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Posterior epidural migration of lumbar disc fragment as an unusual ring-enhancing mass.

A 60-year-old man was admitted to the hospital because of 2-month history of low back pain and difficulty in walking. Bladder and bowel functions were normal. The clinical history was unremarkable. On physical examination, both lower limbs showed muscular weakness with increased muscle tone, especially on the right side. Sensation was intact in all dermatomes, and reflexes were normal. Laboratory tests revealed normal findings. Magnetic resonance imaging showed a wellcircumscribed smoothly marginated solid mass within the posterior epidural space at L2–L3, which compressed the dura. Signal intensity of the mass was similar to that of the intervertebral disc on all sequences (Fig. 1). The lesion revealed an intense rim enhancement on fat-saturated contrastenhanced magnetic resonance images (Fig. 1). There was no calcification in the epidural mass lesion on computed tomography scan (Fig. 2). Decompressive L2 laminectomy was

Rare and challenging extra-axial brain lesions: CT and MRI findings with clinico-radiological differential diagnosis and pathological correlation.

There are many kinds of extra-axial brain tumors and tumor-like lesions, and definitive diagnosis is complicated in some cases. In this pictorial essay, we present rare and challenging extra-axial brain lesions including neuroenteric cyst, primary leptomeningeal melanomatosis, isolated dural neurosarcoidosis, intradiploic epidermoid cyst, ruptured dermoid cyst, intraventricular cavernoma, and cavernous hemangioma of the skull with imaging findings and clinico-radiological differential diagnosis, including the pathologic correlation. Familiarity with these entities may improve diagnostic accuracy and patient management.

Ossified-calcified intradural and extradural thoracic spinal meningioma with neural foraminal extension

A 26-year-old woman presented with progressive back pain and paraparesis. Thoracic spine magnetic resonance imaging revealed an intradural-extradural D9–D11 mass that extended to the enlarged left neural foramens. The tumor showed heterogeneous low signal on the T2and T1-weighted images, and intense enhancement on postcontrast images. The compressed spinal cord revealed T2-hyperintensity caused by myelopathy (Figs. 1–3). The plain computed tomography scan demonstrated a heavily ossified-calcified tumor (Fig. 4). Total tumor resection was performed, and the pathologic diagnosis was meningothelial meningioma WHO grade 1 with psammoma bodies. Ossified-calcified intradural and extradural thoracic spinal meningioma is extremely rare [1–3], and together with foraminal extension is yet to be reported. Awareness of the imaging findings of this rare presentation is essential to overcoming diagnostic and therapeutic difficulties.

Isolated third ventricle glioblastoma

AbstractIntroduction Glioblastoma is the most common and the most malignant type of gliomas. Cerebral hemispheres are usual locations for gliomas. Isolated third ventricular presentation is very rare for glioblastomas. A new case of isolated third ventricular glioblastoma has been presented in this report.Case descriptionA 36-year-old woman was admitted to outpatient clinic with headache, blurred vision and confusion. A head CT scan and MRI had showed third ventricular mass lesion with obstructive hydrocephalus. Previous to her admission to our clinic, a ventriculo-peritoneal shunt had been inserted and her hydrocephalus had been relieved to some extent in acute settings. In our clinic, stereotactic biopsy was performed and a second ventriculoperitoneal shunt was inserted from the opposite site. Histopathological diagnosis was glioblastoma. Radiotherapy and chemotherapy were started immediately after the surgery. Patient’s hydrocephalus has resolved and she was well at post-operative 6th month.Discussion and evaluationIn differential diagnosis list of the tumors presenting in the third ventricle, there are plenty of tumors such as colloid cyst, meningioma, germinoma, craniopharyngioma, lymphoma, choroid plexus papilloma, subependymal giant cell astrocytoma, chiasmatic and hypothalamic benign astrocytoma. Ring enhancement of this region pathology is a peculiar sign for glioblastoma, yet not pathognomonic. Tumor histology is crucial to yield the final diagnosis.ConclusionManagement of obstructive hydrocephalus, making histopathological diagnosis, starting adjuvant radiotherapy and chemotherapy in isolated third ventricular glioblastomas is a safe and effective approach when we consider malignant nature and intractable progress of glioblastomas.

Immature ganglioneuroma of the thoracic spine with lipomatous component: a rare cause of scoliosis.

A 33-year-old male patient presented to the neurosurgery clinic with scoliosis. Magnetic resonance (MR) imaging of the thoracic spine revealed scoliosis and a right paravertebral soft-tissue mass at the T6–T11 level (Fig. 1) that involved the spinal canal and expanded the right neural foramens. The mass revealed heteregeneous low-signal intensity on unenhanced T1-weighted MR images with high-signal intensity lipomatous component (Fig. 2) and intense enhancement on contrast-enhanced T1-weighted MR images (Fig. 3). Plain computed tomography demonstrated scattered fatty areas, calcifications, and vertebral scalloping (Fig. 4). The mass was totally resected in the operation performed by neurosurgery. Histologically, the tumor revealed mature ganglion cells, their processes, ensheathing Schwann cells, and mature adipose tissue within the tumor. Rare immature ganglion cells were identified in the tumor after applying thorough examination with additional

Lumbar Spinal Immature Ganglioneuroma with Conus Medullaris Invasion: Case Report.

Ganglioneuroma (GN) is a benign rare tumor that originates from neural crest cells. It shares a common histogenic family with ganglioneuroblastoma and neuroblastoma and represents the most benign and differentiated form of the group. The most common locations of the GNs are the mediastinum and retroperitoneum. We report an extremely rare case of lumbar spinal GN with conus medullaris invasion and extradural paraspinal extension. A 10-year-old girl presented with a history of worsening lower-back pain and an intermittent tingling sensation in the left leg. Neurological examination revealed reduced sensation in the left L2-L5 dermatomes. Magnetic resonance imaging revealed an intra- and extradural mass extending from the D11 to L5 vertebral body level. There was conus medullaris invasion by the tumor. After L1-L5 laminotomies, the patient underwent tumor resection. Histopathological diagnosis was immature GN. GNs occurring within the spinal column are rare and may grow to a large size. Despite the size and the common involvement of both intra- and extraspinal compartments, the prognosis is usually excellent after complete excision using microsurgical techniques.

A rapidly expanding calvarial Langerhans cell histiocytosis with low Ki-67 in an adult: a challenging diagnosis on magnetic resonance imaging

Langerhans cell histiocytosis may have a wide variety of clinical presentations. The growth of localised form is usually slow and it mainly involves bones such as the skull, femur, spine, ribs, mandible and pelvis in children. The spectrum of clinical manifestations and magnetic resonance imaging findings of the disease may sometimes mimic infections as well as benign and malignant tumours. In this report, we describe an unusual case of rapidly progressive calvarial Langerhans cell histiocytosis with a painful and tender mass in a 27-year-old man that created diagnostic and therapeutic challenges. We also discuss the relationship between Ki-67 proliferative index and the expansion of the disease. Magnetic resonance imaging studies revealed a bone defect on the left frontal bone with soft tissue components, showing a prominent expansion within a month. The clinical manifestation with the enhancement pattern of epidural soft tissue component on contrast-enhanced magnetic resonance imaging suggested an infection besides Langerhans cell histiocytosis. Immunohistochemical expression of Ki-67 antigen was 5%. The presence of a relatively low Ki-67 value indicates that the inflammatory response may have a more important role than local Langerhans cell proliferation in the aggressive clinical course and rapid expansion.

Hydatid disease: MR imaging of calvarium and superior sagittal sinus involvement:

Extra-axial hydatid disease (HD) is rare and may create a diagnostic challenge. Herein, we report an extremely rare case of calvarial HD with superior sagittal sinus invasion and an extension to the scalp with unusual magnetic resonance imaging findings simulating osteomyelitis and abscess. Recognition of detached endocystic membranes was the most important clue for the correct diagnosis. HD should be included in the differential diagnosis for a patient having a destructive skull lesion with peripheral enhancing extra-axial soft tissue component. Preoperative correct imaging diagnosis is crucial to improving patient management.

Posterior Third Ventricular Glioblastoma with Primary Leptomeningeal Metastasis in a Child

pineoblastoma were considered in the histopathological differential diagnosis. Medulloblastoma and pineoblastoma were excluded on the basis of synaptophysin immunonegativity. The absence of typical histomorphological features such as rhabdoid cells and the immunonegativity of epithelial membrane antigen excluded the diagnosis of atypical teratoid rhabdoid tumor. The pathological diagnosis was glioblastoma (Fig. 2). Adjuvant chemotherapy (Temodal) and radiation therapy were initiated after obtaining the final diagnosis. At the latest follow-up (3 months), the patient had severe progressive neurological symptoms, and did not return for another follow-up. Written informed consent was obtained from the patient.

Progress of an isolated collagenoma during pregnancy

Collagenomas are connective tissue naevi composed predominantly of collagen. Isolated collagenomas are usually localized to a single body region, acquired, and of rare occurrence. We describe a patient with an isolated collagenoma that showed an increase in size during pregnancy and regressed afterwards.