Central neurocytoma with intraventricular haemorrhage

Case contributed by A.Prof Frank Gaillard

Presentation

Sudden onset of headache and decreased conscious state.

Patient Data

Age: 20 years
Gender: Male

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Case Discussion

CTA demonstrates florid intraventricular haemorrhage with the impression of a mass in the body of the right lateral ventricle. Hydrocephalus is present with dilatation of the temporal horns of the lateral ventricles. 

MRI confirms the presence of mass which has a heterogeneous appearance with multiple cysts embedded in a mass which is of increased signal on T2 weighted sequences. Enhancement is present but not prominent and also heterogeneous. 

Features suggest a central neuorcytoma complicated by haemorrhage, a rare, but recognised complication 1

Pathology

The sections show multiple fragments of tumour which shows areas of necrosis and foci of microcalcification.   The tumour consists of sheets of regular  rounded  cells  with  round  nuclei. Chromatin  is  speckled or vesicular  and  small  nucleoli  are often  seen.   In  places,  the nuclei surround small  rounded eosinophilic  areas resembling  neuropil.  There is also a minor pattern of perivascular pseudorosetting.  The mitotic count is elevated at up to 5/10 hpf.  There is focal microvascular proliferation.

Immunohistochemical  stains  show positive  staining for  synaptophysin and NeuN.  The Ki67  stain shows areas of  the tumour with  up to 15% of nuclei staining.

The features are  those of a central  neurocytoma.   However, the increased proliferative  activity,  with microvascular   proliferation  and areas of necrosis   suggest  that  the  lesion  is  best  regarded  as  an atypical neurocytoma. A higher chance of recurrence could be anticipated.

References

1. Smets K, Salgado R, Simons PJ et-al. Central neurocytoma presenting with intraventricular hemorrhage: case report and review of literature. Acta Neurol Belg. 2005;105 (4): 218-25. 

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Case information

rID: 14112
Case created: 29th Jun 2011
Last edited: 14th Nov 2015
Inclusion in quiz mode: Included

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