Case contributed by Frank Gaillard
Diagnosis certain


Vague headaches.

Patient Data

Age: 70 years
Gender: Female

MRI brain


A heterogeneous but mostly T2 bright mass appears to arise from the septum pellucidum and project into the right lateral ventricle. It demonstrates minor enhancement, and regions of susceptibility induced signal drop out, likely representing calcification. 

Annotated images


On T2 weighted images the mass (red arrow) is almost the same signal intensity as CSF and you could be excused for at least thinking that it could be flow related artefact. On FLAIR the mass is clearly not CSF as is much more easily seen (yellow dotted line).

The patient went on to have a craniotomy and resection of the mass. 


MICROSCOPIC DESCRIPTION: The sections show somewhat lobulated fragments of moderately cellular glial tumor. The tumor cells show prominent clustering. They have round to ovoid nuclei with no significant nuclear pleomorphism. There is microcystic change in the background. No mitoses, endothelial cell hyperplasia or necrosis is identified. No evidence of metastatic carcinoma is seen. The features are those of a subependymoma.

FINAL DIAGNOSIS: Right frontal horn tumor subependymoma (WHO Grade I).

Case Discussion

Typical appearances of a subependymoma, although a central neurocytoma could have essentially identical appearances. 

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