% occurring below the age of 20 years1, can demonstrate solid and cystic components as well as fine, speckled calcification.
  • ganglioglioma: although primarily occurs in a paediatric population, the incidence in young adults is higher than that of ganglioneuroma
  • Pilocytic astrocytoma: occurring mostly in paediatric age group, 60% are found in cerebellum with optic nerve, hypothalamus and brain stem consisting most of the other 40%. The location of the lesion, in this case, is somewhat unusual for a pilocytic astrocytoma
  • DNET: mostly occurring in temporal lobes of young people, this is a relevant consideration in this case
  • cystic metastasis: cystic metastasis with a mural nodule is the last but not least differential for this lesion

The patient went on to have surgery. 

Histology

Final diagnosis: Anaplastic ganglioglioma (WHO grade III) with high-grade glial component resembling glioblastoma. 

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Case information

rID: 44921
Case created: 9th May 2016
Last edited: 21st May 2017
Inclusion in quiz mode: Included

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