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There is a large well circumscribed heterogeneously enhancing lesion with internal cystic degeneration within the right lateral ventricle.
Extension of the mass into third ventricle with secondary obstruction of the foramen of Monro and supratentorial hydrocephalus also is seen.
Periventricular signal changes most probably representing small vessel ischemic changes.
Most supratentorial subependymomas have characteristic appearance on MR imaging.
Subependymomas are usually homogeneous tumors with no or minimal enhancement, which differentiates them from other supratentorial intraventricular tumors as well as from infratentorial subependymomas.
However, the presence of symptoms, high vascularity, heterogeneous enhancement and large size should not deter the radiologist from including it in the differential diagnosis.
It is important to consider supratentorial subependymomas in the differential diagnosis of supratentorial lesions, even if their radiological features are atypical.
Our case was pathologically proven.