Presentation
New onset seizure for two months and confusion.
Patient Data
Note: The diagnostic criteria reflect practice at the time and do not necessarily match the current WHO classification of CNS tumors.
Large heterogeneous intra-axial mass involving grey and white matter (but with extensive cortical involvement) occupying the left temporal lobe. This extends into the left basal ganglia, body and splenium of the corpus callosum, left frontal operculum and posterior frontal white matter left parietal and left occipital lobes.
There is marked mass effect with diffuse sulcal effacement in the left hemisphere, effacement of the right lateral ventricle at the occipital horn, body and trigone portions, uncal herniation and swelling of the left hippocampus and 12 millimeters of midline shift to the right. Midline shift has resulted in entrapment of the right lateral ventricle which is enlarged. Abnormal surrounding FLAIR hyperintensity in keeping with transependymal fluid shift.
The lesion is predominantly FLAIR hyperintense with regions of susceptibility related signal loss corresponding to calcification demonstrated on CT (not shown). Patchy and gyral contrast enhancement also is seen.
Case Discussion
Pathology proven case of an oligodendroglioma NOS grade 3