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From the Archives of the AFIP

Superficial Gliomas: Radiologic-Pathologic Correlation¹

¹ From the Departments of Radiologic Pathology (K.K.K.) and Neuropathology (J.M.H.), Armed Forces Institute of Pathology, Bldg 54, Rm M-121, 14th St at Alaska Ave, Washington, DC 20306-6000; and the Departments of Radiology and Nuclear Medicine (K.K.K.) and Pathology (J.M.H.), Uniformed Services University of the Health Sciences, Bethesda, Md. Received June 11, 2001; revision requested June 27 and received July 26; accepted July 30. Address correspondence to K.K.K. (e-mail: koeller@afip.osd.mil).

View larger version (195K): [in a new window]   Figure 1.   Photomicrograph (original magnification, x60; hematoxylineosin stain) of a ganglioglioma shows typical nesting and clustering of tumor cells due to delicate branching vasculature (arrows). The larger neuronal elements (arrowheads) are imbedded within a spindled glial matrix.

View larger version (157K): [in a new window]   Figure 2.   Photomicrograph (original magnification, x180; hematoxylineosin stain) of a ganglioglioma shows a continuum of neuronal elements, including a multinucleated variant (arrow), within a well-differentiated spindled glial matrix that resembles pilocytic astrocytoma. Nissl substance (arrowheads) is present in the cytoplasm of a large neuron.

View larger version (128K): [in a new window]   Figure 3a.   Ganglioglioma in a 15-year-old girl who experienced a generalized tonic-clonic seizure. (a) Axial CT image shows a heavily calcified mass (arrows) of the posterior right temporal lobe. The mass is otherwise hypoattenuating. (b) Axial T1-weighted MR image better shows the true size of the lesion. It is heterogeneously hypointense with a central region of ringlike high signal intensity (arrowheads), an appearance that corresponds to the calcification seen at CT. (c) Axial T2-weighted MR image shows high signal intensity of the mass without evidence of surrounding vasogenic edema. (d) Contrast material-enhanced axial T1-weighted MR image shows ringlike enhancement of the mass.

View larger version (120K): [in a new window]   Figure 3b.   Ganglioglioma in a 15-year-old girl who experienced a generalized tonic-clonic seizure. (a) Axial CT image shows a heavily calcified mass (arrows) of the posterior right temporal lobe. The mass is otherwise hypoattenuating. (b) Axial T1-weighted MR image better shows the true size of the lesion. It is heterogeneously hypointense with a central region of ringlike high signal intensity (arrowheads), an appearance that corresponds to the calcification seen at CT. (c) Axial T2-weighted MR image shows high signal intensity of the mass without evidence of surrounding vasogenic edema. (d) Contrast material-enhanced axial T1-weighted MR image shows ringlike enhancement of the mass.

View larger version (120K): [in a new window]   Figure 3c.   Ganglioglioma in a 15-year-old girl who experienced a generalized tonic-clonic seizure. (a) Axial CT image shows a heavily calcified mass (arrows) of the posterior right temporal lobe. The mass is otherwise hypoattenuating. (b) Axial T1-weighted MR image better shows the true size of the lesion. It is heterogeneously hypointense with a central region of ringlike high signal intensity (arrowheads), an appearance that corresponds to the calcification seen at CT. (c) Axial T2-weighted MR image shows high signal intensity of the mass without evidence of surrounding vasogenic edema. (d) Contrast material-enhanced axial T1-weighted MR image shows ringlike enhancement of the mass.

View larger version (108K): [in a new window]   Figure 3d.   Ganglioglioma in a 15-year-old girl who experienced a generalized tonic-clonic seizure. (a) Axial CT image shows a heavily calcified mass (arrows) of the posterior right temporal lobe. The mass is otherwise hypoattenuating. (b) Axial T1-weighted MR image better shows the true size of the lesion. It is heterogeneously hypointense with a central region of ringlike high signal intensity (arrowheads), an appearance that corresponds to the calcification seen at CT. (c) Axial T2-weighted MR image shows high signal intensity of the mass without evidence of surrounding vasogenic edema. (d) Contrast material-enhanced axial T1-weighted MR image shows ringlike enhancement of the mass.

View larger version (160K): [in a new window]   Figure 4a.   Ganglioglioma in an 8-year-old girl with diplopia and headaches. (a) Axial CT image shows a large, heterogeneous mass of the posterior right temporal lobe. Calcification within the mass and thinning of the adjacent skull are clearly evident. (b) Axial T1-weighted MR image shows mild, heterogeneous low signal intensity of the mass. (c) Axial T2-weighted MR image shows a markedly heterogeneous appearance with apparent septa within the mass, which is hyperintense relative to the gray matter. (d) Contrast-enhanced coronal T1-weighted MR image shows intense enhancement in some areas and ringlike enhancement in others. (e) Intraoperative photograph obtained after opening of the dura shows an obviously bulging cortical surface. The mass was well-encapsulated, facilitating gross total resection. Histologic examination revealed a mixture of abnormal ganglion cells and astrocytes, with the astrocytic component appearing similar to pilocytic astrocytoma and oligodendroglioma.

View larger version (146K): [in a new window]   Figure 4b.   Ganglioglioma in an 8-year-old girl with diplopia and headaches. (a) Axial CT image shows a large, heterogeneous mass of the posterior right temporal lobe. Calcification within the mass and thinning of the adjacent skull are clearly evident. (b) Axial T1-weighted MR image shows mild, heterogeneous low signal intensity of the mass. (c) Axial T2-weighted MR image shows a markedly heterogeneous appearance with apparent septa within the mass, which is hyperintense relative to the gray matter. (d) Contrast-enhanced coronal T1-weighted MR image shows intense enhancement in some areas and ringlike enhancement in others. (e) Intraoperative photograph obtained after opening of the dura shows an obviously bulging cortical surface. The mass was well-encapsulated, facilitating gross total resection. Histologic examination revealed a mixture of abnormal ganglion cells and astrocytes, with the astrocytic component appearing similar to pilocytic astrocytoma and oligodendroglioma.

View larger version (144K): [in a new window]   Figure 4c.   Ganglioglioma in an 8-year-old girl with diplopia and headaches. (a) Axial CT image shows a large, heterogeneous mass of the posterior right temporal lobe. Calcification within the mass and thinning of the adjacent skull are clearly evident. (b) Axial T1-weighted MR image shows mild, heterogeneous low signal intensity of the mass. (c) Axial T2-weighted MR image shows a markedly heterogeneous appearance with apparent septa within the mass, which is hyperintense relative to the gray matter. (d) Contrast-enhanced coronal T1-weighted MR image shows intense enhancement in some areas and ringlike enhancement in others. (e) Intraoperative photograph obtained after opening of the dura shows an obviously bulging cortical surface. The mass was well-encapsulated, facilitating gross total resection. Histologic examination revealed a mixture of abnormal ganglion cells and astrocytes, with the astrocytic component appearing similar to pilocytic astrocytoma and oligodendroglioma.

View larger version (142K): [in a new window]   Figure 4d.   Ganglioglioma in an 8-year-old girl with diplopia and headaches. (a) Axial CT image shows a large, heterogeneous mass of the posterior right temporal lobe. Calcification within the mass and thinning of the adjacent skull are clearly evident. (b) Axial T1-weighted MR image shows mild, heterogeneous low signal intensity of the mass. (c) Axial T2-weighted MR image shows a markedly heterogeneous appearance with apparent septa within the mass, which is hyperintense relative to the gray matter. (d) Contrast-enhanced coronal T1-weighted MR image shows intense enhancement in some areas and ringlike enhancement in others. (e) Intraoperative photograph obtained after opening of the dura shows an obviously bulging cortical surface. The mass was well-encapsulated, facilitating gross total resection. Histologic examination revealed a mixture of abnormal ganglion cells and astrocytes, with the astrocytic component appearing similar to pilocytic astrocytoma and oligodendroglioma.

View larger version (128K): [in a new window]   Figure 4e.   Ganglioglioma in an 8-year-old girl with diplopia and headaches. (a) Axial CT image shows a large, heterogeneous mass of the posterior right temporal lobe. Calcification within the mass and thinning of the adjacent skull are clearly evident. (b) Axial T1-weighted MR image shows mild, heterogeneous low signal intensity of the mass. (c) Axial T2-weighted MR image shows a markedly heterogeneous appearance with apparent septa within the mass, which is hyperintense relative to the gray matter. (d) Contrast-enhanced coronal T1-weighted MR image shows intense enhancement in some areas and ringlike enhancement in others. (e) Intraoperative photograph obtained after opening of the dura shows an obviously bulging cortical surface. The mass was well-encapsulated, facilitating gross total resection. Histologic examination revealed a mixture of abnormal ganglion cells and astrocytes, with the astrocytic component appearing similar to pilocytic astrocytoma and oligodendroglioma.

View larger version (129K): [in a new window]   Figure 5a.   Ganglioglioma in a 20-year-old woman with an 8-year history of partial complex seizures. (a) Coronal T1-weighted MR image shows a focal hypointense mass (arrow) of the medial left temporal lobe. (b) Coronal T2-weighted MR image shows high signal intensity within the mass without evidence of surrounding edema. (c) Contrast-enhanced coronal T1-weighted MR image shows intense focal enhancement (arrowheads) of the medial margin of the mass extending to the cortical surface. (d) Photograph of a specimen obtained after en bloc resection of the lateral temporal cortex shows abnormal enlargement of the gyrus. Histologic examination of this specimen showed abnormal ganglion cells combined with abnormal astrocytes and oligodendrocytes, which confirmed the diagnosis.

View larger version (156K): [in a new window]   Figure 5b.   Ganglioglioma in a 20-year-old woman with an 8-year history of partial complex seizures. (a) Coronal T1-weighted MR image shows a focal hypointense mass (arrow) of the medial left temporal lobe. (b) Coronal T2-weighted MR image shows high signal intensity within the mass without evidence of surrounding edema. (c) Contrast-enhanced coronal T1-weighted MR image shows intense focal enhancement (arrowheads) of the medial margin of the mass extending to the cortical surface. (d) Photograph of a specimen obtained after en bloc resection of the lateral temporal cortex shows abnormal enlargement of the gyrus. Histologic examination of this specimen showed abnormal ganglion cells combined with abnormal astrocytes and oligodendrocytes, which confirmed the diagnosis.

View larger version (128K): [in a new window]   Figure 5c.   Ganglioglioma in a 20-year-old woman with an 8-year history of partial complex seizures. (a) Coronal T1-weighted MR image shows a focal hypointense mass (arrow) of the medial left temporal lobe. (b) Coronal T2-weighted MR image shows high signal intensity within the mass without evidence of surrounding edema. (c) Contrast-enhanced coronal T1-weighted MR image shows intense focal enhancement (arrowheads) of the medial margin of the mass extending to the cortical surface. (d) Photograph of a specimen obtained after en bloc resection of the lateral temporal cortex shows abnormal enlargement of the gyrus. Histologic examination of this specimen showed abnormal ganglion cells combined with abnormal astrocytes and oligodendrocytes, which confirmed the diagnosis.

View larger version (125K): [in a new window]   Figure 5d.   Ganglioglioma in a 20-year-old woman with an 8-year history of partial complex seizures. (a) Coronal T1-weighted MR image shows a focal hypointense mass (arrow) of the medial left temporal lobe. (b) Coronal T2-weighted MR image shows high signal intensity within the mass without evidence of surrounding edema. (c) Contrast-enhanced coronal T1-weighted MR image shows intense focal enhancement (arrowheads) of the medial margin of the mass extending to the cortical surface. (d) Photograph of a specimen obtained after en bloc resection of the lateral temporal cortex shows abnormal enlargement of the gyrus. Histologic examination of this specimen showed abnormal ganglion cells combined with abnormal astrocytes and oligodendrocytes, which confirmed the diagnosis.

View larger version (129K): [in a new window]   Figure 6a.   Ganglioglioma in a 19-year-old man with a 12-year history of medically refractory seizures. (a) Axial T2-weighted MR image shows an ill-defined mass of the posterior left parietotemporal lobe (arrows) that distorts the margin of the lateral ventricle. The mass is heterogeneous, with areas of high signal intensity combined with regions that are equivalent in signal intensity to the gray matter. (b) Axial positron emission tomographic (PET) image shows mild hypometabolic activity (arrows) in the region of the mass.

View larger version (124K): [in a new window]   Figure 6b.   Ganglioglioma in a 19-year-old man with a 12-year history of medically refractory seizures. (a) Axial T2-weighted MR image shows an ill-defined mass of the posterior left parietotemporal lobe (arrows) that distorts the margin of the lateral ventricle. The mass is heterogeneous, with areas of high signal intensity combined with regions that are equivalent in signal intensity to the gray matter. (b) Axial positron emission tomographic (PET) image shows mild hypometabolic activity (arrows) in the region of the mass.

View larger version (144K): [in a new window]   Figure 7a.   Desmoplastic infantile ganglioglioma in a 5-month-old boy with central apnea. (a) Axial CT image shows a large, heterogeneous mass of the right temporal region. Cystlike areas (c) combined with mildly hyperattenuating soft-tissue areas (s) are seen. (b) Axial T1-weighted MR image shows heterogeneity within the mass, an appearance similar to the CT appearance. The soft-tissue component appears to be extraaxial. (c) Axial T2-weighted MR image shows that the soft-tissue component is hypointense relative to the brain parenchyma. A mild amount of surrounding vasogenic edema is noted. (d) Contrast-enhanced axial T1-weighted MR image shows intense enhancement of the soft-tissue component. (e) Intraoperative photograph shows the extraaxial location of the mass (indicated by the silver probe). (f) Photograph shows resected specimens, which correlate morphologically with the extraaxial soft-tissue component seen at cross-sectional imaging.

View larger version (143K): [in a new window]   Figure 7b.   Desmoplastic infantile ganglioglioma in a 5-month-old boy with central apnea. (a) Axial CT image shows a large, heterogeneous mass of the right temporal region. Cystlike areas (c) combined with mildly hyperattenuating soft-tissue areas (s) are seen. (b) Axial T1-weighted MR image shows heterogeneity within the mass, an appearance similar to the CT appearance. The soft-tissue component appears to be extraaxial. (c) Axial T2-weighted MR image shows that the soft-tissue component is hypointense relative to the brain parenchyma. A mild amount of surrounding vasogenic edema is noted. (d) Contrast-enhanced axial T1-weighted MR image shows intense enhancement of the soft-tissue component. (e) Intraoperative photograph shows the extraaxial location of the mass (indicated by the silver probe). (f) Photograph shows resected specimens, which correlate morphologically with the extraaxial soft-tissue component seen at cross-sectional imaging.

View larger version (146K): [in a new window]   Figure 7c.   Desmoplastic infantile ganglioglioma in a 5-month-old boy with central apnea. (a) Axial CT image shows a large, heterogeneous mass of the right temporal region. Cystlike areas (c) combined with mildly hyperattenuating soft-tissue areas (s) are seen. (b) Axial T1-weighted MR image shows heterogeneity within the mass, an appearance similar to the CT appearance. The soft-tissue component appears to be extraaxial. (c) Axial T2-weighted MR image shows that the soft-tissue component is hypointense relative to the brain parenchyma. A mild amount of surrounding vasogenic edema is noted. (d) Contrast-enhanced axial T1-weighted MR image shows intense enhancement of the soft-tissue component. (e) Intraoperative photograph shows the extraaxial location of the mass (indicated by the silver probe). (f) Photograph shows resected specimens, which correlate morphologically with the extraaxial soft-tissue component seen at cross-sectional imaging.

View larger version (146K): [in a new window]   Figure 7d.   Desmoplastic infantile ganglioglioma in a 5-month-old boy with central apnea. (a) Axial CT image shows a large, heterogeneous mass of the right temporal region. Cystlike areas (c) combined with mildly hyperattenuating soft-tissue areas (s) are seen. (b) Axial T1-weighted MR image shows heterogeneity within the mass, an appearance similar to the CT appearance. The soft-tissue component appears to be extraaxial. (c) Axial T2-weighted MR image shows that the soft-tissue component is hypointense relative to the brain parenchyma. A mild amount of surrounding vasogenic edema is noted. (d) Contrast-enhanced axial T1-weighted MR image shows intense enhancement of the soft-tissue component. (e) Intraoperative photograph shows the extraaxial location of the mass (indicated by the silver probe). (f) Photograph shows resected specimens, which correlate morphologically with the extraaxial soft-tissue component seen at cross-sectional imaging.

View larger version (114K): [in a new window]   Figure 7e.   Desmoplastic infantile ganglioglioma in a 5-month-old boy with central apnea. (a) Axial CT image shows a large, heterogeneous mass of the right temporal region. Cystlike areas (c) combined with mildly hyperattenuating soft-tissue areas (s) are seen. (b) Axial T1-weighted MR image shows heterogeneity within the mass, an appearance similar to the CT appearance. The soft-tissue component appears to be extraaxial. (c) Axial T2-weighted MR image shows that the soft-tissue component is hypointense relative to the brain parenchyma. A mild amount of surrounding vasogenic edema is noted. (d) Contrast-enhanced axial T1-weighted MR image shows intense enhancement of the soft-tissue component. (e) Intraoperative photograph shows the extraaxial location of the mass (indicated by the silver probe). (f) Photograph shows resected specimens, which correlate morphologically with the extraaxial soft-tissue component seen at cross-sectional imaging.

View larger version (71K): [in a new window]   Figure 7f.   Desmoplastic infantile ganglioglioma in a 5-month-old boy with central apnea. (a) Axial CT image shows a large, heterogeneous mass of the right temporal region. Cystlike areas (c) combined with mildly hyperattenuating soft-tissue areas (s) are seen. (b) Axial T1-weighted MR image shows heterogeneity within the mass, an appearance similar to the CT appearance. The soft-tissue component appears to be extraaxial. (c) Axial T2-weighted MR image shows that the soft-tissue component is hypointense relative to the brain parenchyma. A mild amount of surrounding vasogenic edema is noted. (d) Contrast-enhanced axial T1-weighted MR image shows intense enhancement of the soft-tissue component. (e) Intraoperative photograph shows the extraaxial location of the mass (indicated by the silver probe). (f) Photograph shows resected specimens, which correlate morphologically with the extraaxial soft-tissue component seen at cross-sectional imaging.

View larger version (136K): [in a new window]   Figure 8a.   Desmoplastic infantile ganglioglioma in a 6-month-old boy with increasing head circumference over a 2-month period. (a) Axial T1-weighted MR image shows a large, heterogeneous mass of the left parietal lobe with surrounding vasogenic edema and marked midline shift. Both soft-tissue (S) and cystlike (C) components are visible. (b) Axial T2-weighted MR image shows the soft-tissue areas as regions of low signal intensity compared with the high signal intensity of the cystic territories. (c) Contrast-enhanced axial T1-weighted MR image shows intense enhancement of the soft-tissue portions of the tumor. (d) Contrast-enhanced coronal T1-weighted MR image shows that the enhancing soft-tissue component contacts the dural sinus (arrow), which shows abnormal nonenhancement, suggestive of dural sinus involvement. At surgery, a portion of the mass remained tightly adherent to the dural sinus.

View larger version (128K): [in a new window]   Figure 8b.   Desmoplastic infantile ganglioglioma in a 6-month-old boy with increasing head circumference over a 2-month period. (a) Axial T1-weighted MR image shows a large, heterogeneous mass of the left parietal lobe with surrounding vasogenic edema and marked midline shift. Both soft-tissue (S) and cystlike (C) components are visible. (b) Axial T2-weighted MR image shows the soft-tissue areas as regions of low signal intensity compared with the high signal intensity of the cystic territories. (c) Contrast-enhanced axial T1-weighted MR image shows intense enhancement of the soft-tissue portions of the tumor. (d) Contrast-enhanced coronal T1-weighted MR image shows that the enhancing soft-tissue component contacts the dural sinus (arrow), which shows abnormal nonenhancement, suggestive of dural sinus involvement. At surgery, a portion of the mass remained tightly adherent to the dural sinus.

View larger version (128K): [in a new window]   Figure 8c.   Desmoplastic infantile ganglioglioma in a 6-month-old boy with increasing head circumference over a 2-month period. (a) Axial T1-weighted MR image shows a large, heterogeneous mass of the left parietal lobe with surrounding vasogenic edema and marked midline shift. Both soft-tissue (S) and cystlike (C) components are visible. (b) Axial T2-weighted MR image shows the soft-tissue areas as regions of low signal intensity compared with the high signal intensity of the cystic territories. (c) Contrast-enhanced axial T1-weighted MR image shows intense enhancement of the soft-tissue portions of the tumor. (d) Contrast-enhanced coronal T1-weighted MR image shows that the enhancing soft-tissue component contacts the dural sinus (arrow), which shows abnormal nonenhancement, suggestive of dural sinus involvement. At surgery, a portion of the mass remained tightly adherent to the dural sinus.

View larger version (126K): [in a new window]   Figure 8d.   Desmoplastic infantile ganglioglioma in a 6-month-old boy with increasing head circumference over a 2-month period. (a) Axial T1-weighted MR image shows a large, heterogeneous mass of the left parietal lobe with surrounding vasogenic edema and marked midline shift. Both soft-tissue (S) and cystlike (C) components are visible. (b) Axial T2-weighted MR image shows the soft-tissue areas as regions of low signal intensity compared with the high signal intensity of the cystic territories. (c) Contrast-enhanced axial T1-weighted MR image shows intense enhancement of the soft-tissue portions of the tumor. (d) Contrast-enhanced coronal T1-weighted MR image shows that the enhancing soft-tissue component contacts the dural sinus (arrow), which shows abnormal nonenhancement, suggestive of dural sinus involvement. At surgery, a portion of the mass remained tightly adherent to the dural sinus.

View larger version (129K): [in a new window]   Figure 9a.   Dysplastic cerebellar gangliocytoma in a 47-year-old woman with cervical myelopathy. (a) Axial T1-weighted MR image shows a cerebellar mass (arrowheads) with a striped appearance. (b) Axial T2-weighted MR image shows the same laminar morphology, composed of alternating hyperintense and isointense bands. (c) Contrast-enhanced axial T1-weighted MR image shows no enhancement of the mass.

View larger version (138K): [in a new window]   Figure 9b.   Dysplastic cerebellar gangliocytoma in a 47-year-old woman with cervical myelopathy. (a) Axial T1-weighted MR image shows a cerebellar mass (arrowheads) with a striped appearance. (b) Axial T2-weighted MR image shows the same laminar morphology, composed of alternating hyperintense and isointense bands. (c) Contrast-enhanced axial T1-weighted MR image shows no enhancement of the mass.

View larger version (129K): [in a new window]   Figure 9c.   Dysplastic cerebellar gangliocytoma in a 47-year-old woman with cervical myelopathy. (a) Axial T1-weighted MR image shows a cerebellar mass (arrowheads) with a striped appearance. (b) Axial T2-weighted MR image shows the same laminar morphology, composed of alternating hyperintense and isointense bands. (c) Contrast-enhanced axial T1-weighted MR image shows no enhancement of the mass.

View larger version (126K): [in a new window]   Figure 10a.   Dysplastic cerebellar gangliocytoma in a 16-year-old girl with occipital headaches. (a) Axial T1-weighted MR image shows a mass (arrowheads) within the left cerebellar hemisphere. Alternating hypointense and isointense bands characterize the lesion. (b) Axial T2-weighted MR image shows alternating hyperintense and isointense bands. (c) Contrast-enhanced axial T1-weighted MR image shows no enhancement within the mass.

View larger version (124K): [in a new window]   Figure 10b.   Dysplastic cerebellar gangliocytoma in a 16-year-old girl with occipital headaches. (a) Axial T1-weighted MR image shows a mass (arrowheads) within the left cerebellar hemisphere. Alternating hypointense and isointense bands characterize the lesion. (b) Axial T2-weighted MR image shows alternating hyperintense and isointense bands. (c) Contrast-enhanced axial T1-weighted MR image shows no enhancement within the mass.

View larger version (122K): [in a new window]   Figure 10c.   Dysplastic cerebellar gangliocytoma in a 16-year-old girl with occipital headaches. (a) Axial T1-weighted MR image shows a mass (arrowheads) within the left cerebellar hemisphere. Alternating hypointense and isointense bands characterize the lesion. (b) Axial T2-weighted MR image shows alternating hyperintense and isointense bands. (c) Contrast-enhanced axial T1-weighted MR image shows no enhancement within the mass.

View larger version (193K): [in a new window]   Figure 11.   Photomicrograph (original magnification, x150; hematoxylineosin stain) of a pleomorphic xanthoastrocytoma shows densely cellular glial elements, including a large multinucleated xanthomatous cell (arrow) with foamy cytoplasm. Pleomorphism as reflected by variation in shape, size, and staining characteristics is prominent.

View larger version (123K): [in a new window]   Figure 12a.   Pleomorphic xanthoastrocytoma in a 13-year-old boy with neurofibromatosis I and headaches. (a) Nonenhanced axial CT image shows a heterogeneous mass (arrows) of the right frontal lobe with both cystic and soft-tissue components. A mild amount of surrounding vasogenic edema (arrowheads) is present. (b) Axial T1-weighted MR image obtained at a slightly different level than in a shows that the mass does not extend to the cortical surface. Soft-tissue (S) and cystic (C) components are again noted. (c) Axial T2-weighted MR image shows mild low signal intensity of the soft-tissue portion of the mass, whereas the cystic portions are hyperintense. Small "fingers" of vasogenic edema surround the mass. (d) Contrast-enhanced axial T1-weighted MR image shows intense enhancement of the soft-tissue portion of the mass with rim enhancement of the cystic margin.

View larger version (123K): [in a new window]   Figure 12b.   Pleomorphic xanthoastrocytoma in a 13-year-old boy with neurofibromatosis I and headaches. (a) Nonenhanced axial CT image shows a heterogeneous mass (arrows) of the right frontal lobe with both cystic and soft-tissue components. A mild amount of surrounding vasogenic edema (arrowheads) is present. (b) Axial T1-weighted MR image obtained at a slightly different level than in a shows that the mass does not extend to the cortical surface. Soft-tissue (S) and cystic (C) components are again noted. (c) Axial T2-weighted MR image shows mild low signal intensity of the soft-tissue portion of the mass, whereas the cystic portions are hyperintense. Small "fingers" of vasogenic edema surround the mass. (d) Contrast-enhanced axial T1-weighted MR image shows intense enhancement of the soft-tissue portion of the mass with rim enhancement of the cystic margin.

View larger version (117K): [in a new window]   Figure 12c.   Pleomorphic xanthoastrocytoma in a 13-year-old boy with neurofibromatosis I and headaches. (a) Nonenhanced axial CT image shows a heterogeneous mass (arrows) of the right frontal lobe with both cystic and soft-tissue components. A mild amount of surrounding vasogenic edema (arrowheads) is present. (b) Axial T1-weighted MR image obtained at a slightly different level than in a shows that the mass does not extend to the cortical surface. Soft-tissue (S) and cystic (C) components are again noted. (c) Axial T2-weighted MR image shows mild low signal intensity of the soft-tissue portion of the mass, whereas the cystic portions are hyperintense. Small "fingers" of vasogenic edema surround the mass. (d) Contrast-enhanced axial T1-weighted MR image shows intense enhancement of the soft-tissue portion of the mass with rim enhancement of the cystic margin.

View larger version (135K): [in a new window]   Figure 12d.   Pleomorphic xanthoastrocytoma in a 13-year-old boy with neurofibromatosis I and headaches. (a) Nonenhanced axial CT image shows a heterogeneous mass (arrows) of the right frontal lobe with both cystic and soft-tissue components. A mild amount of surrounding vasogenic edema (arrowheads) is present. (b) Axial T1-weighted MR image obtained at a slightly different level than in a shows that the mass does not extend to the cortical surface. Soft-tissue (S) and cystic (C) components are again noted. (c) Axial T2-weighted MR image shows mild low signal intensity of the soft-tissue portion of the mass, whereas the cystic portions are hyperintense. Small "fingers" of vasogenic edema surround the mass. (d) Contrast-enhanced axial T1-weighted MR image shows intense enhancement of the soft-tissue portion of the mass with rim enhancement of the cystic margin.

View larger version (135K): [in a new window]   Figure 13a.   Pleomorphic xanthoastrocytoma in an 8-year-old boy with a history of vomiting, headaches, and decreased coordination for several months. (a) Contrast-enhanced axial CT image shows a heterogeneous mass of the left frontal region with both cystlike and soft-tissue components. (b) Axial CT image obtained with bone windows shows lytic change in the adjacent calvaria. (c) Axial T1-weighted MR image shows that the mass is cystlike with a peripheral soft-tissue component. (d) Axial T2-weighted MR image shows high signal intensity of the cystlike area and relative low signal intensity of the soft-tissue component. (e) Contrast-enhanced coronal T1-weighted MR image shows intense enhancement of the soft-tissue portion of the mass.

View larger version (101K): [in a new window]   Figure 13b.   Pleomorphic xanthoastrocytoma in an 8-year-old boy with a history of vomiting, headaches, and decreased coordination for several months. (a) Contrast-enhanced axial CT image shows a heterogeneous mass of the left frontal region with both cystlike and soft-tissue components. (b) Axial CT image obtained with bone windows shows lytic change in the adjacent calvaria. (c) Axial T1-weighted MR image shows that the mass is cystlike with a peripheral soft-tissue component. (d) Axial T2-weighted MR image shows high signal intensity of the cystlike area and relative low signal intensity of the soft-tissue component. (e) Contrast-enhanced coronal T1-weighted MR image shows intense enhancement of the soft-tissue portion of the mass.

View larger version (131K): [in a new window]   Figure 13c.   Pleomorphic xanthoastrocytoma in an 8-year-old boy with a history of vomiting, headaches, and decreased coordination for several months. (a) Contrast-enhanced axial CT image shows a heterogeneous mass of the left frontal region with both cystlike and soft-tissue components. (b) Axial CT image obtained with bone windows shows lytic change in the adjacent calvaria. (c) Axial T1-weighted MR image shows that the mass is cystlike with a peripheral soft-tissue component. (d) Axial T2-weighted MR image shows high signal intensity of the cystlike area and relative low signal intensity of the soft-tissue component. (e) Contrast-enhanced coronal T1-weighted MR image shows intense enhancement of the soft-tissue portion of the mass.

View larger version (120K): [in a new window]   Figure 13d.   Pleomorphic xanthoastrocytoma in an 8-year-old boy with a history of vomiting, headaches, and decreased coordination for several months. (a) Contrast-enhanced axial CT image shows a heterogeneous mass of the left frontal region with both cystlike and soft-tissue components. (b) Axial CT image obtained with bone windows shows lytic change in the adjacent calvaria. (c) Axial T1-weighted MR image shows that the mass is cystlike with a peripheral soft-tissue component. (d) Axial T2-weighted MR image shows high signal intensity of the cystlike area and relative low signal intensity of the soft-tissue component. (e) Contrast-enhanced coronal T1-weighted MR image shows intense enhancement of the soft-tissue portion of the mass.

View larger version (157K): [in a new window]   Figure 13e.   Pleomorphic xanthoastrocytoma in an 8-year-old boy with a history of vomiting, headaches, and decreased coordination for several months. (a) Contrast-enhanced axial CT image shows a heterogeneous mass of the left frontal region with both cystlike and soft-tissue components. (b) Axial CT image obtained with bone windows shows lytic change in the adjacent calvaria. (c) Axial T1-weighted MR image shows that the mass is cystlike with a peripheral soft-tissue component. (d) Axial T2-weighted MR image shows high signal intensity of the cystlike area and relative low signal intensity of the soft-tissue component. (e) Contrast-enhanced coronal T1-weighted MR image shows intense enhancement of the soft-tissue portion of the mass.

View larger version (89K): [in a new window]   Figure 14.   Photograph of a resected intracortical dysembryoplastic neuroepithelial tumor shows multiple semicystic nodules (arrows) along the cortical boundary.

View larger version (168K): [in a new window]   Figure 15.   Photomicrograph (original magnification, x160; hematoxylineosin stain) of a dysembryoplastic neuroepithelial tumor with cystic degeneration shows a trabecular pattern (long arrows) of glial elements, including astrocytes and oligodendrocytes. Oligodendroglial cells (arrowhead) contain small dark nuclei, whereas the astrocytic cells (short arrow) are somewhat larger with pink cytoplasm.

View larger version (194K): [in a new window]   Figure 16.   Photomicrograph (original magnification, x120; hematoxylineosin stain) of a dysembryoplastic neuroepithelial tumor shows neuronal elements surrounded by prominent vacuoles, which represent so-called floating neurons (arrows).

View larger version (112K): [in a new window]   Figure 17a.   Dysembryoplastic neuroepithelial tumor in a 14-year-old girl who experienced a seizure while sleeping. (a) Axial CT image shows a hypoattenuating mass of the right parietal lobe. Note the remodeling of the adjacent inner table of the skull. (b) Axial T2-weighted MR image shows marked high signal intensity of the mass, which extends beyond the normal cortical margin ("soap bubble" appearance) and directly remodels the skull. There is no evidence of vasogenic edema associated with the mass. (c) Contrast-enhanced axial T1-weighted MR image shows no evidence of enhancement within the mass.

View larger version (144K): [in a new window]   Figure 17b.   Dysembryoplastic neuroepithelial tumor in a 14-year-old girl who experienced a seizure while sleeping. (a) Axial CT image shows a hypoattenuating mass of the right parietal lobe. Note the remodeling of the adjacent inner table of the skull. (b) Axial T2-weighted MR image shows marked high signal intensity of the mass, which extends beyond the normal cortical margin ("soap bubble" appearance) and directly remodels the skull. There is no evidence of vasogenic edema associated with the mass. (c) Contrast-enhanced axial T1-weighted MR image shows no evidence of enhancement within the mass.

View larger version (123K): [in a new window]   Figure 17c.   Dysembryoplastic neuroepithelial tumor in a 14-year-old girl who experienced a seizure while sleeping. (a) Axial CT image shows a hypoattenuating mass of the right parietal lobe. Note the remodeling of the adjacent inner table of the skull. (b) Axial T2-weighted MR image shows marked high signal intensity of the mass, which extends beyond the normal cortical margin ("soap bubble" appearance) and directly remodels the skull. There is no evidence of vasogenic edema associated with the mass. (c) Contrast-enhanced axial T1-weighted MR image shows no evidence of enhancement within the mass.

View larger version (135K): [in a new window]   Figure 18a.   Dysembryoplastic neuroepithelial tumor in an 8-year-old boy with a 5-year history of seizures. (a) Coronal T1-weighted MR image shows a hypointense mass (arrows) extending to the cortical surface and remodeling the adjacent inner table of the skull. (b) Axial T2-weighted MR image shows high signal intensity within the mass, which has gently lobulated margins. (c) Contrast-enhanced axial T1-weighted MR image shows lack of enhancement within the mass. (d) Intraoperative photograph obtained after opening of the dura shows the mass as enlargement of the cortical surface (arrows). (e) Photograph of the resected specimen shows a mildly lobulated mass measuring 3.5 x 2.5 x 1.2 cm, an appearance that correlates with the imaging findings.

View larger version (137K): [in a new window]   Figure 18b.   Dysembryoplastic neuroepithelial tumor in an 8-year-old boy with a 5-year history of seizures. (a) Coronal T1-weighted MR image shows a hypointense mass (arrows) extending to the cortical surface and remodeling the adjacent inner table of the skull. (b) Axial T2-weighted MR image shows high signal intensity within the mass, which has gently lobulated margins. (c) Contrast-enhanced axial T1-weighted MR image shows lack of enhancement within the mass. (d) Intraoperative photograph obtained after opening of the dura shows the mass as enlargement of the cortical surface (arrows). (e) Photograph of the resected specimen shows a mildly lobulated mass measuring 3.5 x 2.5 x 1.2 cm, an appearance that correlates with the imaging findings.

View larger version (139K): [in a new window]   Figure 18c.   Dysembryoplastic neuroepithelial tumor in an 8-year-old boy with a 5-year history of seizures. (a) Coronal T1-weighted MR image shows a hypointense mass (arrows) extending to the cortical surface and remodeling the adjacent inner table of the skull. (b) Axial T2-weighted MR image shows high signal intensity within the mass, which has gently lobulated margins. (c) Contrast-enhanced axial T1-weighted MR image shows lack of enhancement within the mass. (d) Intraoperative photograph obtained after opening of the dura shows the mass as enlargement of the cortical surface (arrows). (e) Photograph of the resected specimen shows a mildly lobulated mass measuring 3.5 x 2.5 x 1.2 cm, an appearance that correlates with the imaging findings.

View larger version (133K): [in a new window]   Figure 18d.   Dysembryoplastic neuroepithelial tumor in an 8-year-old boy with a 5-year history of seizures. (a) Coronal T1-weighted MR image shows a hypointense mass (arrows) extending to the cortical surface and remodeling the adjacent inner table of the skull. (b) Axial T2-weighted MR image shows high signal intensity within the mass, which has gently lobulated margins. (c) Contrast-enhanced axial T1-weighted MR image shows lack of enhancement within the mass. (d) Intraoperative photograph obtained after opening of the dura shows the mass as enlargement of the cortical surface (arrows). (e) Photograph of the resected specimen shows a mildly lobulated mass measuring 3.5 x 2.5 x 1.2 cm, an appearance that correlates with the imaging findings.

View larger version (128K): [in a new window]   Figure 18e.   Dysembryoplastic neuroepithelial tumor in an 8-year-old boy with a 5-year history of seizures. (a) Coronal T1-weighted MR image shows a hypointense mass (arrows) extending to the cortical surface and remodeling the adjacent inner table of the skull. (b) Axial T2-weighted MR image shows high signal intensity within the mass, which has gently lobulated margins. (c) Contrast-enhanced axial T1-weighted MR image shows lack of enhancement within the mass. (d) Intraoperative photograph obtained after opening of the dura shows the mass as enlargement of the cortical surface (arrows). (e) Photograph of the resected specimen shows a mildly lobulated mass measuring 3.5 x 2.5 x 1.2 cm, an appearance that correlates with the imaging findings.

View larger version (140K): [in a new window]   Figure 19a.   Dysembryoplastic neuroepithelial tumor in a 15-year-old boy with long-standing progressive seizures. (a) Sagittal T1-weighted MR image shows a well-circumscribed hypointense mass of the parietal lobe. The mass extends to the cortical margin and produces a "megagyrus" appearance. (b) Coronal T2-weighted MR image shows high signal intensity within the mass. Linear areas of mild low signal intensity suggest septa or vessels within the mass. (c) Contrast-enhanced coronal T1-weighted MR image shows linear enhancement, which correlates with the findings in b. (d) Contrast-enhanced sagittal T1-weighted MR image shows similar linear enhancement within the substance of the mass.

View larger version (146K): [in a new window]   Figure 19b.   Dysembryoplastic neuroepithelial tumor in a 15-year-old boy with long-standing progressive seizures. (a) Sagittal T1-weighted MR image shows a well-circumscribed hypointense mass of the parietal lobe. The mass extends to the cortical margin and produces a "megagyrus" appearance. (b) Coronal T2-weighted MR image shows high signal intensity within the mass. Linear areas of mild low signal intensity suggest septa or vessels within the mass. (c) Contrast-enhanced coronal T1-weighted MR image shows linear enhancement, which correlates with the findings in b. (d) Contrast-enhanced sagittal T1-weighted MR image shows similar linear enhancement within the substance of the mass.

View larger version (111K): [in a new window]   Figure 19c.   Dysembryoplastic neuroepithelial tumor in a 15-year-old boy with long-standing progressive seizures. (a) Sagittal T1-weighted MR image shows a well-circumscribed hypointense mass of the parietal lobe. The mass extends to the cortical margin and produces a "megagyrus" appearance. (b) Coronal T2-weighted MR image shows high signal intensity within the mass. Linear areas of mild low signal intensity suggest septa or vessels within the mass. (c) Contrast-enhanced coronal T1-weighted MR image shows linear enhancement, which correlates with the findings in b. (d) Contrast-enhanced sagittal T1-weighted MR image shows similar linear enhancement within the substance of the mass.

View larger version (113K): [in a new window]   Figure 19d.   Dysembryoplastic neuroepithelial tumor in a 15-year-old boy with long-standing progressive seizures. (a) Sagittal T1-weighted MR image shows a well-circumscribed hypointense mass of the parietal lobe. The mass extends to the cortical margin and produces a "megagyrus" appearance. (b) Coronal T2-weighted MR image shows high signal intensity within the mass. Linear areas of mild low signal intensity suggest septa or vessels within the mass. (c) Contrast-enhanced coronal T1-weighted MR image shows linear enhancement, which correlates with the findings in b. (d) Contrast-enhanced sagittal T1-weighted MR image shows similar linear enhancement within the substance of the mass.