Key points

Introduction

Tumors of neuroepithelial tissues in the central nervous system include diverse mixtures of glial and/or neuronal differentiated tumor cells with variable histologic grades. With more sophisticated immunohistochemical studies, subsets of classic glial or neuronal tumors have been further classified into tumors having both characteristics of glial and neuronal lineages. The glial and neuronal markers can be identified by combined staining of a single type of tumor simultaneously or by use of 2 different stains, exclusively. The clinical significance of these unclassified (ie, gray-zone) tumors is yet to be confirmed.

One of the most remarkable changes proposed in the fourth edition of the WHO classification of tumors of the central nervous system, which was published in 2007, is the incorporation of new entities, variants, and patterns of neuronal and/or glial tumors. Traditionally, categories of neuronal and mixed neuronal-glial tumors included the diagnosis of dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos), desmoplastic infantile astrocytoma/ganglioglioma, dyembryoplastic neuroepithelial tumor (DNET), gangliocytoma, ganglioglioma, anaplastic ganglioglioma, central neurocytoma, cerebellar liponeurocytoma, and paraganglioma of the filum terminale. Three new entities, however, were added to this category in the 2007 WHO classification. They are the rosette-forming glioneuronal tumor (RGNT), PGNT, and extraventricular neurocytoma (EVN), which consist of almost entirely benign lesions. The main difference between newly introduced glial tumors with neuronal differentiation and conventional ganglioglioma is that the former has cells with a broad spectrum of neuronal differentiation, whereas the ganglioglioma tumor contains mature neurons. Controversies still exist, however, concerning the spectrum of glial tumors with neuronal differentiation, and the definition of their clinical significance should be further established. Candidates of particular interest, which have yet to be included in this disease spectrum, include the GNTs, and GTNIs. Previous studies described GTNI synonymously with rosette-forming glioneuronal tumors, which should not be confused with RGNTs. In addition, atypical or aggressive forms of PGNT and GNT need to be studied, and the extreme variants of malignant glioneuronal tumors (MGNTs) should also be further evaluated.

This article reviews the literature as well as several series reports on RGNT, PGNT, GNT, GTNI, and MGNT, focusing on clinical aspects of these diseases.

Rosette-forming glioneuronal tumors of the fourth ventricle

RGNTs are a rare benign tumor type arising in the cerebellum adjacent to the fourth ventricle. In 1995, a case of a benign-appearing tumor in the inferior vermis of a 28-year-old patient, consisting of oligodendrocyte-like cells with prominent rosette formation and microcystic astrocytoma, was reported. The clinicians diagnosed the lesion as a DNET of the cerebellum. This case was the first description of RGNT, with typical characteristics of location in the cerebellum, young age onset, benign histology and clinical course, rosette formation, and a neuronal/glial differentiation pattern. Komori and colleagues described a series of 11 patients with similar lesions and termed the disease RGNT. The number of reported cases has steadily increased, especially after the adoption of RGNT as a new entity in the 2007 WHO classification of brain tumors. Recently published meta-analyses of the RGNT included 85 cases of RGNT reported from 1998 to 2012. The median age at diagnosis was 27 years (range 6–79 years), and there was a slight female predominance.

The tumor location was one of the defining features of the tumor type; hence, the name includes the phrase, “of the fourth ventricle.” RGNT is typically located in the fourth ventricle, with possible extension into the cerebellar vermis, cerebellar hemisphere, and brainstem. However, atypical tumor locations of RGNT in the tectal/pineal region, septum pellucidum, and spinal cord have been reported. In the meta-analyses of 85 patients, typical posterior fossa locations were found in 68 patients (80%), 13 patients (15%) had supratentorial tumors, and 1 patient had a spinal tumor. Multifocal tumor locations have also been reported. A patient with multifocal masses in the cerebellum and cerebellopontine angle also showed spinal intramedullary lesions and spinal leptomeningeal enhancement, suggesting the possibility of widespread seeding (metastasis) of RGNT.

In the authors’ clinic, 3 patients with RGNT were all female, and the ages at initial diagnosis were 6, 13, and 15 years. The tumors were located in the cerebellar vermis (1 patient) or cerebellar hemisphere (2 patients). In 2000, a 13-year-old girl with a large cystic rim-enhancing mass in the vermis had surgical removal, and, at that time, her pathologic diagnosis was pilocytic astrocytoma ( Fig. 1 A). Ten years later, follow-up imaging revealed a nonenhancing lesion growing in the operative bed. Reoperation and pathologic classification, according to the current knowledge base, indicated it was RGNT rather than pilocytic astrocytoma (see Fig. 1 B). The case illustrated the challenges of rapidly changing diagnostic criteria and classification imposed on neurosurgeons and pathologists.

A case of recurrence of a rosette-forming glioneuronal tumor (RGNT). ( A ) Initial presentation at 13 years of age shows a huge cystic mass in the vermis accompanied by hydrocephalus ( left ). The tumor was completely removed and the diagnosis at that time was pilocytic astrocytoma. Ten years later, a recurred nonenhancing mass ( arrow , right ) was found at the operative bed on routine surveillance imaging ( right ). It was removed again and found to be RGNT based on the revised 2007 WHO classification. ( B ) Histologic features show characteristics of RGNT in a recurrent tumor. Light microscopy of RGNT, showing numerous small rosettes with central pink neuropil-like cores. The tumor cells have uniform small round nuclei and clear cytoplasm (hematoxylin-eosin stain, ×400). The cores of the rosettes are robustly positive for synaptophysin and microtubule-associated protein 2 (MAP2).

The majority of RGNT was situated in the posterior fossa. Therefore, headache was the most common symptom due to the obstructive hydrocephalus. Nausea/vomiting, ataxia, and visual disturbances were also common manifestationsd. Radiologic characteristics on MRI of RGNT revealed a relatively circumscribed tumor with discernible margins. MRI usually showed low signal intensity in T1-weighted images and high signal intensity in T2-weighted images. The tumors frequently showed gadolinium enhancement and could be solid, cystic, or mixed solid and/or cystic in type. Intratumoral calcification was inconsistently found.

RGNT is a benign and indolent tumor, and, based on reported clinical experience and the current WHO classification, it corresponds to a grade 1 tumor. As is common for low-grade brain tumors, surgery is the primary treatment. In the meta-analyses results, complete tumor resection was reported in 36 of 63 evaluated cases. The results of radiation therapy for RGNT were limited because only a few patients received adjuvant radiation after surgery. Recurrence of RGNT was an uncommon event and only 4 of 52 patients experienced tumor recurrence. In the authors’ study, however, 1 patient experienced a recurred RGNT at 10 years after the initial operation (see Fig. 1 ). Therefore, long-term follow-up is mandatory after surgery. Results from the patient with leptomeningeal seeding (discussed previously) also raised concerns about the nature of the RGNT, because there may be more genetic/clinical heterogeneity in this benign neoplasm.

Introduction

Tumors of neuroepithelial tissues in the central nervous system include diverse mixtures of glial and/or neuronal differentiated tumor cells with variable histologic grades. With more sophisticated immunohistochemical studies, subsets of classic glial or neuronal tumors have been further classified into tumors having both characteristics of glial and neuronal lineages. The glial and neuronal markers can be identified by combined staining of a single type of tumor simultaneously or by use of 2 different stains, exclusively. The clinical significance of these unclassified (ie, gray-zone) tumors is yet to be confirmed.

One of the most remarkable changes proposed in the fourth edition of the WHO classification of tumors of the central nervous system, which was published in 2007, is the incorporation of new entities, variants, and patterns of neuronal and/or glial tumors. Traditionally, categories of neuronal and mixed neuronal-glial tumors included the diagnosis of dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos), desmoplastic infantile astrocytoma/ganglioglioma, dyembryoplastic neuroepithelial tumor (DNET), gangliocytoma, ganglioglioma, anaplastic ganglioglioma, central neurocytoma, cerebellar liponeurocytoma, and paraganglioma of the filum terminale. Three new entities, however, were added to this category in the 2007 WHO classification. They are the rosette-forming glioneuronal tumor (RGNT), PGNT, and extraventricular neurocytoma (EVN), which consist of almost entirely benign lesions. The main difference between newly introduced glial tumors with neuronal differentiation and conventional ganglioglioma is that the former has cells with a broad spectrum of neuronal differentiation, whereas the ganglioglioma tumor contains mature neurons. Controversies still exist, however, concerning the spectrum of glial tumors with neuronal differentiation, and the definition of their clinical significance should be further established. Candidates of particular interest, which have yet to be included in this disease spectrum, include the GNTs, and GTNIs. Previous studies described GTNI synonymously with rosette-forming glioneuronal tumors, which should not be confused with RGNTs. In addition, atypical or aggressive forms of PGNT and GNT need to be studied, and the extreme variants of malignant glioneuronal tumors (MGNTs) should also be further evaluated.

This article reviews the literature as well as several series reports on RGNT, PGNT, GNT, GTNI, and MGNT, focusing on clinical aspects of these diseases.

Rosette-forming glioneuronal tumors of the fourth ventricle

RGNTs are a rare benign tumor type arising in the cerebellum adjacent to the fourth ventricle. In 1995, a case of a benign-appearing tumor in the inferior vermis of a 28-year-old patient, consisting of oligodendrocyte-like cells with prominent rosette formation and microcystic astrocytoma, was reported. The clinicians diagnosed the lesion as a DNET of the cerebellum. This case was the first description of RGNT, with typical characteristics of location in the cerebellum, young age onset, benign histology and clinical course, rosette formation, and a neuronal/glial differentiation pattern. Komori and colleagues described a series of 11 patients with similar lesions and termed the disease RGNT. The number of reported cases has steadily increased, especially after the adoption of RGNT as a new entity in the 2007 WHO classification of brain tumors. Recently published meta-analyses of the RGNT included 85 cases of RGNT reported from 1998 to 2012. The median age at diagnosis was 27 years (range 6–79 years), and there was a slight female predominance.

The tumor location was one of the defining features of the tumor type; hence, the name includes the phrase, “of the fourth ventricle.” RGNT is typically located in the fourth ventricle, with possible extension into the cerebellar vermis, cerebellar hemisphere, and brainstem. However, atypical tumor locations of RGNT in the tectal/pineal region, septum pellucidum, and spinal cord have been reported. In the meta-analyses of 85 patients, typical posterior fossa locations were found in 68 patients (80%), 13 patients (15%) had supratentorial tumors, and 1 patient had a spinal tumor. Multifocal tumor locations have also been reported. A patient with multifocal masses in the cerebellum and cerebellopontine angle also showed spinal intramedullary lesions and spinal leptomeningeal enhancement, suggesting the possibility of widespread seeding (metastasis) of RGNT.

In the authors’ clinic, 3 patients with RGNT were all female, and the ages at initial diagnosis were 6, 13, and 15 years. The tumors were located in the cerebellar vermis (1 patient) or cerebellar hemisphere (2 patients). In 2000, a 13-year-old girl with a large cystic rim-enhancing mass in the vermis had surgical removal, and, at that time, her pathologic diagnosis was pilocytic astrocytoma ( Fig. 1 A). Ten years later, follow-up imaging revealed a nonenhancing lesion growing in the operative bed. Reoperation and pathologic classification, according to the current knowledge base, indicated it was RGNT rather than pilocytic astrocytoma (see Fig. 1 B). The case illustrated the challenges of rapidly changing diagnostic criteria and classification imposed on neurosurgeons and pathologists.

A case of recurrence of a rosette-forming glioneuronal tumor (RGNT). ( A ) Initial presentation at 13 years of age shows a huge cystic mass in the vermis accompanied by hydrocephalus ( left ). The tumor was completely removed and the diagnosis at that time was pilocytic astrocytoma. Ten years later, a recurred nonenhancing mass ( arrow , right ) was found at the operative bed on routine surveillance imaging ( right ). It was removed again and found to be RGNT based on the revised 2007 WHO classification. ( B ) Histologic features show characteristics of RGNT in a recurrent tumor. Light microscopy of RGNT, showing numerous small rosettes with central pink neuropil-like cores. The tumor cells have uniform small round nuclei and clear cytoplasm (hematoxylin-eosin stain, ×400). The cores of the rosettes are robustly positive for synaptophysin and microtubule-associated protein 2 (MAP2).

The majority of RGNT was situated in the posterior fossa. Therefore, headache was the most common symptom due to the obstructive hydrocephalus. Nausea/vomiting, ataxia, and visual disturbances were also common manifestationsd. Radiologic characteristics on MRI of RGNT revealed a relatively circumscribed tumor with discernible margins. MRI usually showed low signal intensity in T1-weighted images and high signal intensity in T2-weighted images. The tumors frequently showed gadolinium enhancement and could be solid, cystic, or mixed solid and/or cystic in type. Intratumoral calcification was inconsistently found.

RGNT is a benign and indolent tumor, and, based on reported clinical experience and the current WHO classification, it corresponds to a grade 1 tumor. As is common for low-grade brain tumors, surgery is the primary treatment. In the meta-analyses results, complete tumor resection was reported in 36 of 63 evaluated cases. The results of radiation therapy for RGNT were limited because only a few patients received adjuvant radiation after surgery. Recurrence of RGNT was an uncommon event and only 4 of 52 patients experienced tumor recurrence. In the authors’ study, however, 1 patient experienced a recurred RGNT at 10 years after the initial operation (see Fig. 1 ). Therefore, long-term follow-up is mandatory after surgery. Results from the patient with leptomeningeal seeding (discussed previously) also raised concerns about the nature of the RGNT, because there may be more genetic/clinical heterogeneity in this benign neoplasm.

Papillary glioneuronal tumor

The first established study of PGNT reported a series of 9 cases. Original studies were published in 1997, however, under the description, “pseudopapillary neurocytoma with glial differentiation.” Since then, a total of 69 cases have been reported in the literature. For the purpose of meta-analyses, 12 cases from the authors’ institute, including 5 previously reported cases, were combined with the reported cases for a total 76 cases ( Table 1 ). Histologic features of PGNT include the pseudopapillary architecture of glial cells with interpapillary collections of oligodendroglia-like neurocytic cells ( Fig. 2 ). No prominent mitosis, necrosis, and vascular proliferation were observed. In general, the proliferative index was low, but there were subsets of cases with an increased Ki-67 index. There was no difference in male-to-female ratio. The age distribution ranged from 3 to 75 years (mean, 26.3 years). A strong preponderance for affecting young adults and children was observed, however, and 82.9% of the patients were younger than 40 years of age (see Fig. 2 ). The relative proportion of patients with a high proliferative index (Ki-67 ≥5%), however, was greater in the older age group (62.5% in age ≥40 years) than in the younger age group (26.0% in age <40 years). Most of the patients presented with headache or seizure.

Table 1

Case summary of papillary glioneuronal tumors

Case No.	Reference, Reported Year	Gender	Age	Presentation	Location	Ventricular Relationship	Mass Characteristics	Contrast Media Enhancement	Peritumoral Edema	KI-67 (%)	Treatment	Outcome	Rescue Management	Follow-Up Period
1	Kim & Suh, 1997	M	25	Seizure	Temporal	Contiguous	Cystic	Rim	None	3.8	GTR	NER		5
2	Komori et al, 1998	M	13	Headache	Temporal	Contiguous	Cystic with mural nodule	Rim, mural nodule	Marked	1.3	GTR	NER		45
3		F	30	None	Parietal	Distant	Mixed cystic and solid	Solid portion	Mild	NA	GTR	NER		43
4		M	11	Seizure	Temporal	Contiguous	Cystic	Rim	Marked	NA	PR and radiotherapy	NER		12
5		F	27	Seizure	Temporal	Contiguous	Mixed cystic and solid	Solid portion	Mild	NA	GTR	NER		18
6		M	36	Headache	Parietal	Contiguous	Cystic with mural nodule	Rim, mural nodule	Mild	NA	GTR	NER		6
7		F	19	Cognitive decline	Temporal	Distant	Solid	Equivocal	Mild	NA	GTR	NER		12
8		F	35	Seizure	Temporal	Distant	Mixed cystic and solid	Rim	Mild	NA	GTR	NER		12
9		M	52	Headache	Frontal	Contiguous	Cystic with mural nodule	Rim, mural nodule	Mild	NA	GTR	NER		6
10		F	26	Headache	Frontal	Contiguous	Cystic with mural nodule	Rim, mural nodule	Mild	NA	GTR	NER		NA
11	Bouvier-Labit et al, 2000	M	23	Headache, visual disturbance	Parietooccipital	NA	Mixed cystic and solid	Solid portion	None	<1	GTR	NER		84
12	Prayson, 2000	M	18	Headache, visual disturbance	Parietooccipital	Contiguous	Cystic with mural nodule	Rim, mural nodule	None	1.1	GTR	NER		3
13	Barnes et al, 2002	M	4	Headache	Temporal	Contiguous	Solid, hemorrhage	Solid portion	Mild	Few	GTR	NER		30
14	Broholm et al, 2002	M	16	Seizure	Frontal	Distant	Cystic with mural nodule	Rim, mural nodule	None	0.5	GTR	NER		6
15	Tsukayama & Arakawa, 2002	F	75	Vertigo, vomiting	Frontal	Contiguous	Cystic with mural nodule	Mural nodule	Mild	NA	PR	NER		20
16	Lamszus et al, 2003	F	24	Seizure	Parietal	Distant	Cystic	None	None	3.0	GTR	NER		3
17	Kordek et al, 2003	F	14	Seizure	Parietal	Distant	Cystic	Rim	None	NA	GTR	NER		12
18	Borges et al, 2004	F	14	Seizure	Frontoparietal	Contiguous	Cystic	Rim	None	NA	GTR	NA		56
19	Tanaka et al, 2005	F	28	NA	Intraventricular	Contiguous	NA	NA	NA	NA	NA	NA		NA
20	Stosic-Opincal et al, 2005	F	16	Headache, vomiting	Parietal	Adjacent	Cystic	Rim	None	NA	PR	NER		36
21	Vajtai et al, 2006	M	13	Seizure	Temporal	Adjacent	Cystic with mural nodule	Rim, mural nodule	None	<1	GTR	NER		2
22	Buccoliero et al, 2006	F	15	Intracranial hemorrhage	Temporal	Contiguous	Cystic with mural nodule, hemorrhage	Rim, mural nodule	Mild	1.0	GTR	NER		12
23	Ishizawa et al, 2006	M	67	Hemiparesis	Parietal	NA	Cystic	Rim	NA	10.0	PR and radiotherapy, chemotherapy	Progressed in 6 m	NA	NA
24	Celli et al, 2006	M	27	Seizure	Frontal	Contiguous	Cystic with mural nodule	Rim, mural nodule	None	<1	GTR	NER		30
25	Dim et al, 2006	F	20	Visual disturbance	Frontal	Contiguous	Mixed cystic and solid	Rim, solid portion	Moderate	Very low	GTR	NER		2
26	Chen et al, 2006	M	35	Headache	Temporal	Adjacent	Cystic with mural nodule	None	None	1.9	GTR	NER		50
27		F	26	Seizure	Temporal	Contiguous	Mixed cystic and solid	Solid portion	None	2.4	GTR	NER		13
28	Konya et al, 2006	F	49	Headache	Frontal	Adjacent	Cystic, hemorrhage	NA	None	NA	GTR	NER		12
29	Epelbaum et al, 2006	M	27	Headache, vomiting	Temporal	Contiguous	Cystic	Rim	Marked	1–2	GTR and radiotherapy	NER		228
30		F	17	Mental change	Frontal	Contiguous	Solid	Solid portion	None	2–3	GTR	NER		24
31	Vaquero & Coca, 2007	M	34	Headache	Frontal	Adjacent	Mixed cystic and solid	Solid portion	None	15.0	GTR and radiotherapy	NER		60
32	Gelpi et al, 2007	M	12	Headache	Intraventricular	Contiguous	Mixed cystic and solid	Rim	None	9.0	GTR	NER		4
33	Radotra et al, 2007	M	41	Headache	Periventricular	Contiguous	Solid	NA	None	NA	NTR	NER		12
34	Adam et al, 2007	M	38	Seizure	Frontal	Adjacent	Cystic, hemorrhage	Rim	Marked	<1	GTR	NA		18
35		F	74	Dysphasia, cognitive decline	Frontal	Contiguous	Mixed cystic and solid	Rim	Marked	10.0	PR and radiotherapy	Progressed in 8 m	Chemotherapy	NA
36	Atri et al, 2007	M	4	Headache, hemiparesis	Frontal	NA	Cystic with mural nodule	Rim, mural nodule	Mild	12.0	STR and chemotherapy	NER		12
37	Newton et al, 2008	F	19	Headache, vomiting	Temporo-occipital	Distant	Solid	Solid portion	Marked	26.0	STR and radiotherapy, chemotherapy	NER		11
38	Faria et al, 2008	F	9	Seizure	Temporal	Adjacent	Cystic with mural nodule	Rim, mural nodule	None	1.1	GTR	NER		11
39	Williams et al, 2008	F	26	Headache	Frontal	Contiguous	Cystic	Rim	None	<1	GTR	NA		NA
40	Guo et al, 2008	M	23	Headache	Frontoparietal	Contiguous	Mixed cystic and solid	Solid portion	None	<1	GTR	NER		14
41	Izycka-Swieszewska et al, 2008	M	15	Seizure	Frontal	Distant	Mixed cystic and solid	Solid portion	Mild	<1	GTR	NER		72
42	Javahery et al, 2009	F	13	Headache	Frontal	Contiguous	Cystic	Rim	Mild	5.0	GTR	Recurred in 42 m	Radiotherapy, chemotherapy	90
43		F	7	Headache	Parietal	Contiguous	Cystic	Rim	None	7.0	STR	Progressed in 3 m	Surgery	24
44	Husain & Husain, 2009	M	4	Headache, vomiting	Intraventricular	Contiguous	Mixed cystic and solid	Solid portion	None	<1	Biopsy only	NA		NA
45	Govindan et al, 2009	M	47	Seizure	Frontoparietal	NA	Cystic with mural nodule	Mural nodule	None	2–3	GTR	NER		3
46		M	25	Seizure	Temporal	Contiguous	Cystic	Rim	None	2–3	GTR	NA		NA
47	Pimentel et al, 2009	F	19	Headache	Occipital	Contiguous	Mixed cystic and solid	Solid portion	Marked	1.9	GTR	NER		32
48		F	9	Seizure	Temporal	Contiguous	Cystic with mural nodule	Rim, mural nodule	Mild	1.1	GTR	NER		19
49	Xiao et al, 2010	F	12	Seizure	Temporal	Contiguous	Cystic	Rim	None	<1	GTR	NER		12
50		M	27	Seizure	Temporal	Distant	Cystic with mural nodule	Mural nodule	None	<2	GTR	NER		8
51	Mahajan et al, 2010	F	17	Seizure	Frontal	Distant	Cystic	None	None	NA	GTR	NA		NA
52	Agarwal et al, 2012	M	6	Seizure, headache	Periventricular	Contiguous	Mixed cystic and solid	Rim, solid portion	Moderate	5.0	NTR	Progressed in 24 m	NA	24
53		F	26	NA	NA	NA	NA	NA	NA	13.0	NA	NA		NA
54		M	14	Seizure	Parietal	Adjacent	Mixed cystic and solid	Rim, solid portion	Marked	<1	NTR	NER		30
55		M	4	Hemiparesis	Frontoparietal	Adjacent	Cystic	Rim	NA	12.0	STR and radiotherapy	NER		48
56	Lavrnic et al, 2012	F	23	Headache, hemiparesis	Parietal	Adjacent	Cystic with mural nodule	Rim, mural nodule	None	5.0	GTR	Recurred in 5 m	NA	5
57		F	27	Headache	Intraventricular	Contiguous	Solid	Solid portion	None	<1	STR	NER		5
58	Benzagmout et al, 2013	F	74	Headache	Occipital	Adjacent	Solid, hemorrhage	Solid portion	None	3.0	GTR	NER		24
59		F	27	Headache	Frontal	Contiguous	Cystic, hemorrhage	None	None	NA	GTR	NER		12
60	Demetriades et al, 2013	M	35	Seizure	Frontal	Distant	Cystic	Rim	None	NA	GTR	NER		44
61		M	45	Seizure	Intraventricular	Contiguous	Solid	Solid portion	None	NA	GTR	NER		44
62	Momota et al, 2014	M	12	Seizure	Temporal	Distant	Cystic with mural nodule	Mural nodule	None	14.0	GTR	NER		20
63	Portela-Oliveira et al, 2014	M	3	Seizure	Intraventricular	Contiguous	Solid	Solid portion	None	NA	GTR	NER		48
64	Gessi et al, 2014	M	33	NA	Frontal	Contiguous	Cystic with mural nodule	Rim, mural nodule	None	NA	NA	NA		NA
65	SNUH-reported, 2010	F	7	Seizure	Intraventricular	Contiguous	Solid	None	None	3.0	GTR	NER		18
66	SNUH-reported, 2011	F	75	Headache	Parietal	Contiguous	Cystic with mural nodule	Rim, mural nodule	None	14.7	STR	Progressed in 3 m	None	9
67		M	22	Seizure	Frontal	Distant	Cystic with mural nodule	Rim	None	16.8	GTR and radiotherapy	NER		35
68		M	24	Seizure	Frontal	Distant	Solid	None	None	<1	GTR	NER		34
69		M	12	Seizure	Frontal	Contiguous	Cystic with mural nodule	Rim, mural nodule	None	<1	GTR	NER		48
70	SNUH, present	M	59	Recurred tumor	Frontal	Distant	Solid	Solid portion	None	5.0	STR	Progressed in 30 m	Radiosurgery	63
71		F	45	Recurred tumor	Frontal	Contiguous	Solid	Solid portion	None	15.0	GTR	Progressed in 24 m	Surgery, radiotherapy	85
72		F	31	Headache	Intraventricular	Contiguous	Solid	Solid portion	None	1.0	STR and radiosurgery	NER		92
73		F	41	Headache	Intraventricular	Contiguous	Cystic with mural nodule	Mural nodule	None	2.2	GTR	NER		31
74		F	30	Headache, dysphasia	Parietal	Contiguous	Mixed cystic and solid	Solid portion	Moderate	2.6	STR	NER		17
75		M	32	Headache, vomiting	Parietooccipital	Contiguous	Cystic with mural nodule	Mural nodule	Mild	4.2	GTR	NER		18
76		M	17	Seizure	Frontal	Distant	Mixed cystic and solid	Solid portion	Mild	9.0	GTR	NER		15

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