Case contributed by Bruno Di Muzio


Temporal lobe epilepsy.

Patient Data

Age: 40 years
Gender: Female

MRI Brain


There is a 12 mm cystic lesion in the inferomedial aspect of the left anterior temporal pole with surrounding flair hyperintense focus of cortical expansion. It demonstrates minimal choline elevation with no NAA depression or lactate peak on spectroscopy. No cerebral blood volume (CBV) increase. No diffusion restriction. On the post contrast sequences there is impression of enhancement, however this region does contain phase artefact related to the skull base vessels.

Remainder the brain is within expected limits.


MICROSCOPIC DESCRIPTION: 1-6. All the sections contain tumor which is moderately cellular. The glial cells have elongated, angulated and hyperchromatic nuclei. Some fascicular arrangement is noted. Scattered dysmorphic neurons are seen, intermixed with the glial cells. They are haphazardly arranged. Some are binucleated. They have nucleomegaly. Mitoses are inconspicuous. No microvascular proliferation or necrosis is present. Occasional eosinophilic granular bodies are noted. There is no oligodendroglial component. The adjacent cortex shows cortical dysplasia with disorganized neurons but no balloon cells (FCD Type IIIb). Some of the tumor cells are GFAP positive and other cells NeuN and synaptophysin positive, indicating both glial and neuronal differentiation. IDH-1 and MGMT are negative. The topoisomerase index is 1-2%. ATRX shows no loss of staining (non-mutated). The features appear to show a low rade glioneuronal tumor, consistent with a ganglioglioma.

DIAGNOSIS: 1-6. Left temporal tumor: Low grade glioneuronal tumor, consistent with a ganglioglioma (WHO Grade I).

Case Discussion

The imaging features of this case are those of a low-grade tumor such as ganglioglioma or DNET. Histopathology confirmed to be a ganglioglioma. 

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