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Non-Syndromic Optic Chiasm Mass in an Adult

Non-Syndromic Optic Chiasm Mass in an Adult. Gaurav Gupta, M.Sc. Stanford University School of Medicine MGH Neurosurgery Subinternship September 23, 2010. Case Presentation. ID: 42 yo M with optic chiasm mass

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Non-Syndromic Optic Chiasm Mass in an Adult

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  1. Non-Syndromic Optic Chiasm Mass in an Adult Gaurav Gupta, M.Sc. Stanford University School of Medicine MGH Neurosurgery Subinternship September 23, 2010

  2. Case Presentation • ID: 42 yo M with optic chiasm mass • HPI: 40 lb weight loss over 6 months; loss of libido, fatigue, polydipsia/polyuria X 4 months; blurred vision X 6 weeks • No significant PMH, no medications, FH/SH noncontributory • No history of radiation • MRI 2005: “partially empty sella”, no other abnormalities • Exam: Dense bitemporal hemianopsia

  3. Work-up and Differential Diagnosis • Primary glial neoplasm • Germ cell tumor • Primary CNS lymphoma • Metastasis of unknown primary • Isolated inflammatory process (e.g. neurosarcoidosis)

  4. NF1: Age at Diagnosis Dermatology. 2008;216(4):347-8.

  5. J Clin Neurosci. 2007 May;14(5):502-5.

  6. Germ Cell Tumor J Neurooncol. 2009 Dec;95(3):437-43.

  7. Surgical Approaches • Minimally invasive • Extended endoscopic endonasal • Endoscopic transventricular • Open • Pterional • Transorbital/subfrontal • Subfrontal

  8. Extended Endoscopic Endonasal Adv Tech Stand Neurosurg. 2008;33:151-99

  9. Endoscopic Transventricular ETV J Neurosurg. 2010 Aug 13.

  10. Craniotomy for Optic Chiasm Malignancy Medlock and Scott. Pediatr Neurosurg. 1997 Sep;27(3):129-36.

  11. Gross Appearance at Biopsy

  12. Pathology • In initial stain of tissue samples, < 50% of cells took up GFAP, CD45, p53, Ki-67, IDH-1, and CD68 • These will be re-stained along with PLAP (placental alkaline phosphatase), Oct4, c-kit/CD117

  13. Emerging Diagnostic Modalities • PET-CT co-registered with MR spectroscopy • Increase in SUV and choline/creatine ratio distinguish high-grade from low-grade optic glioma in NF1 patients (Clin Nucl Med. 2010 Oct;35(10):838-9.) • 3.0T DTI • Optic gliomas may be detected by decreases in fractional anisotropy (J Magn Reson Imaging. 2010 Jul;32(1):76-81.) • Dynamic contrast-enhanced (DCE) MRI • Clinically aggressive optic gliomas have significantly higher mean permeability values (Pediatr Radiol. 2008 38:1293–1299)

  14. Questions

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