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02.02.2015 КТ головного мозга. Консультация!!! Образование.

Девочка, 11 лет, направлена на КТ с диагнозом нейропатия лицевого нерва справа. Жалобы на асимметрию лица. Вот такая находка. 

Прошу помощи, не могу точно определиться, образование это или сосудистая мальформация. Опухоли головного мозга попадаются очень редко, раз в год, не хватает опыта. 

 

 

создано при помощи www.radiographia.info

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Приличные размеры, а

Приличные размеры, а масс-эффект минимальный, отека нет. Вполне может оказаться каверномой. Можно МРТ сделать? 

 
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Да, и это меня смутило. Отека

Да, и это меня смутило. Отека нет совсем, а масс-эффект есть, небольшой. Ну, и клиника не подходящая. С нейропатиями лицевого нерва нам через одного направляют. МРТ рекомендую, сделают, но в другой больнице, я результат, вероятно, не узнаю. Девочка не в нашей больнице лежит. 

 
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Образование гиперваскулярное,

Образование гиперваскулярное, с видимыми сосудами внутри и обызвествлениями. Не думаю, что это кавернома, не типично. Это опухоль мозга, а какая - дело за гистологами.

 
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С сосудами и

С сосудами и обызвествлениями, но не такая уж и гиперваскулярная.Она и на нативе довольно плотная.

То что не типично, согласна.

Из опухолей может быть олигодендроглиома подходит по виду. Но у 11 летней девочки, и без перифокального отека...

Больше просто ничего на ум не приходит. Подождем МРТ. Не против МРТ, я думаю?

 
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Опухоль головного мозга.

Опухоль головного мозга. Учитываю возраст, срединную локализацию, плотность и кальцинаты, может быть герминома. Хорошо бы сделать МРТ. Окончательный ответ за гистологами.

http://www.google.com.ua/url?sa=t&rct=j&q=&esrc=s&source=web&cd=10&cad=rja&uact=8&ved=0CFEQFjAJ&url=http%3A%2F%2Fwww.ajnr.org%2Fcontent%2F15%2F8%2F1435.full.pdf&ei=3cDQVKr6Bqv7ywPrioGIDw&usg=AFQjCNFr1lhsT5-G8xuuMB7M9UJm9Ff4Pw&bvm=bv.85076809,d.bGQ

 

Germinoma Originating in the Basal Ganglia and Thalamus: MR and CT Evaluation

Shuichi Higano, Shoki Takahashi, Kiyoshi Ishii, Ko Matsumoto, Hidetoshi Ikeda, and Kiyohiko Sakamoto

PURPOSE: T o describe MR and CT features of germinoma originating in the basal ganglia and thalamus and to discuss the roles of each m odality for its diagnosis. METHODS: MR and CT studies of six cases of germinomas, five of which were histologically proved, were retrospectively reviewed. T1-weighted, T2-weighted, and contrast-enhanced T1 -weighted conventional spin-echo images, and unenhanced and contrast-enhanced CT images were evaluated. RESULTS: Typically, the tumor consisted of an irregular solid area with contrast enhancement and various-size cysts. Cystic components were found in five cases and calcification in four. lntratumoral hemorrhage was noted in one. Ipsilateral cerebral hemiatrophy and brain stem hemiatrophy were noted in three cases each. MR was superior to CT in evaluating precise tumor extension, cystic components, and intratumoral hemorrhage, although in one case, extension of the tumor was better defined on CT in its early stage. Calcification was difficult to identify by MR alone. The solid components of the tumors generally showed slightly high density on CT, which seemed to be characteristic compared with nonspecific intensity pattern on MR. CONCLUSION: The combination of CT and MR findings allows early detection and appropriate diagnosis of the mass in the basal ganglia and/or thalamus.

Index terms: Germinoma; Thalamus; Basal ganglia, neoplasms; Brain neoplasms, computed tomography; Brain neoplasms, magnetic resonance; Brain neoplasms, in infants and children

AJNR Am J Neuroradiol 15:1435-1441 , Sep 1994

The preferential location of intracranial germ- cell tumors is in the midline, such as the pineal and suprasellar regions (1 ). However, there have been several reports about germinal neo- plasms originating in the basal ganglia and/or thalamus, especially in Japanese patients (2-13). Because a germinoma is generally ra- diosensitive and potentially curable, its early detection and the differentiation from glial tu- mors are desirable. In addition to reports of computed tomography (CT) of germ-cell tu- mors in the basal ganglia and thalamus, their magnetic resonance (MR) findings have been recently but only sporadically described (2, 3, 5, 6, 9). We describe CT and MR findings in six

Received May 26, 1993; accepted for publication December 2.

From the Departments of Radiology (S.H., S.T., K.l., K.M., K.S.) and Neurosurgery (H.I.), Tohoku University School of Medicine, Japan.

Address reprint requests to Shuichi Higano, MD, Department of Radi- ology, Tohoku University School of Medicine, 1-1 Seiryomachi Aobaku Sendai, Tohoku 980, Japan.

AJNR 15:1435-1441, Sep 1994 0195-6108/94/1508-1435 © American Society of Neuroradiology

cases of germinoma in this special location and discuss its features and the roles of MR and CT in its detection and diagnosis.

Subjects and Methods

MR and CT findings of six patients with germinoma of the basal ganglia and/or thalamus were retrospectively reviewed. The patients were all boys, ranging in age from 8 to 16 years (mean, 11.3 years). The pathologic diagno- sis was made by CT-guided stereotaxic needle biopsy in all patients but one, who underwent total removal of the tu- mor. In five of six cases, typical two-cell-pattern germi- noma (composed of two cell types, large polygonal cells and lymphocytes) was histologically confirmed. In the other case, the specimen included only gliosis, probably because of inappropriate biopsy; we finally diagnosed this tumor as of germ-cell origin because of its high sensitivity to radiotherapy, high serum content of a-fetoprotein, and its characteristic CT image features. Five patients devel- oped slowly progressive hemipareses; the remaining one presented with precocious puberty without any other neu- rologic symptoms. The latter patient proved to have an increased value of serum human chorionic gonadotropin. In two other cases, the level of serum a-fetoprotein or human chorionic gonadotropin was increased.

1435

1436 HIGANO

AJNR: 15, September 1994

Basal ganglia and thalamus germinomas: CT and MR features

Case Tumor Extention

  1. 1  Right LN

  2. 2  Left LN-CH

  3. 3  Right LN-IC

  4. 4  Right LN-IC

  5. 5  Left LN-IC-TH

6 Right LN-IC-TH-MB-IV + (Xanthochomic)

+ +

:!: +

+ +

-~+a -~+a + +

Sharp + Sharp :!: Irregular + Irregular

Cerebrum

+

:!:~+ b +

Brain Stem

+

+

=~ +b +

Cystic and Necrotic Components

Calcification

Contrast

+ (Xanthochromic) + (Hemorrhage)
+

+ (Necrotic)

Irregular + + Irregular ++

Tumor Enhancement Margin

Perifocal Hyperintensity Area (T2-Weighted)

Hemiatrophy

Note.-Contents in cystic and necrotic regions revealed by surgery are in parentheses. LN indicates lentiform nucleus; CH, caudate head; IC, internal capsule; TH, thalamus; MB, midbrain; and IV, intraventricular.

Appeared later on follow-up study. b Remarkable on follow-up study.

MR was performed on a 1.5-T system in all six patients. Using multisection conventional spin-echo sequences, we obtained T1 -weighted images (500-550/15-20/2 [repeti- tion time/echo time/excitations)), T2-weighted images (2500/90/1) and T1-weighted images with intravenous injection of gadopentetate demeglumine (0.1 mmol/kg of body weight). We used a field of view of 19 to 25 em and a matrix of 256 X 256. We obtained images in the axial plane with 5- to 8-mm section thickness and 1- to 2-mm intersection gap for all patients, with additional contrast- enhanced T1-weighted images in coronal planes in three cases. CT study was also performed in all patients with and without intravenous contrast material (2 ml/kg of 300 mg of iodine/ml) with 8-mm section thickness and no inter- section gap. CT density and MR intensity of the lesions were evaluated by comparing the lesions with normal gray matter.

Results

The neuroradiologic features obtained from CT and MR studies are summarized in the Table. MR and CT images of four representative cases are shown in Figure 1-4. The tumors generally consisted of solid areas and various sizes of cystic components. The solid com- ponents tended to appear characteristically slightly hyperdense on precontrast CT , whereas they showed isointensity to slight hy- pointensity on T1-weighted images and isoin- tensity to hyperintensity on T2-weighted im- ages. All the tumors but one demonstrated contrast enhancement; in one case (case 4), the tumor was not enhanced initially on both CT and MR but subsequently enhanced 11/2 years later (Fig 2). Although the tumor exten- sion was generally evaluated better on MR than on CT, the tumor in case 4 demonstrated as a more extensive high-density area without contrast enhancement on initial CT; on MR, the lesion appeared only as a less-extensive

area of hyperintensity on T2-weighted images and was hardly detectable on T1-weighted im- ages (Fig 2).

Cystic or necrotic components were noted in five patients. In three (cases 1, 2, and 6), the tumors had relatively large cysts that were proved by surgical intervention. In two of them, the cysts showed marked hyperintensity on T2-weighted images and hypointensity on T1-weighted images and demonstrated no con- trast enhancement except in their capsules. In the other one (case 2), the cysts showed two kinds of different intensity and density patterns, indicating different phases of intracystic hemor- rhage, which was confirmed by stereotaxic sur- gery (Fig 3).

The tumors invariably involved the lentiform nuclei with frequent extensions to the internal capsules. In one case (case 6), the tumor was huge and extended to the thalamus, midbrain, and even into the third and lateral ventricles (Fig 4).

Intratumoral calcification, presenting as nod- ular or spotty hyperdensity on CT, was obvious in four cases. In one of them, calcification appeared later on follow-up study (Fig 2). Parts of calcified foci appeared hyperintense on T1-weighted images in three cases.

In three patients, dilatation of cortical sulci, especially the Sylvian fissures, of the cerebral hemispheres was noted on the sides of the tu- mors, suggesting ipsilateral hemicerebra) atro- phy (Fig 1). In three cases, the ipsilateral cere- bral peduncles were shrunken compared with those of the contralateral sides. In case 4, the hemiatrophy of both brain stem and cerebral hemisphere progressed remarkably during a period of 11/2 years (Fig 2).

AJNR: 15, September 1994 GERMINOMA 1437

ABc

DE

Fig 1. Case 5.

A, Precontrast CT shows an ill-defined, slightly hyperdense area with a small low-density component in the left basal ganglia. Note a nodular calcification in the tumor (arrow).

8, Tl-weighted, C, contrast-enhanced Tl-weighted, and 0, T2-weighted images. The tumor is delineated as an area of slightly low intensity with irregular enhancement on the T l-weighted image and a heterogeneously hyperintense area on the T2-weighted image. The MR evaluates the tumor extension and cystic and necrotic components, whereas CT is superior in detecting calcification. Note mild dilatation of the Sylvian fissure and cortical sulci in the left cerebral hemisphere.

E, Photomicrogram. The tumor is composed of two different types of cells: large spheroidal or polygonal cells (arrow) and lymphocytes (arrowhead).

Discussion

According to previous CT studies of germi- noma in the basal ganglia and thalamus (4-8, 10, 12, 14), the tumor was usually composed of a solid area with irregular margins and various sizes of cystic components. Calcification was frequently associated. Our study revealed fea- tures similar to those findings . The MR intensity

of the solid areas, which often demonstrated contrast enhancement, was fairly nonspecific; that is, isointense to low on T1-weighted images and isointense to high on T2-weighted images. On the other hand, they showed characteristic hyperdensity on precontrast CT. In the previous CT reports, a similar tendency of high density of the tumor was described (12). Soejima et al

1438 HIGANO

AJNR: 15, September 1994

ABc

Fig 2. Case 4.
A , Precontrast CT shows a high-density

area in the right basal ganglia.
B, T1 -weighted and C, contrast-

enhanced T1-weighted images fail to show a definite abnormality.

D, T2-weighted image shows an ill- defined hyperintense area in the right len- tiform nucleus and internal capsule, which may be difficult to differentiate from isch- emic foci by MR alone.

£, In a lower section, atrophy of the right cerebral peduncle is noted. The tumor was observed for a 1lh years by CT and MR.

F, Precontrast and G, postcontrast T1- weighted images obtained 14 months af-
ter the initial study. The tumor shows slightly high intensity with a high-signal G spot (arrow}, which corresponds to the calcification on CT and demonstrates ir- regular enhancement.

H, The same section as E revealed pro- gressive hemiatrophy of the brain stem.

H

AJNR: 15, September 1994 GERMINOMA 1439

A

hyperdense component on CT as multiloculated areas with a fluid-fluid level of high and markedly low intensity on the T2-weighted image, which suggests acute to subacute hematoma. On stereotaxic drainage, intracystic hemorrhage was confirmed.

Fig 3. Case 2.
A, Precontrast CT shows a high-density mass with a well-defined low-density cyst in the left basal ganglia.
8, T1-weighted image.
C, T2-weighted image. The hypodense area on CT is depicted as high-signal areas on both T1- and T2-weighted images and the

Fig 4. Case 6.

A, Precontrast CT, B, T2-weighted image, and C. contrast-enhanced T1-weighted image show a large tumor in the right basal ganglia and thalamus with intraventrivular extension. The tumor shows slightly high density on CT. Various size of cysts are associated. A marked perifocal hyperintensity area is noted on the T2-weighted image.

pointed out that this high density on precontrast CT should be one of the diagnostic features differentiating it from most glial tumors, which also may have calcification and cystic areas. In one of our cases, MR showed the characteristic intensity pattern of acute to subacute hemor- rhage, which was verified by surgery. Anno et al (3) also reported a case of basal ganglionic germinoma with old hemorrhage with a sur-

rounding hypointense rim on T2-weighted im- ages. As is often the case in most types of tumors, MR was superior to CT in evaluating precise extension of the tumor, cystic compo- nents, and intratumoral hemorrhage, but asso- ciated calcification recognized on CT was diffi- cult to identify on MR.

Several investigators have noted ipsilateral hemicerebra) atrophy in cases with germinoma

1440 HIGANO

AJNR: 15, September 1994

of the basal ganglia and thalamus (4, 6, 12, 15-17). Although this hemiatrophy was thought to be a characteristic of germinoma, this feature is now regarded as a result of the tumor involve- ment of fiber tracks by any kind of tumor (16). In addition to hemicerebra) atrophy, we found hemiatrophy of the brain stem on MR in three cases. This hemiatrophy was better delineated

on MR because of the lack of artifacts from petrous bones. Such hemiatrophic features tended to be more remarkable in the cases in which the tumors had irregular margins extend- ing to the dense white matter bundles of the internal capsules. In one case (case 4), progres- sion of the hemiatrophy of the brain stem and cerebral hemisphere was observed with en- largement of the tumor involving the internal capsule. To the contrary, there was no definite atrophic change in our case 1, with a relatively well-circumscribed tumor restricted to the basal ganglia. These findings support the belief that

hemiatrophy is secondary to tumoral involve- ment of internal capsule.

Despite the high radiosensitivity and potential curability of germinoma in this region, an ad- vanced stage of the tumor with considerable degree of hemiatrophy results in a clinically poor prognosis (7) . Therefore, early diagnosis and treatment are necessary for a better out- come. In the early stage of this disease, abnor- mality may not be detectable on CT despite the neurologic deficits (4 , 12) . With progression of symptoms, CT reveals a small high-density area with subtle mass effect, followed by further enlargement of an inhomogeneous density mass and formation of cystic components. We

found no report about early detectability of this tumor on MR, but we report a small tumor (case 4) that was not clearly demonstrated on the initial MR in comparison with CT. We believe the combination of CT and MR would enable earlier detection of this lesion.

The CT and MR findings of germinoma in the pineal and suprasellar regions have been well documented (1, 18-24). Germinomas in these familiar locations calcify or contain cystic com- ponents less often than those in the basal gan- glia. Calcification seen in cases with pineal re- gion germinoma is now believed to be limited to the normal pineal gland possibly engulfed by the tumor, although abnormal intratumoral cal- cification is more frequently associated with other pineal region tumors such as teratoma- tous tumors, embryonal cell carcinoma, and tu-

mors of pineal cell origin (19, 23, 24). The reason for such neuroradiologic differences be- tween germinomas in different locations is un- certain. Soejima et al (12) proposed that the anatomic difference might influence the mode of tumor growth; that is, germinomas of the basal ganglia and thalamus are intraaxial tu- mors, whereas those in the pineal and suprasel- lar regions are extraaxial. Extraaxial germino- mas in the suprasellar and pineal regions are usually well circumscribed but occasionally may infiltrate into the adjacent brain such as the thalamus (pineal) , hypothalamus, or optic chi- asm (suprasellar), causing perifocal edema, and may spread through subarachnoid spaces (1, 18, 22). The tendency for infiltrative exten- sion was also and frequently found in intraaxial germinoma of the basal ganglia and thalamus, in which they presented with irregular margins

and perifocal hyperintensity.
In addition to
the neuroradiologic features,

some demographic information is helpful in the differential diagnosis. First, there is a high inci- dence of intracranial germinomas in Japan (18), with germinomas of the basal ganglia and thalamus accounting for 5% to 10% of all intra- cranial germinomas (4, 7, 25). Second, germ- cell tumors of the basal ganglia and thalamus show a striking male predominance and were found only in children or young adults. We could find in the literature only two female subjects with germ-cell tumors in the basal ganglia (13, 14).

Because the radiosensitivity of mixed-type germ-cell tumors (eg, components ofteratoma- tous tumors, embryonal cell carcinoma, chorio- carcinoma, and yolk-sac tumors) is less than pure germinoma, differentiation among them is important for appropriate therapy. There should be no essential difference in CT findings be- tween pure germinoma and the other kind of germ-cell tumors in the basal ganglionic region. The laboratory examinations of tumor markers are, however, useful for this purpose. Generally speaking, the choriocarcinoma releases human chorionic gonadotropin, yolk-sac tumor a-feto- protein, and embryonal cell carcinoma releases both human chorionic gonadotropin and a-feto- protein, whereas pure germinoma is known to produce neither a-fetoprotein nor human chori- onic gonadotropin (7, 26). This means that there should be some germ-cell components other than pure germinoma mixed in cases with increased tumor markers even if the biopsy

AJNR: 15, September 1994

GERMINOMA 1441

specimens reveal two-cell-pattern histology typical of pure germinoma. In our_three cases with elevated values of tumor markers, how- ever, there has been no recurrence of tumors for

l 1/2 to 4 years after radiation therapy.
In
summary, germ-cell tumors can involve the basal ganglia and/or the thalamus espe- cially in young male patients. Unlike typical germinomas in pineal or suprasellar regions, they showed a high tendency to cystic forma- tion, calcification, and progressive infiltration into the internal capsule, which in turn may cause progressive cerebral hemiatrophy. Al- though the MR intensity is not specific to this type of tumor, MR can demonstrate precise ex- tension, associated cysts, and intratumoral hemorrhage. CT disclosed a slightly hyper- dense mass in the basal ganglia and the thala- mus, which seemed to be characteristic and would be helpful for the differential diagnosis. Consideration of the patient's age and sex and combination of MR and CT studies are impor- tant for its early detection and differential diag- nosis from other kinds of masses in the basal ganglia and/or the thalamus. When typical find- ings are present, one can avoid biopsy and pro-

ceed with radiotherapy. Refe rences

1. Kucharczyk W, Montanera WJ. The sella and parasellar region. In: Atlas SW, ed. Magnetic Resonance Imaging of the Brain and Spine. New York: Raven Press, 1991 :625-667

2. Aguzzi A, Hedinger CF, Kleihues P, Yasargil MG. Intracranial mixed germ cell tumor with syncytiotrophoblastic giant cells and precocious puberty. Acta Neuropathol (Bert) 1988;75:427-431

3. Anno Y, Hori T, Watanabe T, et al. Germinoma originating in the basal ganglia. Report of a case showing unusual appearance on MRI. Neuroradiology 1990;32:529 - 530

4. Kobayashi T, Kageyama N, Kida Y, Yoshida J, Shibuya N, Okamura K. Unilateral germinoma involving the basal ganglia and thalamus. J Neurosurg 1981 ;55:55- 62

5. Kobayashi T , Yoshida J, Kida Y. Bilateral germ cell tumors involv- ing the basal ganglia and thalamus. Neurosurgery 1989;24: 579-583

6. Komatsu Y, Narushima K, Kobayashi E, et al. CT and MR of germinoma in the basal ganglia. AJNR Am J Neuroradiol 1989; 10:S9- S11

7. Mabuchi S, Abe H, Nakagawa Y, Aida T , T ashiro K, T suru M. Germinoma originating in the basal ganglia: report of 2 cases. Neurol Surg (Tokyo) 1982;10:977-982

8. Masuzawa T , Shimabukuro H, Nakahara N, lwasa H, Sato F . Germ cell tumors (germinoma and yolk sac tumor) in unusual sited in the brain. Clin Neuropathol 1986;5: 190-202

9. Matsumoto K, Onoda K, Tsuno K, et al. Basal ganglia germinoma treated with interstitial brachytherapy: case report. No Shinkei Geka 1991 ;19:985-989

10. Nonaka T, Shimabukuro H, Oguro K, Sato F, Masuzawa T . Germ cell tumors originating in the basal ganglia and thalamus. Neurol Med Chir (Tokyo) 1987;27:1098-1103

11. Ono N, Inoue HK, Naganuma H, Misumi S, Tamura M. Germ cell tumor in the basal ganglia: immunohistochemical demonstration of a-fetoprotein, human chorionic gonadotropin, and carcinoem- bryonic antigen. Surg f'leuro/ 1986;25:495- 500

12. Soejima T, Takeshita I, Yamamoto H, Tsukamoto Y, Fukui M, Matsuoka S. Computed tomography of germinoma in basal gan- glia and thalamus. Neuroradiology 1987;29:366-370

13. Tamaki N, Lin T, Shirataki K, et al. Germ cell tumors of the thalamus and the basal ganglia. Childs Neru Syst 1990;6:3-7 14. OnoN,lnoueHK,NaganumaH,KunimineH,ZamaA,TamuraM.

Diagnosis of germinal neoplasm in the thalamus and basal gan-

glia. Surg Neurol 1986;26:24-28
15. Kwak RC, Satoh S, Suzuki J. Ipsilateral cerebral atrophy with

thalamic tumor of childhood. J Neurosurg 1978;48:443- 449
16. Mutoh K, Okuno T , Ito M, et al. Ipsilateral atrophy in children with hemispheric cerebral tumors: CT findings. J Comput Assist To-

mogr 1988;12:740- 743
17
. Nakagawa Y, Hamajima I, Iwasaki Y, Yada K, Kunita H. Ipsilateral

cerebral atrophy caused by ectopic pinealoma: report of a case.

No To Shinkei 1973;25:69-75
18. Atlas SW. lntraaxial brain tumors. In: Atlas SW, ed. Magnetic

Resonance Imaging of the Brain and Spine. New York: Raven

Press, 1991:625- 667
19. C
hang T, Teng MMH, Guo W-Y, Shen W-C. CT of pineal tumors

and intracranial germ-cell tumors. AJNR Am J Neuroradiol 1989;

10:1039-1044
20
. Futrell NN, Osborn AG, Cleson BD. Pineal region tumors: com-

21 . 22.

23.

puted tomographic-pathologic spectrum. AJNR Am J Neurora- diol 1981 ;2:415-420
Kilgore DP, Strother CM, Strashak RJ, Haugton VM. Pineal ger- minoma. Radiology 1986;158:435-438

Latchaw RE, Johnson DW, Kana! E. Primary intracranial tumors: tumors of congenital, pineal, and vascular origin and the phako- matoses. In: Latchaw RE, ed. MR and CT Imaging of the Head, Neck, and Spine. 2nd ed. St. Louis: Mosby-Year Book, 1991: 561-595

Chang CGS, Kageyama N, Kobayashi T, Yoshida J, Negoro M. Pineal tumors: clinical diagnosis, with special emphasis on the significance of pineal calcification. Neurosurgery 1981 ;8: 656 - 668

24. Zimmerman RA, Bilaniuk LT, Wood JH, Bruce DA, Schut L. Computed tomography of pineal, parapineal, and histologically related tumors. Radiology 1980;137:669-677

  1. Saitoh M, Tamaki N, Kokunai T, Matsumoto S. Clinicobiological behavior of germ-cell tumors. Childs Neru Syst 1991 ;7:246- 250

  2. Kurisaki M, Moruyasu N, Kitajima K. Immunohistochemical stud- ies of brain tumors associated with precocious puberty: a prelim- inary report of correlation between tumor secreting hormone and Leydig cells in precocious puberty. Neurol Med Chir (Tokyo)

    1979;19:675-682

 
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Очень похоже , Марио. Однако

Очень похоже yes, Марио. Однако экзотика, японская.wink

Оля, а нельзя унать как-нибудь, позвонить может, что там на МРТ будет.

 
 #

Гистологический тип по данным

Гистологический тип по данным визуализации образований мозга без спектроскопии и перфузии дело не благодарное. Перечень образований мозга с обызвествлениями достаточно большой к сожалению.

Reeder and Felson's

GAMUT A-46
SOLITARY INTRACRANIAL CALCIFICATION (See also A-47)

COMMON
1.    Arteriosclerosis (esp. carotid siphon)
2.    [Artifact; foreign body; calcified sebaceous cyst]
3.    Chordoma
4.    Choroid plexus
5.    Craniopharyngioma  
6.    Dura (eg, falx; tentorium; superior sagittal sinus)
7.    Glioma (eg, low-grade astrocytoma ; oligodendroglioma)
8.    Habenular commissure
9.    Hemangioma; arteriovenous malformation; Sturge-Weber S.
10.    Idiopathic
11.    Interclinoid ligament (diaphragma sellae)
12.    [Skull neoplasm (eg, osteoma; chondroma; osteochondroma; osteosarcoma; chondrosarcoma)]
13.    Petroclinoid ligament
14.    Pineal gland
15.    Tuberculosis  (eg, tuberculoma; healed meningitis)

UNCOMMON
1.    Aneurysm (incl. vein of Galen "aneurysm")
2.    Basal ganglia; dentate nucleus
3.    Choroid plexus papilloma
4.    Dermoid; teratoma
5.    Encephalitis; meningitis; brain abscess (healed)
6.    Ependymoma 
7.    Epidermoid
8.    Fungus disease (esp. cryptococcosis {torulosis}; coccidioidomycosis; zygomycosis {mucormycosis})
9.    Granuloma (congenital cerebral)
10.    Hamartoma
11.    Hemangioma
12.    Hematoma, chronic (eg, intracerebral; subdural; epidural)
13.    Hypophysis
14.    [Iatrogenic (eg, contrast medium injection into an abscess or cyst)]
15.    Infarct, cerebral
16.    Lipoma of corpus callosum
17.    Meningioma
18.    Metastatic neoplasm (eg, from osteosarcoma; mucinous adenocarcinoma of colon)
19.    Pacchionian granulation
20.    Parasitic cyst (eg, hydatid  ; Cysticercus ; Paragonimus )
21.    Pinealoma (eg, germinoma; teratoma)
22.    Pituitary adenoma (esp. chromophobe)
23.    Pituitary "stone"
24.    Porencephalic cyst (porencephaly)
25.    Radiation necrosis
26.    Scarring; gliosis
27.    Schwannoma; neurofibroma
28.    Syphilitic gumma
29.    Tuberous sclerosis

 
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Попробую как-нибудь

Попробую как-нибудь узнать.

Коллеги, еще вопрос по технике: не подскажите, почему у нас такие выраженные артефакты от костных структур, вроде раньше были меньше, не так мешали, а сейчас просто ужас. Может, что-то изменить в режимах сканирования?

 
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иногда спасает полная

иногда спасает полная калибровка по воздуху

 
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Честно говоря не нашел ни

Честно говоря не нашел ни каких артефактов, качество изображений очень хорошее.

 
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Больше данных в пользу

Больше данных в пользу каверномы. Артефакты из-за спирального режима и тонких срезов. Это нормально.

 
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Вот прислали с МРТ несколько

Вот прислали с МРТ несколько сканов и описание.

 
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Прикольное описание

Прикольное описание локализации:) К височной доли образование не имеет ни какого отношения! Как в прочем и к таламусу. Находится в базальных ганглиях, а точнее в области бледного шара справа. Картина идентична данным КТ - опухоль остается и это не кавернома к сожалению.

 
 

Новый опрос

Кто подскажет как попасть в DropBox для загрузки видео в свой каталог? Не могу нигде найти.
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Total votes: 10

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