Large tumour that consists of both enhancing solid component and multiple cystic components with marked surrounding oedema, centered within the right frontal lobe.
It causes subfalcine herniation to the left and obstructs the third ventricle at the level of foramen of Monro resulting in marked hydrocephalus Mass effect on mid-brain causing shift of mid-brain to the left and uncal herniation is noted.
MR spectroscopy obtained from solid enhancing component of the lesion demonstrates markedly increased choline peak, consistent with high cellularity of this mass. NAA peak is not seen. The solid components of the tumor have restricted diffusion.
Differential diagnosis includes Primitive neuroectodermal tumor, atypical rhabdoid/ teratoid tumor, anaplastic ependymoma, extraventricular neurocytoma and desmoplastic infantile ganglioglioma.