Tumors with a cyst and enhancing nodule

Question 1

Hemangioblastoma

Answer 1

associated with VHL. Most commonly in brain stem or posterior fossa

Best diagnostic clue: Adult with a cerebellar mass with cyst and enhancing mural nodule

T1: isointense nodule
T2: nodule and cystic portion both bright
FLAIR: nodule and cystic portion both bright
C+: nodule enhancement

may have flow voids

Question 2

Juvenile Pilocytic astrocytoma

Answer 2

aa

Question 3

Pleomorphic Xanthoastrocytoma (PXA)

Answer 3

Children/adolescents with chronic seizures
Peripherally located often involving the cortex.
Temporal lobe most commonly

Cyst and enhancing mural nodule typical. with adjacent enhancing dural “tail”
Rarely have significant edema/mass affect

T1 iso/hypo
T2 bright
FLAIR bright
C+ mural nodule and dural tail enhances.

Question 4

Ganglioglioma

Answer 4

Best diagnostic clue: Partially cystic, enhancing, cortically based mass in child/young adult with TLE. Most common neoplastic cause of temporal lobe epilepsy (TLE)

50% have Ca++, lack of surrounding edema/mass affect

T1 dark
T2 bright
C+ mural nodule moderately enhances, heterogenously.
GRE Ca++ will bloom. Ca++ also can gives a slightly heterogenous look to the lesion.