Central, Extraventricular and Atypical Neurocytomas: a Clinicopathologic Study of 35 Cases from Pakistan Plus a Detailed Review of the Published Literature

Clinicopathological features and treatment outcome of central neurocytoma: a single institute experience

Background

Despite the increased interest in publishing data on central neurocytoma, its management remains controversial. The overall incidence is approximately 0.5% of brain tumors. The reporting of institutional experience is of major need for such category of tumors to increase our knowledge and experience. In this study, we describe the clinical presentation, pathological data, and treatment outcomes of central neurocytoma.

Results

Medical records of patients with neurocytoma treated in our center from July 2008 to December 2018 were retrospectively reviewed. Extra ventricular neurocytomas were excluded from analysis due to the known aggressive behavior compared to central neurocytoma. Seventeen patients treated at our center as central neurocytoma were included in the study. The frequent clinical presentation was headaches (58.8%) and paresis (35.3%). Ten patients (58.8%) developed symptoms before the age of 30 years. All patients were treated with surgical resection. Gross total resection was performed in 11 cases (64.7%) and subtotal resection was performed in 3 cases (17.7%). Four patients developed disease progression following the first excision (23.5%), for which additional resection was performed. Two patients received fractionated radiotherapy; one after the first resection due to residual disease postoperatively and the other patient following the third excision due to multiple recurrences with radiotherapy doses of 50.4 Gy and 54 Gy, respectively. The median follow-up time was 51 months (range of 14–106). The 5-year progression-free survival was 70 ± 13%. The overall survival for our cohort of patients was 100%.

Conclusions

Central neurocytoma is a rare tumor of neuronal origin and surgery is the mainstay of treatment with a favorable prognosis. Adjuvant radiotherapy can be offered in patients with residual disease or multiple recurrences, especially in patients with tumors of high MIC-1 LI.

Complete resection of hypervascularised extraventricular neurocytoma after preoperative embolisation

A 13-year-old female arrived at the Emergency Department with a two-week history of headache, and bilateral papilloedema on examination. The initial study with CT and MRI showed a large multicystic left frontal mass with calcification surrounded by peripheral oedema, subacute intralesional bleeding and association of multiple large vessels. She was initially operated on in another centre where a subacute haematoma was found, evacuating to multiple vessels and arteriolised veins. Despite the earlier neuroimaging findings, arteriovenous malformation (AVM) was suspected, so she was referred to our centre for further treatment. We performed angiography, MR angiography and MRI with advanced sequences, diagnosing a highly vascularised intra-axial tumour which was embolised. The patient was then definitively operated on, with the resulting finding of extraventricular neurocytoma (EVN). EVN are extremely rare lesions, not previously described in the literature as hypervascularised lesions, which in our case required prior angiography and embolisation for proper diagnosis and adequate management.

Adult Brain Tumors and Pseudotumors: Interesting (Bizarre) Cases

Some brain tumors results are interesting due to their rarity at presentation and overwhelming imaging characteristics, posing a diagnostic challenge in the eyes of any experienced neuroradiologist. This article focuses on the most important features regarding epidemiology, location, clinical presentation, histopathology, and imaging findings of cases considered "bizarre." A review of the most recent literature dealing with these unusual tumors and pseudotumors is presented, highlighting key points related to the diagnosis, treatments, outcomes, and differential diagnosis.