Presentation
Seizures were the first symptoms that led MRI investigations.
Patient Data
Expansile right anterior temporal lobe lesion involving grey and white matter is noted measuring 4.5 x 5.1 x 4.1cm (trans x ap x cc) with positive mass effect and slight uncal herniation on this side. The lesion is very high signal on T2 with areas of suppression on T2 FLAIR. There is also slight contralateral midline shift of 3 mm.
There is slight scalloping of the overlying bone suggesting it is longstanding. A small area of faint enhancement with diffusion restriction is noted in the superior portion of the tumor. The lesion is solitary.
Impression:
Expansile cortical and subcortical right anterior temporal lobe lesion in keeping with a glioma. The slight enhancement with diffusion restriction superiorly is suggestive of a higher grade component. The cystic nature can sometimes be seen with particular subtypes of gliomas such as protoplasmic astrocytomas.
The imaging features show characteristics of a low grade glioma with a probable component of progression to a high grade tumor. Resection of the tumor revealed an Anaplastic astrocytoma WHO III.
No change to high signal FLAIR surrounding the right temporal lobe surgical cavity. No contrast enhancement. No suspicious areas of spectroscopy though no voxel has been placed in the region showing a raised choline to creatinine ration on the previous study. There is perhaps minor increased cerebral blood volume medial and anterior to the resection cavity, but this is not convincingly different to previous studies.
Interval increase in size of the heterogeneously enhancing nodule posteriorly within the cystic cavity in the right temporal lobe-current dimensions are 15.3 x 16.8 x 16.8 mm compared to 7.1 x 12.2 x 12.2 mm in previous exam. There is probable increased cerebral blood volume (CBV) at the base of the nodule. Surrounding increased FLAIR signal is unchanged.
Punctate foci of susceptibility artefact in the right cerebral hemisphere compatible with micro hemorrhages secondary to radiotherapy.
Conclusion:
Disease progression with interval enlargement of the nodular area of enhancement in the right temporal cystic cavity.
Case Discussion
A high grade glioma are those classified as WHO grade III or IV and have a poor prognosis. This tumor was treated with the standard protocol for these cases and on follow up imaging there was identified tumor recurrence/progression of the disease after two years.
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