Presentation
Two weeks of headache, initially occipital with orbital frontal irradiation, evolving to holocranial.
Patient Data
Pre and post-contrast MRI shows a heterogeneously hyperintense signal lesion on the T2WI in the midline fourth ventricle, with intratumoral hemorrhage and internal cystic components. After the administration of contrast, the lesion shows irregular enhancement with non-enhancing cystic components — the mass results in obstructive supratentorial hydrocephalus, with mild dilatation of the third and lateral ventricles.
Case Discussion
Ependymomas are glial tumors that originate from differentiated cells lining the surface of the cerebral ventricles and the central canal of the spinal cord 1,2. Ependymomas constitute tumors with different molecular types, which classification in the posterior fossa are Group A and B 3. This case demonstrates imaging features of a 4th ventricular tumor, pathology-proven to be a WHO grade 3 posterior fossa ependymoma.
Case courtesy
- Sterfferson Morais, MD - PGY-3, Radiology Resident, Department of Radiology
- Antonio Rodrigues de Aguiar Neto, MD - Radiologist, Department of Radiology
- Hospital da Restauração – Recife, PE – Brazil
Note: as molecular profiling is unavailable in this case, it would have the diagnosis of posterior fossa ependymoma not otherwise specified (NOS).