Neuro-Oncology

Large right frontal mass with cystic and solid components. The lesion shows evidence of hemorrhage and areas of calcification (panel C). (A) Axial T1 post-contrast imaging. (B) Axial T2 flair image. (C) Sagital T1 flair image. (Contributed by Dr. Adriana Fonseca Sheridan.)

MRI in a 72-year-old man with pituitary apoplexy demonstrates a sellar and suprasellar heterogeneous lesion with high T1-signal within the mass compatible with acute hemorrhage as well as evidence of laterosellar macroadenoma. (Source: Drissi Oudghiri M, Motaib I, Elamari S, Laidi S, Chadli A. Pituitary apoplexy in geriatric patients: a report of four cases. Cureus 2021;13[12]:e20318. Creative Commons Attribution License [CC-BY 4.0].)

MRI demonstrates enhancement of a sellar and suprasellar heterogeneous lesion in a 72-year-old man with pituitary apoplexy. (Source: Drissi Oudghiri M, Motaib I, Elamari S, Laidi S, Chadli A. Pituitary apoplexy in geriatric patients: a report of four cases. Cureus 2021;13[12]:e20318. Creative Commons Attribution License [CC-BY 4.0].)

MRI in a 72-year-old man with pituitary apoplexy demonstrates a sellar and suprasellar heterogeneous lesion with high T1-signal within the mass compatible with acute hemorrhage. The patient presented with sudden onset of left ptosis with a complete third nerve palsy evident on examination. He underwent endoscopic endonasal transsphenoidal resection of the pituitary adenoma. There were no postoperative complications, and he completely recovered 10 days postoperatively. Anatomopathological examination of the resected tumor showed a nonsecreting pituitary macroadenoma. (Source: Drissi Oudghiri M, Motaib I, Elamari S, Laidi S, Chadli A. Pituitary apoplexy in geriatric patients: a report of four cases. Cureus 2021;13[12]:e20318. Creative Commons Attribution License [CC-BY 4.0].)

CT in a 31-year-old man with pituitary apoplexy precipitated by systemic chemotherapy demonstrates expansion of the sella consistent with a prior slow-growing tumor. (Source: Hamrick FA, Findlay MC, Rennert RC, Budohoski KP, Couldwell WT. Pituitary apoplexy precipitated by systemic chemotherapy. Cureus 2022;14[3]:e23004. Creative Commons Attribution License [CC-BY 4.0].)

MRI from a 31-year-old man with pituitary apoplexy precipitated by systemic chemotherapy demonstrates expansion of the sella consistent with a prior slow-growing tumor. Enhancement of the sphenoid sinus mucosa is also seen (gray arrows), which has been linked to higher intrasellar pressures and more severe pituitary apoplexy. (Source: Hamrick FA, Findlay MC, Rennert RC, Budohoski KP, Couldwell WT. Pituitary apoplexy precipitated by systemic chemotherapy. Cureus 2022;14[3]:e23004. Creative Commons Attribution License [CC-BY 4.0].)

MRI in a 31-year-old man with pituitary apoplexy precipitated by systemic chemotherapy shows a 2.0×2.8×2.1 cm sellar and suprasellar mass with upward displacement of the optic chiasm (white arrow) and internal blood products. (Source: Hamrick FA, Findlay MC, Rennert RC, Budohoski KP, Couldwell WT. Pituitary apoplexy precipitated by systemic chemotherapy. Cureus 2022;14[3]:e23004. Creative Commons Attribution License [CC-BY 4.0].)

MRI in a 31-year-old man with pituitary apoplexy precipitated by systemic chemotherapy shows a 2.0×2.8×2.1 cm sellar and suprasellar mass with upward displacement of the optic chiasm (white arrow) and internal blood products. The pituitary stalk and gland are displaced to the left, best seen on this postcontrast image. There is heterogeneous enhancement of the sellar and suprasellar mass. (Source: Hamrick FA, Findlay MC, Rennert RC, Budohoski KP, Couldwell WT. Pituitary apoplexy precipitated by systemic chemotherapy. Cureus 2022;14[3]:e23004. Creative Commons Attribution License [CC-BY 4.0].)

A 31-year-old man with a recent diagnosis of seminomatous germ cell testicular cancer with metastases to the pelvis and retroperitoneum presented to the emergency department with several days of severe, progressive bifrontal headaches, nausea, and right-sided blurry vision 1 week after initiating chemotherapy (bleomycin, etoposide, and cisplatin). Neurologic examination was normal except for decreased right temporal visual acuity. MRI showed a 2.0×2.8×2.1 cm sellar and suprasellar mass with upward displacement of the optic chiasm (white arrow) and internal blood products. He underwent urgent transnasal transsphenoidal surgery. Pathological analysis showed a partially necrotic and hemorrhagic adenoma with rare growth hormone– and adrenocorticotropic hormone–positive tumor cells, with a low proliferation rate (Mib-1 less than 2%).. (Source: Hamrick FA, Findlay MC, Rennert RC, Budohoski KP, Couldwell WT. Pituitary apoplexy precipitated by systemic chemotherapy. Cureus 2022;14[3]:e23004. Creative Commons Attribution License [CC-BY 4.0].)

Pathologically confirmed IDH-mutated diffuse astrocytoma. Axial MRI with a 26 mm x 23 mm x 18 mm in the L frontal cortex that is T2 (left) and FLAIR (middle) bright. No evidence of enhancement on T1 post-contrast (right). (Contributed by Dr. Orwa Aboud.)

In WHO CNS-5, all IDH-mutant infiltrating astrocytomas are considered a single entity (ie, astrocytoma, IDH-mutant) and are graded as CNS WHO Grade 2, 3, or 4 depending on both histologic and molecular features. (Reproduced from: Weller M, van den Bent M, Preusser M, et al. EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol 2021;18(3):170-86.)

One of the most-used decision paradigms for selecting appropriate management for spinal metastatic disease is the NOMS framework, which takes into account neurologic, oncologic, mechanical, and systemic considerations to optimize treatment. (Contributed by Dr. Deric Park.)

This section from a 23-year-old woman shows a classic PXA with bizarre, multinucleated giant cells, lipidized cells, EGBs, and chronic inflammatory infiltrates more prominent on the left lower aspect of the image. (Hematoxylin and eosin, 10x) (Contributed by Dr. Elena Daoud.)

MRI of a patient with H3K27M-mutant midline glioma. (2A) Brain MRI axial view, post gadolinium contrast with heterogenous enhancement in the left thalamus. (2B) Brain MRI T2 flair sequence with expansile hyperintensity in the left thalamus without surrounding edema. (2C) Brain MRI sagittal view post gadolinium contrast with heterogenous enhancement in the left thalamus. (Contributed by Dr. Jigisha Thakkar.)

MRI of a patient with H3K27M mutant midline glioma. (1A) Brain MRI axial view post gadolinium contrast with heterogenous enhancement in the pons. (1B) Brain MRI T2 flair sequence with expansile hyperintensity in the pons without surrounding edema. (1C) Brain MRI coronal view post gadolinium contrast with heterogenous enhancement in the pons. (Contributed by Dr. Jigisha Thakkar.)

(Modified from: Weller M, van den Bent M, Preusser M, et al. EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol 2021;18(3):170-86.)

Photomicrograph of tumor immunostained with biotinylated anti-Hu IgG showing staining of some nuclei of tumor cells (dark blue color). Counterstaining with hematoxylin produces the light blue color of the negative cell nuclei. (Contributed by Dr. Francesc Graus.)

Axial FLAIR MRI showing increased signal abnormalities in the medial aspect of temporal lobes (arrows). (Contributed by Dr. Francesc Graus.)

Coronal MRI of left frontal diffuse astrocytic glioma, IDH wildtype, with molecular features of glioblastoma CNS WHO grade 4 demonstrating on post-contrast sequences a minimally enhancing mass (A) with associated mass-like FLAIR but without marked edema (B). (Contributed by Dr. Jennie Taylor.)

The lesion of this 9-year-old girl who has had seizures for more than 3 years is cortically based and has a hyperintense signal on the T2-weighted MR image (left) with a multicystic component that was mistaken for the flow-voids of a cavernous angioma. On the T1-weighted image with gadolinium contrast (right), the lesion is isointense to surrounding brain with some serpentine contrast enhancement. (Contributed by Dr. Scott Mintzer.)