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Posterior fossa ependymoma

Case contributed by Hani Makky Al Salam
Diagnosis probable

Patient Data

Age: 20 years
Gender: Male
Race: Caucasian
ct

A heterogenous, slightly hypersense mass lesion is seen in the floor of the fourth ventricle, resulting in moderate obstructive hydreocephalus. The lesion is extending through the foramen of Magendie and Luschka. 

mri

There is a large heterogenous mass lesion in the floor of the 4th ventricle, predominantly iso-low T1, high on T2, with heterogenous but vivid enhancement. The lesion appears to extend through the foramen of Luschka (both sides) and Magendie. There is upstream obstructive moderate hydrocephalus due to the mass, with mild transependymal speak of CSF. 

Conclusion: Features are highly likely representing a posterior fossa ependymoma.

The differential includes a choroid plexus papilloma an unusually large subependyoma and a pilocytic astrocytoma. All though very unlikely. 

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