Ray Peeples MD Case 1 50 yo F with NF1 hx of meningioma debulking 210 and cervical neurofibroma removal 709 MRI studies showed an enhancing superior cerebellar lesion growing over time and eventually causing obstructive ID: 401390
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Slide1
Neuroradiology-Neuropathology UNC Monthly Conference
Ray Peeples, MDSlide2
Case 1
50 y/o F with NF1
hx
of meningioma
debulking
(2/10) and cervical
neurofibroma
removal (7/09)
MRI studies showed an enhancing
superior cerebellar lesion growing over time and eventually causing obstructive
hydrocephalus, the lesion was biopsiedSlide3
9.10.09Slide4
9.10.09
12.1.09Slide5
10.27.11Slide6
10.2.12Slide7
2.17.13Slide8
Pilocytic
astrocytomaSlide9
Gliomas
in NF1
In one series of 100 NF1 patients with biopsied tumors, there were…
50
pilocytic
astrocytomas
(PA)
28 diffuse
astrocytomas
(Grades II—5%, III—15%, IV—7%)
17 low- grade
astrocytomas
, subtype indeterminate
2
pilomyxoid
astrocytomas
1
desmoplastic
infantile
ganglioglioma
1 conventional
ganglioglioma
24 tumors arose in the optic pathways (14 PAs, 4 low-grade
astrocytomas
of indeterminate type, 4 anaplastic
astrocytomas
, 1
pilomyxoid
astrocytoma, and 1
ganglioglioma
).
Most tumors arising in setting of NF1 are
pilocytic
astrocytomas
(PAs) and, unlike their sporadic counterparts, have a distinctive predilection to involve the optic nerve, chiasm, and hypothalamus.
NF1-related
optic
gliomas are typically in young children and afflict 15% to 20% of NF1 patients.NF-1 related optic gliomas seem to have a more indolent behavior than their sporadic counterparts and may even regress without treatment.
Rodriguez FJ, et al. J
Neuropathol
Exp
Neurol
. 67:240–249, 2008.Slide10
Case 2
26 y/o M with 2
yr
hx
of back pain and lower extremity paresthesias
MRI showed and intradural lesion in the L spineMRI brain showed multiple enhancing cerebellar lesions
Spinal lesion was resectedSlide11
T2
T1
T2Slide12
T1 C+Slide13
T2Slide14
T2
T1 +C
FLAIRSlide15
Myxopapillary
ependymoma
, metastaticSlide16Slide17
Case 3
35 y/o M with 1 year
hx
of back pain and RLE weakness
s
ent from outside institution
with presumptive diagnosis of L3 schwannoma with MRI performed without contrastEMG showed L3 and S1 radiculopathyL3 mass was resectedSlide18
T2
T1
L3
S1
T2
T1
T1
T2Slide19
Sarcoidosis
Slide20
Spinal
sarcoidosis
Spinal syndromes are reported at clinical presentation in 6% to 8% of patients with
neurosarcoidosis
Spinal
sarcoidosis
can be intramedullary,
intradural
extramedullary
, epidural, or in vertebral bodies.
Most cases are intramedullary.
Intradural
,
extramedullary
spinal
sarcoidosis
is extremely rare, with only 8 cases reported in the literature as of 2006.
Schaller B, et al. The Spine Journal 6:204–210, 2006.Slide21
Case 4
26 y/o M who presented in 10/2012 with seizure
CT/MRI showed L frontal
low density lesion in white matter with no enhancement
, this lesion was biopsiedSlide22Slide23
FLAIR
T2
T1
T1 C+
T1 C+
T1Slide24
Gliomatosis
cerebri