ABSTRACT
ABSTRACT CONTEXT: Brain metastases are the most common tumors of the central nervous system. Because of their high frequency, they may be associated with rare situations. Among these are tumor-to-tumor metastasis and an even a rarer situation called simultaneous brain tumors, which are more related to primary tumors of the reproductive and endocrine systems. CASE REPORT: A 56-year-old male patient with a history of renal cell carcinoma (which had previously been resected) presented with a ventricular lesion (suggestive of metastatic origin) and simultaneous olfactory groove lesion (probably a meningioma). First, only the ventricular lesion was dealt with, but after a year, the meningothelial lesion increased and an occipital lesion appeared. Therefore, both of these were resected in a single operation. All the procedures were performed by the same neurosurgeon. The patient evolved without neurological deficits during the postoperative period. After these two interventions, the patient remained well and was referred for adjuvant treatment. CONCLUSIONS: This study provides the first description of an association between these two tumors. Brain metastases may be associated with several lesions, and rare presentations such as simultaneity with meningioma should alert neurosurgeons to provide the best oncological treatment.
RESUMO CONTEXTO: As metástases cerebrais são os tumores mais comuns do sistema nervoso central e, devido à sua elevada frequência, podem estar associadas a situações raras. Entre estas estão as "tumor to tumor metastasis" e uma situação ainda mais rara chamada de tumores cerebrais simultâneos, mais relacionados a tumores primários dos sistemas endocrinológico e reprodutivo. RELATO DE CASO: Um homem de 56 anos com histórico de câncer de células renais (extirpado previamente) apresentou-se com lesão ventricular (sugestiva de origem metastática) e simultaneamente com uma lesão em topografia de goteira olfatória (provavelmente meningioma). Primeiramente, apenas a lesão ventricular foi abordada, porém após um ano, a lesão meningotelial aumentou e uma lesão occipital apareceu e então ambas foram ressecadas em uma única cirurgia. Todos os procedimentos foram realizados pelo mesmo neurocirurgião. O paciente evoluiu sem déficits neurológicos no período pós-operatório. Após essas duas intervenções, o paciente permaneceu bem, sendo encaminhado para tratamento adjuvante. CONCLUSÕES: O presente trabalho é a primeira descrição da associação encontrada entre esses dois tumores. As metástases cerebrais podem associar-se a várias lesões, e manifestações raras, tais como apresentação simultânea com meningioma, devem alertar o neurocirurgião a fornecer o melhor tratamento oncológico.
Subject(s)
Carcinoma, Renal Cell/secondary , Cerebral Ventricle Neoplasms/secondary , Kidney Neoplasms/pathology , Meningeal Neoplasms/secondary , Meningioma/secondary , Immunohistochemistry , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Cerebral Ventricle Neoplasms , Cerebral Ventricle Neoplasms/surgery , Treatment Outcome , Rare Diseases , Meningeal Neoplasms/surgery , Meningeal Neoplasms/diagnostic imaging , Meningioma/surgery , Meningioma/diagnostic imagingABSTRACT
Objective To evaluate the CT and MRI imaging features of primary ventricular lymphoma ,so as to provide a reference for the diagnosis and differential diagnosis of the disease .Methods The clinical data and imaging findings of primary ventricular lymphoma in one case was retrospectively analyzed with literature review and compared with primary lymphoma in parenchymal brain .Results Slightly high density tumor presented with regular shape in the trigone of lateral ventricles on CT findings , and slightly low signal intensity on T 1 and slightly high signal intensity on T 2 appeared on MRI findings with small cystic necrosis in tumour .An enhancement scan showed obviously enriched, and there was perilesional edema.After 14 day’s dehydration treatment, rechecked indicated that the lesions were significantly en-larged, the shape were irregula , the area of cystic necrosis was enlarged , heterogeneous enhanced scanning were enhanced , perilesional ede-ma became more heavier , and the imaging feature of “closed fist” appeared .It was proved to be diffuse large B cell lymphoma with surgical pathologic examination , and there was no lymphoma in other regions of the body with whole body PET-CT examination , which was clinically diagnosed as primary ventricular lymphoma .Conclusion Primary ventricular lymphoma is rarely reported ,and it has similar imaging mani-festations with primary lymphoma in parenchymal brain .The combination of multiple imaging modalities will be helpful to diagnosis and dif -ferential diagnosis for the suspected patients .
ABSTRACT
Ilustramos este ensaio iconográfico com imagens de ressonância magnética obtidas em nosso serviço nos últimos 15 anos e discutimos as principais características de imagem de lesões intraventriculares, de etiologia tumoral (cisto coloide, oligodendroglioma, astroblastoma, lipoma, cavernoma) e de etiologia inflamatória/infecciosa (neurocisticercose e uma incomum apresentação da neuro-histoplasmose). Estas lesões representam um subgrupo de lesões intracranianas com características próprias e alguns dos padrões de imagem que podem facilitar o diagnóstico diferencial.
The present essay is illustrated with magnetic resonance images obtained at the authors' institution over the past 15 years and discusses the main imaging findings of intraventricular tumor-like lesions (colloid cyst, oligodendroglioma, astroblastoma, lipoma, cavernoma) and of inflammatory/infectious lesions (neurocysticercosis and an atypical presentation of neurohistoplasmosis). Such lesions represent a subgroup of intracranial lesions with unique characteristics and some imaging patterns that may facilitate the differential diagnosis.
ABSTRACT
Ilustramos este ensaio iconográfico com imagens de ressonância magnética obtidas em nosso serviço nos últimos 15 anos e discutimos as principais características de imagem de lesões intraventriculares de etiologia tumoral (ependimoma, astrocitoma pilocítico, neurocitoma central, ganglioglioma, papiloma do plexo coroide, tumores neuroectodérmicos primitivos, meningioma, tumor epidermoide). Estas lesões representam um subgrupo de lesões intracranianas com características próprias e alguns dos padrões de imagem que podem facilitar o diagnóstico diferencial.
The present essay is illustrated with magnetic resonance images obtained at the authors' institution over the past 15 years and discusses the main imaging findings of intraventricular tumor-like lesions (ependymoma, pilocytic astrocytoma, central neurocytoma, ganglioglioma, choroid plexus papilloma, primitive neuroectodermal tumors, meningioma, epidermoid tumor). Such lesions represent a subgroup of intracranial lesions with unique characteristics and some image patterns that may facilitate the differential diagnosis.
ABSTRACT
The PNET of CNS are considered malignant undifferentiated tumors, and it represents about 2,8% of all tumors found on infants and teenagers, more rarely found on adults. In the present article will report the case of a patient, male, 23 years-old, with nodular lesion inside the third ventricle, admitted on emergency room with acute intense headache, drowsiness, vomiting and visual clouding, started three days before. Although there have been advances in diagnosis and treatment of PNET in children, few publications were found on the efficiency of available treatment options on adults. In our patient the lesion was completely removed by a anterosuperior interhemispheric transcallosal craniotomy, and subsequently diagnosed as PNET by anatomopathological. Postoperative hydrocephaly was installed and reverted with a ventriculoperitoneal shunt, with clinical and neurological status improvement. The patient died 18 months after diagnosis, due to respiratory hospitalar infection...
Os PNET do SNC são considerados tumores malignos indiferenciados e representam cerca de 2,8% de todos os tumores encontrados em crianças e adolescentes, sendo mais raramente encontrados em adultos. Neste presente artigo, relatamos o caso de um paciente, do sexo masculino, com 23 anos de idade, com lesão nodular dentro do terceiro ventrículo, que foi admitido na emergência com cefaleia intensa e aguda, sonolência, vômitos e turvação visual, iniciados três dias antes da admissão. Embora tenha havido avanços no diagnóstico e tratamento de PNET em crianças, poucas publicações foram encontradas sobre a eficiência de opções de tratamento disponíveis em adultos. No nosso paciente a lesão foi completamente removida por uma craniotomia ântero-transcalosa inter-hemisférica; posteriormente, ele foi diagnosticado como PNET por meio do exame anatomopatológico. A hidrocefalia instalada no pós-operatório foi revertida com uma derivação ventrículo-peritoneal, com melhora do quadro clínico e neurológico. O paciente morreu 18 meses após o diagnóstico, em decorrência de uma infecção hospitalar respiratória...
Subject(s)
Humans , Male , Young Adult , Cerebral Ventricle Neoplasms , Medulloblastoma , Neuroectodermal Tumors, Primitive , Third VentricleABSTRACT
Purpose To investigate the MRI characteristics and differential diagnosis of intraventricular meningioma. Materials and Methods The clinical manifestation and MRI characteristics was retrospectively analyzed in the 11 patients with confirmed intraventricular meningioma by pathology. Results The intraventricular fibrocellular meningioma (7 cases) showed iso- and slightly short T1 signal and short and heterogeneously iso-T2 signal. The syncytial (1 case) and mixed (1 case) miningioma in the fourth ventricle, the syncytial meningioma in the third ventricle, and endothelial meningioma in the septum pellucidum (1 case) all showed slightly long T1 and slightly long T2 signal. Pathology results showed that 7 cases of fibrocellular meningioma in lateral ventricle, 1 case of syncytial meningioma and mixed type in the fourth ventricle, 1 case of syncytial meningioma in the third ventricle, 1 case of endothelial meningioma in septum pellucidum Conclusion The fibrocellular type was commonly encountered for the lateral ventricle meningioma, and hypointensity on T2WI could be regarded as its typical MRI characteristics, and it is diffcult for the differential diagnosis for the other intraventrical meningiomas.
ABSTRACT
The authors review the main technical approaches to the third ventricle, the most common surgical indications and their results. The traditional open techniques are characterized by low rate of residual lesion and risk, although low, epilepsy postoperatively. Endoscopic techniques has gained wide acceptance by patients and neurosurgeons because of the low rates of complications and reduced hospital stay, however one still observes a higher rate of residual lesions, even asymptomatic. All the techniques mentioned have excellent results for surgical approaches to the third ventricle. We observe that the choice of technique will depend mainly on the familiarity of the surgeon and his service with each of these techniques.
Os autores revisaram as principais formas de abordagem do terceiro ventrículo, as indicações cirúrgicas mais comuns e seus resultados. As técnicas abertas tradicionais são caracterizadas pelo baixo índice de lesões residuais e baixo risco de epilepsia pós-operatória. As técnicas endoscópicas têm ganhado espaço pelas baixas taxas de complicações e redução de dias de internamento, apesar de taxas maiores de lesões residuais, mesmo assintomáticas. Todas as técnicas mencionadas para os acessos ao terceiro ventrículo têm excelentes resultados. Observamos que a escolha da técnica utilizada dependerá, principalmente, da familiaridade do cirurgião e do seu serviço com cada uma delas.
Subject(s)
Humans , Cerebral Ventricle Neoplasms , Neuroendoscopy , Third Ventricle/surgeryABSTRACT
O ependimoma é um tumor glioneural do grupo neuroepitelial que se origina no epêndima, de crescimento lento e localização infratentorial em dois terços dos casos. Os infratentoriais são maiscomuns em crianças e os supratentoriais, nos adultos. O presente relato descreve um caso na infância,supratentorial, em íntimo contato com o ventrículo lateral, predominantemente cístico, com áreas sólidas, pequeno efeito expansivo regional, sendo evidenciado, pela anatomopatologia, tratar-se de um subtipo infrequente nesta faixa etária, o subependimoma.
Ependymoma is a neuroepithelial tumor of the glioneural group which originates in the ependima, with slow growth and infratentorial location in 2/3 of the cases. The infratentorials are morecommon in children and the supratentorials in adults. This reportdescribes a case in childhood, supratentorial, in close contact withthe lateral ventricle, predominantly cystic, with solid areas, little regional expansive effect and evidenced by the pathology as an infrequent subtype in this age group, the subependymoma.