Presentation
Headache, visual decrease and weight gain in 6 months
Patient Data
- Brain MRI showing a multilobulated, solid mass in the anterior portion of the third ventricle.
- The lesion is isointense in T1W, heterogenous hyperintense in T2W, moderate diffusion restriction in DWI and ADC. After contrast, the mass shows vivid and homogenous enhancement.
- About the location, the intact of pituitary gland and supraoptic recess (best seen on T1W) indicate that the mass is not originated from sellar and suprasellar regions. Instead, the tumor bows the floor of the third ventricle and the infundibulum downward so it is located in the 3rd ventricle.
Case Discussion
This brain MRI represents typical radiological features of chordoid glioma.
Chordoid gliomas are rare and slow growing, low grade tumors that arise from the anterior part of the third ventricle. It often show strong and homogenous enhancement pattern. The special location and the contrast enhancement pattern suggest the pre-operative diagnosis.
The patient went on to have a craniotomy and partial resection of tumor.
Histology:
Imaging demonstrates epithelioid cells arranged in clusters or cords, with stroma containing lymphoplasmacytic infiltrate.
Histological and immunohistochemical findings revealed a typical chordoid glioma.
FINAL DIAGNOSIS:
The differential diagnosis includes others tumors of sellar and suprasellar regions (macroadenoma, craniopharyngioma).
However, the intact pituitary gland and supraoptic recess help to exclude sellar and suprasellar tumors such as macroadenoma.
Intrinsic third ventricular craniopharyngioma is also a differential diagnosis but it often shows heterogenous enhancement.
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