Abstract
Background
Extraventricular neurocytomas (EVNs) are rare neuronal tumors included as neoplasms in the 2007 World Health Organization (WHO) classification of tumors of the CNS. Although a few case reports describing EVNs have been published, a systematic analysis of MR imaging findings of EVN has not been reported. Furthermore, imaging findings of IDH1 mutation-negative EVNs have not yet been reported. The aim of our study is to describe the MR imaging findings of IDH1 mutation-negative EVNs.
Methods
MR images of ten patients with pathologically confirmed IDH1 mutation-negative EVNs were retrospectively reviewed. Conventional MR imaging of ten EVNs were reviewed with emphasis on the location, signal intensities, patterns, and grades of enhancement as well as the presence/grade of peritumoral edema, intratumoral cyst, hemorrhage, and calcification. The study also reviewed the results of DWI (b = 1,000 s/mm2, n = 7).
Results
Seven EVN cases were located in the cerebral hemisphere, and the remaining cases were in the cerebellum and thalamus. Of those in the cerebral hemisphere, five were cortically based tumors. The tumors showed no or mild peritumoral edema. Eight tumors were enhanced on the postcontrast T1WIs. An intratumoral cyst, hemorrhage, and calcification were detected in four, one, and two cases, respectively. On DWI, only one case showed a lower ADC value than the brain parenchyma.
Conclusion
EVNs are usually cortically based infiltrative hemispheric tumors with contrast enhancement, higher ADC value, and sometimes small cystic component, but hardly show peritumoral edema or intratumoral hemorrhage. The differential diagnosis of these findings includes low-grade glioneuronal tumors and low-grade gliomas.
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Comment
Yi et al. have described the MRI characteristics (including tumor location, enhancement, peritumoral edema, hemorrhage, and calcification) in ten patients with extraventricular neurocytoma (EVN) without IDH1 mutation. The majority of tumors were located in the cerebral hemispheres, showed enhancement after contrast injection, were cortically based, and were not associated with peritumoral edema. The authors have concluded that EVN should be included in the differential diagnosis of low-grade cerebral tumors, such as low-grade glioneuronal tumors and low-grade gliomas.
Overall, this paper is well written and provides some new data regarding these rare tumors. However, this descriptive report may be augmented by including some comparison between intraventricular neurocytoma and EVN. The addition of clinical data, such as the neurological symptoms that led to the diagnosis, the occurrence of seizures in these cortical tumors, clinical outcome, and overall survival (if available) may be of value.
Rachel Grossman
Zvi Ram
Tel Aviv, Israel
Presentation at Conference: We presented this topic as poster presentation in ESNR 2011.
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Yi, K.S., Sohn, CH., Yun, T.J. et al. MR imaging findings of extraventricular neurocytoma: a series of ten patients confirmed by immunohistochemistry of IDH1 gene mutation. Acta Neurochir 154, 1973–1980 (2012). https://doi.org/10.1007/s00701-012-1486-y
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DOI: https://doi.org/10.1007/s00701-012-1486-y