Presentation
Headache and altered gait.
Patient Data
Brainstem lesion centered on the pons. Ventral, bilateral, symmetric and engulfing basilar artery. No post-contrast enhancement. Extension cranially into the cerebral peduncles (left greater than right) and involvement of the left thalamus.
No spinal disease.
Pathology report conclusion
The appearances are of a diffuse midline glioma H3K27M mutant. Previously these tumor were known as diffuse intrinsic pontine glioma.
Case Discussion
Appearances of the pons are typical for a diffuse midline glioma (previously called diffuse intrinsic pontine glioma). This case demonstrates the reason for the change in naming convention - the involvement of additional structures, in this case, thalamus.
The vast majority of cases will have mutation H3 K27M which was confirmed in this case following a biopsy.
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