Korean J Radiol.  2014 Feb;15(1):151-155. 10.3348/kjr.2014.15.1.151.

Infratentorial and Intraparenchymal Subependymoma in the Cerebellum: Case Report

Affiliations
  • 1Department of Radiology, Chungbuk National University Hospital, Cheongju 361-711, Korea.
  • 2Department of Radiology, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju 361-711, Korea. lsyrad@chungbuk.ac.kr
  • 3Department of Pathology, Chungbuk National University Hospital, Cheongju 361-711, Korea.

Abstract

Subependymomas are rare benign tumors located in the ventricular system. Intraparenchymal subependymoma is extremely rare; only 6 cases have been reported, and all were located in the supratentorial region. We describe a case of infratentorial, intraparenchymal subependymoma in a 28-year-old man with intermittent headache. Imaging revealed a well-demarcated cystic and solid cerebellar mass near the fourth ventricle. The mass had a microcystic component and calcification without contrast enhancement. Complete surgical excision was performed, and histopathology confirmed a subependymoma.

Keyword

Subependymoma; Intraparenchymal; Cerebellum

MeSH Terms

Adult
Calcinosis/diagnosis
Cerebellar Neoplasms/*diagnosis/surgery
Fourth Ventricle
Glioma, Subependymal/*diagnosis/surgery
Humans
Magnetic Resonance Imaging
Male
Rare Diseases/*diagnosis/surgery
Tomography, X-Ray Computed

Figure

  • Fig. 1 Imaging features of cerebellar subependymoma in 28-year-old man. A. Unenhanced axial CT scan demonstrates well-defined cystic and solid mass with multiple calcifications (black arrow) in left cerebellum. B-E. Mass exhibits iso- to hypointensity (relative to normal gray matter) on axial T1-weighted MRI and hyperintensity on axial T2-FLAIR. There were multiple, small, high-signal intensity lesions (black arrow) suggesting calcifications on T1-weighted imaging, and numerous dot-like low-signal intensities suggesting microcysts (thin white arrow) on T2-FLAIR. On DWI, mass exhibited hypointense signal (relative to gray matter) on DWI without diffusion restriction and increased ADC relative to brain parenchyma. There is no evidence of peritumoral edema, mass effect or intratumoral hemorrhage. Mass was near fourth ventricle, but clearly separated from it. Isointense area (thick white arrows) suggesting normal cerebellar white matter was observed between mass and fourth ventricle. F, G. On axial and coronal contrast-enhanced MR images, there was no enhancement in solid portion or peripheral wall, and normal parenchyma was clearly identified between mass and fourth ventricle (white arrow). H. Cerebral angiograms did not reveal feeding vessel or tumor staining. I. Microscopic images showing clustered cellular neoplastic proliferation with islands of high nuclear density with dense, abundant fibrillary matrices. Round and isomorphic nuclei were observed, but mitosis was not seen (HE; original magnification, × 40). FLAIR = fluid attenuated inversion recovery, DWI = diffusion-weighted image, ADC = apparent diffusion coefficient, HE = hematoxylin and eosin


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