Third ventricular pilocytic astrocytoma
Headaches for several months, with vomiting for 2 days and a seizure promoting review in the Emergency room.
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Centered on the 3rd ventricle is a mass lesion that is iso-intense to grey-matter on T1 weighted imaging and hyperintense on T2. There is not significant diffusion restriction, but there is avid peripheral enhancement that has a foliated pattern.
The differential diagnosis for this lesion include the supratentorial counterparts of the commoner childhood intracranial tumors, e.g. supratentorial pilocytic astrocytoma and supratentorial ependymoma as well as supratentorial PNET.
Atypical teratorhabdoid tumors (ATRTs) may also have similar appearances although they are usually larger and don't sit within the ventricle.
Biopsy confirmed that this tumor was a supratentorial pilocytic astrocytoma and chemotherapy and radiotherapy were followed by surgical resection (which was near-complete).