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Radiologic Dilemma in an Extra-Axial Petroclival Lesion: Low Grade versus High Grade. | LitMetric

AI Article Synopsis

  • Radiologic differentiation between low-grade and high-grade lesions is essential for treatment decisions and prognosis, but imaging can sometimes be misleading.
  • A 27-year-old woman with multiple neurological symptoms was found to have a complex extra-axial lesion, initially thought to possibly be meningioma or schwannoma, despite signs that suggested a high-grade tumor.
  • The lesion was ultimately diagnosed as giant cell glioblastoma, emphasizing the need for thorough analysis of atypical imaging and the potential role of magnetic resonance spectroscopy in identifying aggressive tumors.

Article Abstract

Background: Radiologic differentiation between a low-grade and high-grade lesion is crucial when deciding extent of resection and prognostication. Occasionally, imaging features can be confusing between the 2 lesions. We report a case that presented such a radiologic dilemma. The lesion appeared benign and extra-axial on routine magnetic resonance imaging sequences. However, subtle clinical and imaging clues pointed to a high-grade lesion.

Case Description: A 27-year-old woman presented with multiple cranial nerve palsies, gait ataxia, and features of increased intracranial pressure. Computed tomography and magnetic resonance imaging showed a petroclival extra-axial contrast-enhancing lesion with areas of chunky calcification. Although choline peak on spectroscopy raised suspicion of a high-grade lesion, the primary differential diagnosis included meningioma and schwannoma considering its characteristic imaging appearance. Postoperative histopathology showed the lesion to be giant cell glioblastoma.

Conclusions: Apart from reporting a rare variant of glioblastoma in an unusual location, this case highlights atypical imaging in a glioblastoma. Brainstem edema may be a subtle indicator of the infiltrative nature of a tumor. Magnetic resonance spectroscopy may be a useful adjunct in such circumstances.

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Source
http://dx.doi.org/10.1016/j.wneu.2017.01.043DOI Listing

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