Embryonal tumour with multilayered rosettes (ETMR)
First seizure with sunsetting. Increasing head circumference and delayed motor milestones.
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The obvious intracranial mass lesion is a mixed solid and cystic lesion that is centred around the midline in the anterior cranial fossa. The more solid elements enhance and demonstrate diffusion restriction.
Features here are of a high-grade, aggressive tumour which is highly vascular. The differential includes supratentorial PNET and supratentorial ependymoma. The MRS is not particularly helpful.
A biopsy of the central solid components was undertaken and revealed that the tumour was a supratentorial PNET. The biopsy of the lesion resulted in significant haemorrhage and 4 units of blood along with clotting factors were required.
Chemotherapy did not significantly alter the volume of MRI characteristics of the lesion and it continued to grow.
Note: The current (2016) WHO classification of CNS tumours has made substantial changes to tumours previously considered to be supratentorial PNET, now classified as embryonal tumours with multilayered rosettes (ETMR), along with a number of other entities, in recognition of characteristic amplification of the C19MC region on chromosome 19 (19q13.42).