Neuroradiology-Neuropathology UNC Monthly Conference

Ray Peeples, MD

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 biopsied

9.10.09

9.10.0912.1.09

10.27.11

10.2.12

2.17.13

Pilocytic astrocytoma

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.

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 spine

MRI brain showed multiple enhancing cerebellar lesions

Spinal lesion was resected

T2 T1

T2

T1 C+

T2

T2 T1 +CFLAIR

Myxopapillary ependymoma, metastatic

Case 3

35 y/o M with 1 year hx of back pain and RLE weakness

sent from outside institution with presumptive diagnosis of L3 schwannoma with MRI performed without contrast

EMG showed L3 and S1 radiculopathy L3 mass was resected

T2 T1

L3

S1T2

T1

T1 T2

Sarcoidosis

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.

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 biopsied

FLAIR

T2

T1

T1 C+T1 C+

T1

Gliomatosis cerebri