Central neurocytoma with hemorrhagic onset

Pediatric primary intraventricular hemorrhage: A case report of isolated fourth ventricle hemorrhage in a 10-year-old boy

Key Clinical Message

Primary intraventricular hemorrhage (PIVH) is a rare condition in pediatric patients, presenting with headache, vomiting, and altered mental status. Surgical interventions, such as external ventricular drain placement, followed by ventriculoperitoneal shunting, show promising outcomes. Further research is needed to enhance understanding and optimize management strategies for pediatric PIVH.

Abstract

This case report describes a 10-year-old boy with isolated primary intraventricular hemorrhage (PIVH) in the fourth ventricle, shedding light on its clinical presentation and management challenges. The patient presented with headache, vomiting, and altered sensorium, and was subsequently diagnosed with obstructive hydrocephalus due to intraventricular bleeding. Emergency external ventricular drain (EVD) insertion was performed, followed by ventriculoperitoneal shunt placement, resulting in a favorable outcome. The etiology of PIVH in children differs from that in adults, with arteriovenous malformations, Moyamoya disease, and aneurysms being commonly implicated causes. Management strategies for pediatric PIVH are challenging due to limited research, but EVD placement and surgical interventions have shown promise.

Central neurocytoma presenting with massive hemorrhage leading to coma--case report

A 21-year-old man presented with a hemorrhagic central neurocytoma manifesting as acute onset of disturbance of consciousness and right hemiparesis. Computed tomography (CT) demonstrated a tumor in the left lateral ventricle during the course of evaluation for mental alteration 12 days before onset, but the tumor was left untreated because the patient refused to visit a neurosurgical institution. CT on admission revealed a large mass lesion located in the body of the lateral ventricle associated with massive intratumoral and intraventricular hemorrhage. He underwent emergent surgery for evacuation of the tumor with hematoma, and his neurological symptoms gradually recovered after surgery. The present case highlights the possibility of rapid deterioration of symptoms by massive hemorrhage from central neurocytoma. Surgical intervention should thoroughly be considered, if intratumoral hemorrhage is present, as hemorrhage from the central neurocytoma may lead to serious neurological complications.

Undiagnosed medulloblastoma presenting as fatal hemorrhage in a 14-year-old boy: case report and review of the literature

INTRODUCTION

A 14-year-old boy with no significant medical history presented to the emergency room with a sudden onset of severe headache of 1 day's duration. On admission, a non-contrast computed tomography (CT) of the head showed a posterior fossa hemorrhagic mass.

MATERIALS AND METHODS

He was immediately intubated and underwent placement of an external drainage tube. A magnetic resonance imaging (MRI) was performed, which showed a large hemorrhagic mass with upward cerebellar herniation.

RESULTS

Despite aggressive measures, he deteriorated and was pronounced brain dead 2 days after admission. Pathological examination of the mass revealed a medulloblastoma with extensive neuronal and astrocytic differentiation.

CONCLUSION

This case represents one of the few cases of rapid, hemorrhagic expansion associated with a previously undiagnosed medulloblastoma. The topic of hemorrhage due to previously unrecognized brain tumors is discussed and the value of imaging methods used in the diagnostic assessment is emphasized.

Central neurocytoma: case report of an 81-year-old and histopathologic findings

Central Neurocytomas are rare and usually benign tumors found primarily in the lateral ventricles of the brain. Central Neurocytomas are composed of uniform round cells exhibiting neuronal differentiation and are found almost exclusively in young adults between 15 and 60 years of age. The authors report the case of an 81-year-old man with a history of severe psychosis and depression, who presented with progressive confusion and ataxia likely unrelated to a central neurocytoma of his right lateral ventricle. The patient underwent a stereotactic biopsy of the lesion, followed by Gamma Knife radiosurgery. Histopathology showed immunohistological staining for synaptophysin, neuron specific enolase (NSE) and neuronal nuclear antigen (NeuN). A review of published literature on central neurocytomas revealed that this tumor occurs most frequently in young adults with a median age between 25 and 30 years. This pathology has never been reported in patients over the age of 80. Gamma Knife radiosurgery was successful in decreasing the tumor volume by 20% at the four month follow-up, but the fact that the patient died of unrelated occurrences in the elderly cannot be ruled out. Patients with central neurocytomas commonly present with obstructive hydrocephalus and immediate treatment may be necessary to tide over urgent situations.

Central neurocytoma: clinical, pathological and neuroradiological findings

AIM

To evaluate the clinical, pathological and neuroradiological features of intraventricular central neurocytoma in six patients.

MATERIALS AND METHODS

Six patients were imaged using non-enhanced and contrast-enhanced magnetic resonance imaging (MRI); three of them were also examined using non-enhanced computed tomography (CT). Two radiologists read the images retrospectively. The imaging data were studied with regard to location, size, margin, signal intensity, enhancement characteristics and presence of calcifications. Clinical data (i.e. presenting signs and symptoms, physical findings and medical histories) were collected and histopathological and immunohistochemical studies were performed by two pathologists.

RESULTS

All lesions were located in the lateral ventricles. Three tumors were confined to the left side, one to the right side and two cases involved both lateral ventricles. The growth of central neurocytoma was of close spatial relation to the septum pellucidum. On MRI, most of the cases showed a heterogeneous hypointensity on T1-weighted images and hyperintensity on T2-weighted images or FLAIR with a well-defined margin. The presence of cystic components, necroses and calcifications caused these internal heterogeneities. After intravenous administration of gadolinium (Gd-DTPA) all tumours showed a heterogeneous enhancement. CT provided additional information by distinguishing intratumoural calcifications in all three evaluated cases. Immunohistochemical analysis showed positive synaptophysin staining in all cases and positive neuron-specific enolase staining in four cases. In three cases a small proportion of the tumour cells could be labelled with antibodies to glial fibrillary acid protein (GFAP).

CONCLUSION

Central neurocytoma should be considered when the following conditions occur: young patients with lesions in the lateral ventricle, which contain calcifications and show some enhancement. This is especially applicable for tumours involving both lateral ventricles with symmetrical growth around the centre of septum pellucidum or for unilateral ventricular tumors with a wide base attachment to the septum pellucidum.

Neurocytoma manifesting as intraventricular hemorrhage--case report

A 43-year-old man presented with a neurocytoma manifesting as severe headache and disturbance of consciousness. Computed tomography revealed intraventricular hemorrhage, and a small mass lesion with calcification on the wall of the left lateral ventricle. The lesion appeared as mixed intensity regions on both T(1)- and T(2)-weighted magnetic resonance imaging, and heterogeneous enhancement with gadolinium-diethylenetriaminepenta-acetic acid. Angiography showed the pooling sign near the calcification in the late venous phase. Neurologically, amnestic syndrome was demonstrated in the subacute phase. Gross total removal of the lesion was performed through a transcallosal approach. His transient memory disturbance resolved. The histological diagnosis was neurocytoma. Intraventricular hemorrhage is rare as the initial presentation of neurocytoma. Surgery should avoid fornix injury and the risk of permanent memory disturbance.

Intraventricular neurocytomas

The literature to date on the treatment of CNC reflects an evolution of clinical practice in neurooncology. The advent of sophisticated tools, such as MRS and molecular pathology, has facilitated more efficient diagnosis of CNC. Decreased morbidity associated with surgical intervention has resulted in better outcomes in patients undergoing resection of CNC. Prospective monitoring of treated patients with MRI coupled with judicious use of radiosurgery will likely further decrease treatment-related morbidity.

Tratamiento del neurocitoma central. Experiencia en nuestro centro

Central neurocytomas are classically considered as a rare, intraventricular benign tumours with neuronal differentiation derived from precursor cells of subventricular matrix. However some patients with neoplasms with histologic atypia and elevated proliferation potential may have a poor outcome. Treatment of choice is complete surgical excision. Adjuvant therapy is reserved for patients with residual or recurrent lesions including reoperation, radiotherapy or chemotherapy. We review our experience with the treatment of this neoplasm. Five patients with an intraventricular mass studied with magnetic resonance imaging underwent craniotomy for tumour resection. All cases were reviewed retrospectively. Histopathological analysis confirmed central neurocytoma in all cases. Proliferation index was assessed by Ki-67 immunohistochemistry. Complete radiological tumor resection through transcortical approach was achieved in all except one patient. In this case adjuvant therapy with radiosurgery was given with important reduction in tumor size. All the tumours had a proliferation index below 2% except one with 5%. Follow-up in four patients ranged from 12 to 36 months. There were no tumour recurrences in this period. Complete surgical excision of central neurocytoma provides better local control and survival compared with other treatments. Radiosurgery as adjuvant therapy in incomplete resections may eliminate the need of reoperation and avoid long-term side effects from conventional radiotherapy.

From the archives of the AFIP. Cerebral intraventricular neoplasms: radiologic-pathologic correlation

Intraventricular neoplasms are readily seen on cross-sectional images, but the myriad possibilities may make a focused differential diagnosis elusive. Consideration of the tissue within and composing the ventricular lining and the clinical findings provide the means to limit the differential diagnosis when analyzing an intraventricular mass on an imaging study. Ependymomas are typically calcified, are more common in children, are more common in the fourth ventricle, and show intense enhancement on contrast-enhanced images. Subependymomas and central neurocytomas have an affinity for the anterior portion of the lateral ventricle, and both commonly demonstrate a heterogeneous cystic appearance on cross-sectional images. Subependymomas are more common in older adults, whereas central neurocytomas are more common before 40 years of age. Subependymal giant cell astrocytomas always lie near the foramen of Monro and are characterized by frequent calcification, intense enhancement on contrast-enhanced studies, and the presence of other stigmata seen in tuberous sclerosis. When a mass is centered on the choroid plexus, a highly vascular tumor-either choroid plexus papilloma, choroid plexus carcinoma, meningioma, or metastasis-should be suspected. The characteristic heavily lobulated appearance of a choroid plexus tumor favors this diagnosis over other possibilities, although it is not always possible to distinguish between the more common benign form, the choroid plexus papilloma, and the less common malignant counterpart, the choroid plexus carcinoma. By using clinical, demographic, and imaging findings, one can significantly limit the differential diagnosis for many of the most common intraventricular neoplasms.

Treatment of central neurocytomas

Central neurocytomas are uncommon tumors of the CNS, representing approximately 0.1-0.5% of all primary CNS tumors. Patients most often present with symptoms of increased intracranial pressure (headache, nausea/vomiting, diplopia) due to obstructive hydrocephalus. Rarely, central neurocytomas may present with a hemorrhage. Central neurocytomas are intraventricular tumors with a predilection for arising in either the lateral or third ventricles. CT or MR cranial imaging demonstrates a circumscribed mass in the ventricles, frequent calcification and moderate contrast enhancement. Surgery provides definitive treatment, as little evidence exists as to response of these tumors to either radiotherapy or chemotherapy. Histopathology reveals a homogenous neoplastic cell population with neuronal differentiation, frequent calcification, occasional perivascular pseudorosettes and infrequent mitoses. Uncommonly, anaplastic variants of central neurocytomas (malignant central neurocytomas) are encountered and are distinguished by frequent mitoses, necrosis and endothelial cell proliferation. Following complete resection, central neurocytomas have a favorable prognosis usually obviating the need for either radiotherapy or chemotherapy.

Neurocitoma central com apresentação incomum por hemorragia intraventricular: relato de caso

O neurocitoma central foi descrito pela primeira vez na literatura em 1982 por Hassoun e colaboradores como tumor bem diferenciado de origem neuronal. O tumor geralmente localiza-se no sistema ventricular, afetando adultos jovens e geralmente cursando com hipertensão intracraniana secundária à hidrocefalia obstrutiva. O diagnóstico diferencial com outros processos intraventriculares como oligodendroglioma é realizado através de métodos imuno-histoquímicos. Raros casos de neurocitoma central associados com hemorragia têm sido descritos na literatura. Descrevemos um caso de neurocitoma central de uma paciente de 35 anos com apresentação atípica. A paciente havia procurado o hospital com quadro súbito de cefaléia, vômitos e rigidez de nuca, sugerindo a presença de hemorragia subaracnóidea. A ressonância magnética demonstrou volumosa massa no ventrículo lateral direito cujos perfis histológico e imuno-histoquímico eram condizentes com neurocitoma central, a ressecção cirúrgica foi realizada com sucesso, embora a paciente tenha evoluído para um quadro de ventriculite no pós-operatório. Salientamos a importância do estabelecimento do neurocitoma central como diagnóstico diferencial de pacientes com hemorragia intraventricular e discutimos as opções de tratamento para este tumor incomum.

A neurocytoma and an associated lenticulostriate artery aneurysm presenting with intraventricular hemorrhage: case report

OBJECTIVE AND IMPORTANCE

Hemorrhage associated with central neurocytoma has been described previously, but never in association with an aneurysm originating from a feeding artery. We present the first reported case of a central neurocytoma in a patient with intraventricular hemorrhage caused by rupture of an aneurysm on a lenticulostriate artery that supplied the tumor.

CLINICAL PRESENTATION

A 35-year-old man who presented with an intraventricular hemorrhage underwent magnetic resonance imaging and cerebral angiography that disclosed a right lateral intraventricular mass and a 7-mm fusiform aneurysm from a lateral lenticulostriate branch of the right middle cerebral artery.

INTERVENTION

The patient underwent a contralateral transcallosal exploration and resection of the tumor, with excision of the adjacent lenticulostriate artery aneurysm. Pathological review demonstrated that the tumor was a neurocytoma. The aneurysm was discrete from the tumor but occurred on a vessel that supplied the tumor.

CONCLUSION

Previous reports have demonstrated that intraventricular neurocytoma may present with tumor hemorrhage. In this case, an aneurysm separate and distinct from the tumor was the bleeding culprit, and the aneurysm was on an artery that fed into the tumor. Any such aneurysm must be identified and treated appropriately for therapy to be complete.

Gamma knife surgery for treatment of central neurocytomas. Report of four cases

The authors investigated the use of gamma knife surgery (GKS) in the treatment of central neurocytoma, a usually benign primary brain tumor of the lateral and third ventricles. Four patients with subtotally resected or recurrent central neurocytomas were retrospectively studied. The prescription isodose was 9 to 13 Gy to the 30 to 50% peripheral isodose line. Pre- and postoperative magnetic resonance (MR) images were compared to determine the volume reduction following GKS. Follow-up review included annual MR imaging and clinical evaluation by a neurosurgeon. Follow-up periods ranged from 12 to 99 months. Marked reduction in tumor size was seen in all four patients; the decrease in tumor volume for each was 48%, 72%, 81%, and 77%, respectively, at the last follow-up review. None of the four patients required additional treatment and none experienced a decline in neurological function during the follow-up period. No complications have been noted in any of these patients to date. Even though there have been few observations and follow-up time has been limited, because of the consistency of the response and the lack of observed side effects, GKS may be the treatment of choice for subtotally resected and recurrent central neurocytomas.

Central neurocytoma: long-term follow-up of a paediatric case

In order to gain a better understanding of the clinical and histological features of central neurocytoma and the role of radiotherapy in the treatment of these tumours, we present an unusual paediatric case and review the pertinent literature. Most patients present in the second and third decade of life, rarely in the teenage years and exceptionally in children. Our patient was treated by a combined surgical and radiation therapy treatment for a central neurocytoma at the age of 7 years, but the tumour had been diagnosed when she was 3 years old. At a 38-year follow-up, she is well with no evidence of tumour progression. This patient seems to be the youngest histologically proven case of central neurocytoma and with the longest recorded survival.

Sudden death due to a central neurocytoma

The central neurocytoma is a common, usually intraventricular tumor with bland histologic features. We report a case of a 51-year-old man who died suddenly. At autopsy, a neurocytoma with acute hemorrhage filled the anterior left lateral ventricle. The tumor matrix and surrounding brain tissue contained accumulations of hemosiderin. Previously, 2 cases of central neurocytoma with associated hemorrhage have been reported. Hemorrhage appears to be a serious complication associated with these neoplasms.

Transient hydrocephalus due to movement of a clot plugging the aqueduct

A rare case of transient hydrocephalus is reported. A 64-year-old woman presented with headache. Computerized tomography (CT) scan revealed hydrocephalus with tiny blood clots in the left foramen of Monro and in the aqueduct. Six hours after the onset, the signs and symptoms disappeared spontaneously. The second CT showed improvement of the hydrocephalus with migration of the clot into the i.v. ventricle. Aqueductal trapping and releasing of the clot formed by bleeding from the choroid plexus located in the left foramen of Monro was suspected for the origin of the transient hydrocephalus.