Left parietal lobe ganglioglioma (grade I)

Case contributed by Andrei Tsoriev
Diagnosis almost certain


8-year-old girl with focal epilepsy.

Patient Data

Age: 8 years
Gender: Female

Well demarcated lobular mass in the cerebral cortex and juxtacortical white matter of left parietal lobe with little mass effect. It contains small cysts and thickened irregular cortex. It is iso- to hyperintense on T2, iso- to slightly hypointense on T1, and presents unusual restriction of diffusion  in the medial part of the tumor. ADC values are 539±13.8x10-6  sq.mm/s.

Annotated image

Focal mass with slightly elevated T2 and FLAIR signal and foci of restricted diffusion.

Case Discussion

MRI detected mass-lesion in left parietal lobe. Surgery was performed with radical resection of the tumor and pathological report statement was "ganglioglioma, WHO grade I".

In this case there is an unusual feature of the tumor which is areas of restricted diffusion in otherwise benign tumor. There are cases in the literature describing such phenomenon, attributing it to intermediate cellularity composed of ganglion cells and neoplastic astrocytes. Therefore, the presence of restricted diffusion itself does not equate with high tumor grade. It is important to acknowledge that intermediate to high cellularity can lead to restricted diffusion even in low grade tumors. 

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