Presentation
Sudden onset headache.
Patient Data
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Within the body of the left lateral ventricle is a mass with heterogeneous signal on all sequences, and only faint irregular enhancement. The lateral ventricle does not follow CSF signal with signal drop out on gradient echo imaging consistent with blood.
The patient went on to have surgery and resection of the mass.
Histology
MICROSCOPIC DESCRIPTION: Sections show fragments of tumor, comprising uniform, rounded nuclei within a delicate fibrillary neuropil-like stroma. There are cell free neuropil-like islands, and delicate branching capillaries within the stroma. Mitotic figures are not observed within tumor cells. The tumor shows strong diffuse staining for synaptophysin and NeuN, and is negative for GFAP, which stains background astrocytic processes. There is no microvascular proliferation. Necrosis is observed, however, particularly in association with areas of hematoma formation within the tumor. ki67 within tumor cell nuclei is interpreted as being low, with hot spots of staining in areas of necrosis that may relate to inflammatory cell infiltration.
FINAL DIAGNOSIS: Intraventricular tumor - central neurocytoma, WHO Grade 2.
Case Discussion
Typical appearances of a central neurocytoma, with an uncommon but certainly recognized complication of intraventricular hemorrhage.
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