Transcript Document

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
12.1.09
9.10.09
10.27.11
10.2.12
2.17.13
Pilocytic astrocytoma
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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
FLAIR
T2
T1 +C
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
T2
T1
L3
T1
S1
T2
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
T1
T1
T2
T1 C+
T1 C+
Gliomatosis cerebri