Presentation
A severe headache for 5 days, vertical diplopia, and nausea.
Patient Data
Ovoid hyperdense suprasellar mass with contact to the anterior wall of the third ventricle.
No calcifications are recognized within the mass.
Ovoid, slightly lobulated, well circumscribed mass with contact to the anterior wall of the third ventricle and the optic chiasm. The mass is isointense to white matter in T1 and T2 weighted sequences and shows vivid uniform enhancement after Gadolinium.
The mass shows no arterial flow in TOF-Angiography and ceMRA (not shown).
No susceptibility-artifacts in SWI are recognized within the mass (not shown).
Case Discussion
Presumptive diagnosis was intraventricular meningioma. Neurosurgical biopsy however confirmed a chordoid glioma of the third ventricle:
Histology
Paraffin sections show a moderate hypercellular tumor with mildly pleomorphic and slightly irregular nuclei. The cells form small noduli/ groups, some are arranged in strands with a myxoid tissue matrix. No mitoses.
- signifikant expression of GFAP and TTF1
- fokal expression of EMA
- no Expression of Keratin, SSTR2A, Mutant IDH1 (R132H) or PR
- Ki67 labellingindex <5%
Diagnosis
Chordoid glioma of the third ventricle (WHO II)