Brain Tumor in Child > 1 Year



Brain Tumor in Child > 1 Year


Susan I. Blaser, MD, FRCPC



DIFFERENTIAL DIAGNOSIS


Common



  • Pilocytic Astrocytoma



    • Cerebellar JPA


    • Optic Pathway Glioma


    • Pilomyxoid Astrocytoma (Rare)


  • Medulloblastoma (PNET-MB)


  • Ependymoma


  • Brainstem Glioma, Pediatric


  • Diffuse Astrocytoma, Low Grade


  • Subependymal Giant Cell Astrocytoma


  • DNET


  • Craniopharyngioma


Less Common



  • Germinoma


  • Choroid Plexus Papilloma


  • Ganglioglioma


  • Oligodendroglioma


  • Neurofibromatosis Type 2



    • Meningioma


    • Schwannoma


  • Pineoblastoma


  • Pleomorphic Xanthoastrocytoma


  • Anaplastic Astrocytoma


  • Glioblastoma Multiforme


  • Gliomatosis Cerebri


  • Supratentorial PNET


  • Teratoma


Rare but Important



  • Astroblastoma


  • Choroid Plexus Carcinoma


  • Atypical Teratoid-Rhabdoid Tumor


  • Primary CNS Sarcoma


  • Metastases



    • Metastases, Skull and Meningeal


    • Metastases, Parenchymal


    • Leukemia


    • Neuroblastoma, Metastatic


    • Neurocutaneous Melanosis (Melanoma, Melanocytoma)


  • Central Neurocytoma


  • Dysplastic Cerebellar Gangliocytoma


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Diffusion weighted imaging helpful


  • All of the following restrict on DWI



    • PNET-MB


    • Pineoblastoma (pineal PNET)


    • Atypical teratoid-rhabdoid tumor (ATRT)


    • Germinoma


    • Epidermoid


  • May present with hemorrhage into tumor



    • Primary CNS sarcoma


    • Supratentorial PNET


    • Neuroblastoma metastatic to brain tissue


    • Pilomyxoid variant of pilocytic astrocytoma


Helpful Clues for Common Diagnoses



  • Pilocytic Astrocytoma



    • Low density NECT


    • High signal T2


  • Medulloblastoma (PNET-MB)



    • Hyperdense 4th ventricle (V) mass on NECT


    • Restricts on DWI


  • Ependymoma



    • 60% posterior fossa



      • “Plastic” tumor in 4th ventricle, extrudes through foramina


    • 40% supratentorial



      • Mixed cystic, solid mass with Ca++


  • Brainstem Glioma, Pediatric



    • Location predicts pathology, prognosis



      • Infiltrating pontine glioma worst


  • Diffuse Astrocytoma, Low Grade



    • Hemispheres, thalami (can be bithalamic), tectum, brainstem (pons, medulla)



      • 50% of brainstem “gliomas” are low grade, diffusely infiltrating astrocytomas


    • Poorly marginated


    • Hypo- on T1WI, hyperintense on T2WI


    • No enhancement


  • Subependymal Giant Cell Astrocytoma



    • Location at foramina of Monro typical


    • Look for cortical/subcortical tubers


    • Look for subependymal nodules


  • DNET



    • Almost all in patients < 20 years


    • Chronic epilepsy


    • “Bubbly appearing” cortically based mass


    • Ring sign on FLAIR


  • Craniopharyngioma



    • Nearly half of pediatric suprasellar masses


    • 90% Ca++/cystic/enhance


Helpful Clues for Less Common Diagnoses



  • Germinoma



    • Suprasellar + pineal masses together best clue


    • Early ependymal infiltration



  • Choroid Plexus Papilloma



    • Densely enhancing


    • Cotyledon- or frond-like surface


  • Neurofibromatosis Type 2



    • If multiple schwannomas, think NF2+


    • Look for “hidden”, dural-based meningiomas with C+


  • Pineoblastoma



    • Restricts on DWI


    • Look for CSF spread (ventricles, ependyma)


  • Pleomorphic Xanthoastrocytoma



    • Cortically based tumor (temporal lobe most common site)


    • Dural reaction (“tail”) common


    • Enhancing ill-defined mass plus cyst


  • Anaplastic Astrocytoma



    • Diffusely infiltrating


    • Classic do not enhance


  • Glioblastoma Multiforme



    • Typically arises from lower grade astrocytoma


  • Gliomatosis Cerebri



    • Less likely to enhance


    • More likely bilateral


    • More likely to spread across callosal tracts


  • Supratentorial PNET



    • Infant with large, bulky, complex hemispheric mass


    • Ca++, hemorrhage, necrosis common


    • Peritumoral edema sparse/absent


  • Teratoma



    • Neonate with large bulky midline mass


    • Ca++, soft tissue, cysts, fat


Helpful Clues for Rare Diagnoses



  • Astroblastoma



    • Large, hemispheric


    • Well-circumscribed


    • “Bubbly” solid and cystic


  • Choroid Plexus Carcinoma



    • Similar to CPP



      • Invades ependymal surface & brain


      • Less homogeneous than CPP


  • Atypical Teratoid-Rhabdoid Tumor



    • Heterogeneous intracranial mass in infant


    • 50% infratentorial, early CSF spread


  • Metastases



    • Pial, leptomeningeal



      • PNET


      • Ependymoma


      • Anaplastic astrocytoma


      • Germinoma


      • Choroid plexus carcinoma


    • Falx



      • Leukemia involves both sides of the falx


    • Bone & dura: Neuroblastoma > leukemia



      • CT: Bone spiculation, “hair on end”


      • MR: Bone expanded and marrow replaced


  • Central Neurocytoma



    • “Bubbly” lobulated mass in body of lateral ventricle


  • Dysplastic Cerebellar Gangliocytoma



    • Look for evidence of Cowden disease


    • Striated cerebellum



      • Enlarged low signal cerebellar folia


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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Brain Tumor in Child > 1 Year

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