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Case Presentation. Gerrit Blignaut Diagnostic Radiology UFS 17/08/2012. History. 3Y6M girl from Lesotho. 3D history of right hemiparesis, preceded by 3D history of vomiting. No previous hospital admission or any other illnesses. Father passed due to TB 3 years ago.

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case presentation

Case Presentation

GerritBlignaut

Diagnostic Radiology

UFS

17/08/2012

history
History

3Y6M girl from Lesotho.

3D history of right hemiparesis, preceded by 3D history of vomiting.

No previous hospital admission or any other illnesses.

Father passed due to TB 3 years ago.

2 Siblings, both healthy

examination
Examination

Extensive TineaCapitis

CNS: Right hemiparesis with power 4/5.

GCS 15/15

CVS, Resp, Abd, ENT: NAD

Bloods: FBC, U&E, HIV normal

CXR: Normal

astrocytoma
Astrocytoma
  • 30% supratentorialtumors in children.
  • 3 Patterns: Cystic with enhancing mural nodule
  • solid with necrotic centre
  • Solid with variable enhancement.
  • Solid part iso- hypodense on CT and hyperintense on T2
slide14
PNET
  • Mean age 5 years.
  • Arise from precursor cells of germinal matrix.
  • Poor prognosis if supratentorial
  • CT: dense ca++, large heterogenous mass.
  • Solid and cystic components.
  • Can be peri/ intraventricular with hydrocephalous.
  • Necrosis and hemorrhage.
  • MRI: Solid- Low signal T1 and intermediate to low signal T2 compared to gray matter.
  • Little peritumoral oedema
ependymoma
Ependymoma
  • From ependymal cells that line ventricular canal.
  • 70% Post fossa
  • Can originate supratentorially 1/3, intraaxially
  • CT: heterogenous, solid, cystic, Ca++, hemorrhage

MRI; Solid: Isointense T1 and hyperintense on T2 compared to gray matter.

More oedema

astroblastoma
Astroblastoma

Rare glial neoplasms,0.45-2.8% of primary glial tumors.

Present as a large well demarcated, supratentorialhemispheric mass.

Prefer frontoparietal region.

Children, adolescents and young adults.

Median age 11 years.

Female predominance

imaging
Imaging

• NECT

  • Solid and cystic lobular mass, solid portion may be mildly hyperattenuated

Occasional punctate Ca++

• CECT:

Heterogeneous enhancement: Rim of cystic

Heterogenous solid

MRI :

  • Mixed solid cystic mass.
  • Solid part has heterogeneous bubbly appearance on T2.
  • Relatively hypointense to gray matter on T1 and isointense to gray
  • matter on T2

Little peritumoraledema on T2.

Mixed signal after contrast administration.

pathology
Pathology

Cell of origin has features of both astrocytoma and ependymoma.

Tancytes, variety of ependymal cells.

Present in the floor of 4th ventricle.

Perivascular pseudorosettes: Astrocytic cell processes

radiate toward a central, often hyalinized blood vessel

  • • Oval to elongated hyperchromatic nuclei; +/- Ca++
  • • Immunohistochemistry: GFAP +, vimentin+, S-100 +
treatment
Treatment
  • Low grade astroblastomas may have long term survival.
  • Anaplastic histology is associated with recurrenceand progression.
  • Surgical excision mainstay of treatment with postoperative adjuvant radiation and chemotherapy.
references
References

1: Astroblastoma: A Radio-histological diagnosis J PediatrcNeurosciVol 3 2008.

2:Astroblastoma: A Rare Glial Tumor International Journal of Pathology; 2004; 2(2):100-102

3: Astroblastoma: Radiologic-Pathologic Correlation and Distinction from EpendymomaAJNR Am J Neuroradiol23:243–247, February 2002

4: