Artikel
A collective of four subependymomas with atypical MR behavior and clinical progress
Ein Kollektiv von vier Subependymomen mit untypischem MR-Verhalten und klinischem Verlauf
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Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Subependymomas are slow, non-invasive growing, largely benign Tumors, developed from the inner walls of the ventricular system. MR morphological described as well delimited lobular, occasionally calcifying, intra- or paraventricular mass, with partial cystic portion and little to no edema [1]. Case studies found a more heterogeneous morphology [2]. Also our collective showed MR morphological criteria that made the diagnosis Subependymom improbable. One case showed histologically a central malignisation during tumor progress. Should subpendymomas be considered more often in therapy planning of ventricular tumors? Can subependymomas malignant, contrary to previous opinions?
Methods: Four cases of unusual subependymomas, in patients 18, 20, 27 and 52 years old, between 2006–17.
Results:
- In the first case, the diagnosis was confirmed by biopsy 10 years prior to excision. At that time, instead of an excision, SEED’s were implanted in the tumor tissue. After resection 10 years later, the tumor showed a central malignisation but at the rim continued be a Subependymoma.
- The second case showed MR-morphologically a strongly vascularized, centrally strong contrast agent accumulating, inhomogeneously delineatable, nodular mass with low edema, supposed to resulting from the right cerebellar tonsil with parts in the IV ventricle and intraspinal. Most likely to be a arteriovenous malformation.
- The third case was MR-morphological supposed to be a pilocytic astrocytoma because of its cystic configuration with inhomogeneous nodular mass at the dorsal rim.
- The fourth case was MR-morphological supposed to be a pineal cyst of the III ventricle, which due to a KM accumulation in the dorsal part could also be considered to be a pinealeom.
Conclusion: All tumors studied were proportionally subependymomas, indicating that this entity MR- morphologically occur much more heterogeneous than previously described [1]. It is important to consider differential diagnosis, since at a subependymoma the complete excision is the treatment of choice. The Pinealis cyst or AV-Malformation considered in our cases, if clinically unobtrusive or small, could also be observed. A spontaneous malignisation of a subependymoma, as believed in the first case, can not be assumed and could be a consequence of the SEED implantation.