G. Hahn (Bereich Kinderradiologie/Uniklinikum Dresden/Deutschland)  

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2 Years  

Male  

Head-Brain and brain nerves  

neoplastic  

2 1/2 year old child with emesis and ataxia.  

The anaplastic Ependymoma is with the WHO classification of grade III the most malignant Ependymoma.  

<- view MRI 1

MRI 1: T2-weighted sequences transversal: Hyperintense tumor in the posterior cranial fossa ca. 6 x 6 c 4,5 cm (W x H x D) in the prepontine cisterne, growing in the right Cisterna pedunculocerebellaris above the Cisterna ambiens towards supratentorial.
Transependymal liquor migration. Narrowed cortical liquor spaces.






<- view MRI 2

MRI 2: T2-weighted sequences sagital: Hyperintense tumor in the posterior cranial fossa ca. 6 x 6 c 4,5 cm (W x H x D) in the prepontine cisterne, growing in the right Cisterna pedunculocerebellaris above the Cisterna ambiens towards supratentorial.
Enclosing of the Chiasma opticum, tumor growth into the Sella turcica. Infratentorial tumor growth through the Foramen Luschkae into the 4th ventricle. Considerable shifting and atrophy of the Medulla oblongata, Pons and right Pedunculus cerebellaris medialis. Tumor spread towards caudal over the Foramen magnum as far as level T2. Tumor growth in the aqueduct and massive occlusion hydrocephalus with dilation of both lateral ventricles and the 3rd ventricle. Transependymal liquor migration. Narrowed cortical liquor spaces.
The tumor encloses both Aa. vertebrales, the A. basilaris, the PcoA bilat. and right PCA - these with normal flow signal.






<- view MRI 3

MRI 3: In the FLAIR seqences also hyperintense tumor ( ca. 6 x 6 * 4,5 cm (W x H x D) in the prepontine cisterne, growing in the right Cisterna pedunculocerebellaris above the Cisterna ambiens towards supratentorial.






<- view MRI 4

MRI 4: In theT1 weighted sequences hypointense tumor, which doesn't show enhancement after contrast application.






<- view MRI 5

MRI 5: In the T1 weighted sequences hypointense tumor.






<- view MRI 6

MRI 6: T1 weighted sequences sagital: Hypointense tumor, which doesn't show enhancement after contrast application. Extensive space-occupuying lesion of the posterior cranial fossa ca. 6 x 6 c 4,5 cm (W x H x D) in the prepontine cisterne, growing in the right Cisterna pedunculocerebellaris above the Cisterna ambiens towards supratentorial. Enclosing of the Chiasma opticum, tumor growth into the Sella turcica. Infratentorial tumor growth through the Foramen Luschkae into the 4th ventricle. Considerable shifting and atrophy of the Medulla oblongata, Pons and right Pedunculus cerebellaris medialis. Tumor spread towards caudal over the Foramen magnum as far as level T2. Tumor growth in the aqueduct and massive occlusion hydrocephalus with dilation of both lateral ventricles and the 3rd ventricle. Transependymal liquor migration. Narrowed cortical liquor spaces.
The tumor encloses both Aa. vertebrales, the A. basilaris, the PcoA bilat. and right PCA - these with normal flow signal.






<- view MRI 7

MRI 7: T1 weighted sequences coronal: Hypointense tumor, which doesn't show any enhancement after contrast application.




 

Surgery / Histo  

none  

Since the tumor is not completely operable the prognosis is poor - despite chemotherapy and radiation therapy. A liquorgenic spread was not evident at the time of diagnosis.  

N/A  

N/A  

1. Medline:
"Pediatric Neuroimaging"
A.J.Barkovich  

infratentorial, brain tumor, anaplastic, Ependymoma, anaplastic infratentorial Ependymoma, emesis, ataxia, malignant grade III Ependymoma, grade 3, child, childhood, pediatric radiology  

G Hahn. Anaplastic infratentorial ependymoma. PedRad [serial online] vol 4, no. 12.
URL: www.PedRad.info/?search=20041216150008