Dysembryoplastic neuroepithelial tumour

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Seizure.

Patient Data

Age: 20
Gender: Female

BRAIN MRI

Modality: MRI

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 oedema. 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 tumours involving the temporal lobe, the general differential diagnosis includes: DNETPXAganglioglioma. Imaging features in this case make DNET more likely.

Dysembryoplastic neuroepithelial tumours (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
Case created: 26th Feb 2016
Last edited: 4th Apr 2016
Inclusion in quiz mode: Included

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