Central neurocytoma: clinical, pathological and neuroradiological findings

Episodic Headache, Periorbital Pain, and Multifocal Paresthesias as Presenting Symptoms of Central Neurocytoma: A Case Report

Central neurocytoma (CN) is a rare intraventricular tumor. The common presenting symptoms of CN are headache, vomiting, and visual disturbance, which results from increased intracranial pressure. This report presents a case of CN with unusual clinical presentations. A 25-year-old female with CN presented with a one-day history of unilateral headache, ipsilateral periorbital pain, multifocal paresthesias, and vomiting. Magnetic resonance images showed an intraventricular mass with a soap-bubble appearance and numerous cystic areas typical for CN, causing obstructive hydrocephalus and a midline shift. After one night of rest, her headache, periorbital pain, and paresthesias disappeared. It is possible that the tumor could be mobile with regard to the patient's head position, causing occasional obstruction of the foramen of Monro. Due to the tumor size, which was larger than 4 centimeters, the surgical approach with either gross tumor resection or subtotal resection plus adjuvant radiotherapy should be carefully considered.

Central Neurocytoma with Hemorrhagic Presentation Case Report and Review of the Literature

Central neurocytoma (CN) is slow-growing rare intraventricular tumor that represents 0.25-0.5% of all intracranial tumors in adults. Typically, it is seen in young adults, yet with surgical resection, it has excellent prognosis. Due to CN rarity and its feature similarities with other common tumors, misdiagnosis can be an issue. With no pathognomonic clinical features of CN, a proper diagnosis can be achieved by radiological imaging, magnetic resonance spectroscopy, histopathology assessment, and immunohistochemistry. Therefore, this is a case report of a 17-year-old male who presented with right lateral ventricular CN with intraventricular hemorrhage. Subtotal tumor resection was carried out via right transcortical approach. Subtle improvement for the patient condition was noted.

Glioneuronal tumors: clinicopathological findings and treatment options

Glioneuronal tumors are very rare CNS neoplasms that demonstrate neuronal differentiation, composed of mixed glial and neuronal cells. The majority of these lesions are low grade and their correct classification is crucial in order to avoid misidentification as ‘ordinary’ gliomas and prevent inappropriate aggressive treatment; nevertheless, precise diagnosis is a challenge due to phenotypic overlap across different histologic subtype. Surgery is the standard of therapeutic approach; literature concerning the benefit of adjuvant treatments is inconclusive and a globally accepted treatment of recurrence does not exist. Targetable mutations in the genes BRAF and FGFR1/2 are recurrently found in these tumors and could take a promising role in future treatment management.

Central Neurocytoma: A Review of Clinical Management and Histopathologic Features

Central neurocytoma (CN) is a rare, benign brain tumor often located in the lateral ventricles. CN may cause obstructive hydrocephalus and manifest as signs of increased intracranial pressure. The goal of treatment for CN is a gross total resection (GTR), which often yields excellent prognosis with a very high rate of tumor control and survival. Adjuvant radiosurgery and radiotherapy may be considered to improve tumor control when GTR cannot be achieved. Chemotherapy is also not considered a primary treatment, but has been used as a salvage therapy. The radiological features of CN are indistinguishable from those of other brain tumors; therefore, many histological markers, such as synaptophysin, can be very useful for diagnosing CNs. Furthermore, the MIB-1 Labeling Index seems to be correlated with the prognosis of CN. We also discuss oncogenes associated with these elusive tumors. Further studies may improve our ability to accurately diagnose CNs and to design the optimal treatment regimens for patients with CNs.

Clinical outcome and prognostic factors for central neurocytoma: twenty year institutional experience

Central neurocytomas are uncommon intraventricular neoplasms whose optimal management remains controversial due to their rarity. We assessed outcomes for a historical cohort of neurocytoma patients and evaluated effects of tumor atypia, size, resection extent, and adjuvant radiotherapy. Progression-free survival (PFS) was measured by Kaplan-Meier and Cox proportional hazards methods. A total of 28 patients (15 males, 13 females) were treated between 1995 and 2014, with a median age at diagnosis of 26 years (range 5-61). Median follow-up was 62.2 months and 3 patients were lost to follow-up postoperatively. Thirteen patients experienced recurrent/progressive disease and 2-year PFS was 75% (95% CI 53-88%). Two-year PFS was 48% for MIB-1 labeling >4% versus 90% for ≤4% (HR 5.4, CI 2.2-27.8, p = 0.0026). Nine patients (32%) had gross total resections (GTR) and 19 (68%) had subtotal resections (STR). PFS for >80% resection was 83 versus 67% for ≤80% resection (HR 0.67, CI 0.23-2.0, p = 0.47). Three STR patients (16%) received adjuvant radiation which significantly improved overall PFS (p = 0.049). Estimated 5-year PFS was 67% for STR with radiotherapy versus 53% for STR without radiotherapy. Salvage therapy regimens were diverse and resulted in stable disease for 54% of patients and additional progression for 38 %. Two patients with neuropathology-confirmed atypical neurocytomas died at 4.3 and 113.4 months after initial surgery. For central neurocytomas, MIB-1 labeling index >4% is predictive of poorer outcome and our data suggest that adjuvant radiotherapy after STR may improve PFS. Most patients requiring salvage therapy will be stabilized and multiple modalities can be effectively utilized.

Magnetic Resonance Imaging of a Case of Central Neurocytoma

Background:

The purpose of this study is to investigate the MRI features of central neurocytoma.

Case report:

A 45 year old man with 3 months of worsening daily headaches. These headaches were diffuse, lasted for several hours, and mostly occurred in the morning. She was initially diagnosed and treated for migraines but later he had epileptic attack and diplopia and neurolog recomaded MRI.

Methods:

precontrast MRI; TSE/T2Wsequence in axial/coronal planes; 3D–Hi-resolution T1W sagittal; FLAIR/T2W axial; FLAIR/T2W and Flash/T2W oblique coronal plane (perpendicular to temporal lobes) GRE/T2W axial plane for detection of heme products. Post-contrast TSE/T1W sequence in axial, coronal and sagittal planes. Diffusion weighted and ADC mapping MRI images for EPI sequence in axial plane.

Results:

A 23x12mm heterogeneous mass within aqueductus cerebri, with calcified and hemorrhagic foci and extending downwards till fourth ventricle. It’s originating from the right paramedian posterior aqueductal wall (tectum), and also extending to and involving the tegmentum of mesencephalon at its right paramedian aspect. CSF flow obstruction secondary to described aqueductal mass, with resultant triventricular hydrocephalus). Marked transependymal CSF leak can be noted at periventricular white matter, secondary to severe hydrocephalus. After IV injection of contrast media, this mass shows mild-to-moderate heterogenous speckled enhancement.

Conclusion:

MRI is helpful in defining tumor extension, which is important in preoperative planning. Although IN is a relatively rare lesion, it should be considered in the differential diagnosis of intraventricular lesions in the presence of such typical MR findings. However, a definitive diagnosis requires immunochemical study and electron microscopy.

Clinical manifestations of central neurocytoma

Central neurocytomas (CNs) are rare central nervous system tumors that occur in the lateral ventricles. They are prevalent in young adults and are typically benign with excellent prognosis following surgical resection. Because of the rarity of the disease and its similar features with more common tumors, misdiagnosis becomes an issue. Optimal treatment is achieved only when the correct tumor types are distinguished. Typical clinical manifestations include symptoms of increased intracranial pressure, although no clinical feature is pathognomonic to CN. Radiologic imaging, histology, magnetic resonance spectroscopy, and immunohistochemistry must be used to elucidate tumor characteristics and properly diagnose CN.

Clinical and imaging features of central neurocytomas

To describe the clinical and imaging characteristics of patients with central neurocytoma (CN), we reviewed data on 27 patients who had histologically confirmed CN and were treated in our institution between 1999 and 2010. Neuro-imaging findings on CT scan (n=18) and MRI (n=25) were retrospectively evaluated. There were 15 males and 12 females with a mean age of 29 years (range, 11-46 years). The most frequent presentations included headache (n=21) and vomiting (n=6). Tumor sites included bilateral lateral ventricles (n=10), right lateral ventricle (n=7), left lateral ventricle (n=7) and fourth ventricle (n=3). On MRI, the T1-weighted signal was hypointense in 12 patients and isointense in 13, and the T2-weighted signal was isointense in 8 patients and hyperintense in 15. CT scans/MRI revealed a cystic component in 18 patients. Tumors showed a mild to marked enhancement in 26 patients. Flow voids from tumor vessels on MRI were present in 14 patients, and calcification was noted in six of 18 patients with CT scans. All lateral ventricle tumors were resected through a transcortical or transcallosal approach. Gross total resection was achieved in 19 patients, near total in two and subtotal in six. One patient died of cerebral infarction in the perioperative period. At the last follow up, there were three known clinical recurrences in this series. However, no recurrence was noted in 17 patients who underwent gross total resection with no adjuvant therapy.

Squash cytomorphology of central neurocytoma: a study of five cases

Intraoperative consultation is an important component in the surgical management of brain tumors. This study was undertaken to describe the cytomorphological features of central neurocytoma (CN) in squash smears. Squash smear of five CNs were reviewed. One to two millimeters of the biopsy material was crushed between two glass slides to make a thin film that was fixed in 95% alcohol and stained with haematoxylin and eosin (H&E). Cytological diagnoses were correlated with clinical and radiological data and finally with histopathological findings in the tumor. We had 5 cases (4 males, 1 female; age, 19-61 years; mean, 32 years). All tumors were located in the lateral ventricle. The smears were highly cellular displaying monomoprhic round tumor cells, round to oval nuclei with evenly distributed finely granular chromatin and ill-defined cytoplasmic borders within fibrillar matrix. Focal rosette formation is also noted. A capillary network was identified in between tumor cells in all the cases. One case had calcification with numerous psamomma bodies identified in the squash smear. The differential diagnosis is discussed. On squash smears, CN can be diagnosed when cytomorphological features are correlated with clinical and radiological finding.

Proton MR spectroscopy of central neurocytoma using short and long echo time: new proofs for the existence of glycine and glutamate

RATIONALE AND OBJECTIVES

Central neurocytomas (CNCs) are rare benign tumors typically located in the lateral ventricle of the central nervous system. The authors report five patients with CNCs and review 16 previously published studies that included 52 patients with CNCs to explore the magnetic resonance spectroscopic features of CNCs.

MATERIALS AND METHODS

Five patients with CNCs were retrospectively reviewed. They were examined using point-resolved spectroscopic series with short and/or long echo times. The integrals of choline, creatine, and the 3.55-ppm peak were determined using Magnetic Resonance User Interface software, and the metabolite ratios relative to creatine were obtained. In two cases, T2 relaxation times of choline and the metabolite resonance at 3.55 ppm were calculated using data points acquired with different echo times and an exponential decay model.

RESULTS

Consistent with previously published studies, all five patients showed highly increased choline and reduced N-acetylaspartate and creatine. Four patients in the present study and 35 in published data demonstrated prominent peaks at 3.55 ppm, which were assigned to glycine because of its relaxation pattern and long T2 relaxation time. In addition, increased in vivo glutamate and glutamine was also confirmed in three patients examined with short echo times. Alanine and lactate peaks were observed in three and two patients, respectively.

CONCLUSIONS

The present study shows that the 3.55-ppm peak characteristic of CNC should be assigned to glycine according to its T2 relaxation time. Besides increased glycine and choline, the presence of glutamate or glutamine, which appears on series with short echo times, may further confirm the diagnosis of CNC.

[Imaging of lateral ventricle tumors]

Lateral ventricular neoplasms are rare, and account for 50% of all intraventricular tumors in adults and 25% in children. Although these neoplasms are easily detected with computed tomography (CT) and magnetic resonance imaging (MRI), both techniques are relatively unspecific in identifying the type of tumor. However, few imaging patterns are specific for a particular pathological process and useful conclusions can be made from the morphological appearance of the lesion, its location and enhancement pattern. The aim of this article was to review and illustrate the CT and MRI findings of a wide spectrum of tumors of the lateral ventricle. We reviewed choroid plexus tumors, meningioma, subependymal giant cell astrocytoma, central neurocytoma, and less frequent lesion such as lymphoma and metastases.

Clinicopathological analysis of central and extraventricular neurocytoma: a report of 17 cases

Neurocytoma, a rare brain tumor, is characterized by a mass located mainly in cerebral ventricles. It is prone to be misdiagnosed as oligodendroglioma or ependymoma due to their similar histopathological features in clinical practice. This study aimed to examine the clinicopathological features and differential diagnosis of central and extraventricular neurocytoma. The clinical and histopathological data of 17 patients (male: female=7:10; age: 4-41 years; mean age: 27.4 years) with central or extraventricular neurocytoma were retrospectively analyzed. These patients showed typical radiological, histopathological and immunohistochemical features of neurocytoma. The tumor tissue was found to be composed of small uniform cells with round nuclei and clear cytoplasm resembling that of oligodendroglioma and ependymoma. Immunohistochemistry revealed the tumor tissues were positive for neuronal markers such as synaptophysin (SYN) and neuronal nuclear antigen (NeuN). It was concluded histopathological features of neurocytoma overlaps with some tumors in the central neural system. Immunopositivity for SYN and NeuN can help differentially diagnose neurocytoma.

A clinicopathological, immunohistochemical and neuroradiological study of eight patients with central neurocytoma

Central neurocytomas are low-grade tumors of neuronal origin located in the lateral ventricle that present predominantly with raised intracranial pressure. In this retrospective study, we investigated the clinical, radiological, histopathological and immunohistochemical features of eight patients (seven males and one female; age range 16-61 years; mean=35.1 years) with neurocytoma. Raised intracranial pressure was the most common presenting feature. In addition, one patient presented with marked visual deterioration and one presented with a visual field defect. All lesions were located in the lateral ventricle (right lateral ventricle: four patients, left lateral ventricle: three patients, both ventricles: one patients). Radiology showed marked intratumoral calcification in two patients. Total microsurgical excision was achieved in seven patients. Histopathology showed sheets of monotonously small-to-medium-sized neoplastic cells with uniform round-to-oval nuclei and inconspicuous nucleoli. Immunohistochemistry was positive for synaptophysin and neuron-specific enolase (NSE) in all tumors, and glial fibrillary acidic protein was focally positive in two patients. One patient had lipomatous differentiation within the tumor. No recurrence was noted in any of our patients until the last follow-up; however, there were two deaths in our series.

[Central neurocytoma: Study of 32 cases and review of the literature]

Central neurocytoma is a rare benign neoplasm of the central nervous system. The intraventricular location close to the Monro foramina and the attachment to the septum pellucidum are characteristic for the diagnosis. However, atypical appearances may be encountered and confused with other neoplasms. The authors report the radiological findings of 32 surgically treated and pathologically confirmed neurocytomas.

[Supratentorial tumors]

Magnetic resonance imaging is a routine diagnostic measure for a suspected intracerebral mass. Computed tomography is usually also indicated. Further diagnostic procedures as well as the interpretation of the findings vary depending on the tumor location. This contribution discusses the symptoms and diagnostics for supratentorial tumors separated in relation to their intra- or extracranial location. Supratentorial tumors include astrocytoma, differentiated by their circumscribed and diffuse growth, ganglioglioma, ependyoma, neurocytoma, primitive neuroectodermal tumors (PNET), oligodendroglioma, dysem-bryoplastic neuroepithelial tumors (DNET), meningoangiomatosis, pineal tumors, hamatoma, lymphoma, craniopharyngeoma and metastases. The supratentorial extracranial tumors include the choroid plexus, colloid cysts, meningeoma, infantile myofibromatosis and lipoma. The most common sub-forms, especially of astrocytoma, will also be presented.

Congenital and acquired lesions of the septum pellucidum

The septum pellicidum is a thin midline brain structure the function of which is poorly understood. Despite its small size, it is the site of a considerable number of anatomical variants, congenital anomalies, and acquired lesions. The review presents the imaging appearances of some of the more common congenital and acquired lesions of the septum pellucidum.