A 13-year-old boy, presenting with a headache, blurring of vision and vomiting, ocular examination showed bilateral papilloedema.
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A large left temporoparietal well-defined mixed solid/cystic space occupying lesion is seen with a predominant cystic component is present. Avid non-homogeneous post contrast enhancement of its solid component is noted.
The lesion is surrounded by a thin rim of subtle cerebral oedema and is exerting marked mass effect in the form of effacement of the overlying cortical sulci and compression of the adjacent left lateral ventricle as well as a contralateral shift of the midline structures.
Subsequent trapped and dilated right lateral ventricle secondary to midline shift is also noted, associated with mild periventricular CSF permeation.
Pleomorphic xanthoastrocytoma is probably the most likely diagnosis, the presentation is typical for age, location and appearance, note the hyperintensity of the cystic component relative to CSF seen on FLAIR denoting higher protein content.
Differential diagnosis includes other temporal lobe tumors such as ganglioneuroma, ganglioglioma or pilocytic astrocytoma.