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Dysembryoplastic neuroepithelial tumor

Case contributed by Dr Mostafa El-Feky

Presentation

Seizure.

Patient Data

Age: 20 years
Gender: Female
MRI

MRI brain

MRI brain revealed a rather defined (2 cm) intra-axial space occupying lesion at the right temporooccipital cortical region. The lesion displays hypo-intense signal on T1WI and high signal on T2WI and T2/FLAIR with bubbly appearance and no appreciable post contrast enhancement. No associated peri lesional vasogenic edema. Mild mass effect is exerted manifested as effacement of the related cortical sulci. The left cerebral hemisphere is unremarkable.

Diffusion-weighted imaging: The lesion shows no appreciable diffusion restriction; with the minimum ADC value of the lesion = 1.3 x10 -3mm2/sec.

Spectroscopy: Choline/Cr ratio =0.74   Choline/NAA ratio=0.95   NAA/Cho ratio = 1.41   NAA/Cr ratio = 1.05  & Lactate peaks

Case Discussion

In cystic cortical tumors involving the temporal lobe, the general differential diagnosis includes DNETPXAganglioglioma. Imaging features, in this case, make DNET more likely.

Dysembryoplastic neuroepithelial tumors (DNET) are usually seen as cortical based tumors in young individuals. It is most often located in the temporal lobe. It appears as a cortical-based "bubbly" appearing mass in the right parietal lobe. The FLAIR image shows characteristic ring-like hyperintense signal (bright rim sign). No perifocal edema and no contrast-enhancement are present.

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Case information

rID: 43177
Published: 4th Apr 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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