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An Ependymal Cyst in Cerebello-Pontine Angle Presenting with Syncope.

Byoung Joo PARK ; Young Il KIM ; Sin Soo JEUN ; Youn Soo LEE

Brain Tumor Research and Treatment.2013;1(2):121-123. doi:10.14791/btrt.2013.1.2.121

Intracranial ependymal cysts are rare, congenital, benign lesions. These commonly occur in the supratentorial regions and usually generate no symptoms. The cerebellopontine angle (CPA) is an extremely rare site for ependymal cysts. Furthermore, there are no previous reports of CPA ependymal cysts related to syncope. We report a case of ependymal cyst in the left CPA with syncope. The patient underwent a cardiologic evaluation for syncope after admission, but there were no definite cardiologic abnormal findings. He underwent fenestration into the subarachnoid space, and the pathologic diagnosis revealed an ependymal cyst. We analyzed this case with review of other literatures.
Cerebellopontine Angle ; Diagnosis ; Humans ; Subarachnoid Space ; Syncope*

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Brain Metastases of Papillary Thyroid Carcinoma with Horner's Syndrome.

Sung Hoon CHO ; Sang Hyo KIM ; Jung Hwan LEE ; Won Il JOO ; Chung Kee CHOUGH ; Hae Kwan PARK ; Kyung Jin LEE ; Hyoung Kyun RHA

Brain Tumor Research and Treatment.2014;2(2):132-137. doi:10.14791/btrt.2014.2.2.132

Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy and has relatively favorable prognosis. Blood-borne metastases of PTC are very rare among the thyroid malignancies. Moreover a case of blood-borne central nervous system metastasized PTC with only unilateral Horner's syndrome, and without any abnormalities in laboratory or physical examinations has not been described before. A 53-year-old female patient had been managed in ophthalmologic clinic due to vague symptoms of right monocular blurred vision with eye dryness for 3 months, but showed no signs of improvement. So it was performed a magnetic resonance imaging and magnetic resonance angiography to evaluate the possibilities of cerebral lesion. And a left frontal mass was incidentally found, and the tumor turned out to be a PTC that had metastasized to brain, regional lymph node, cervical, thoracic spine, and lung. We describe a PTC with extraordinary initial symptoms that metastasized to an unusual site. We recommend that if a papillary thyroid tumor with unusual symptoms or at an advanced stage is found, further investigation should be performed for distant metastasis.
Brain* ; Central Nervous System ; Female ; Horner Syndrome* ; Humans ; Lung ; Lymph Nodes ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis* ; Physical Examination ; Prognosis ; Spine ; Thyroid Gland ; Thyroid Neoplasms*

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Large Solid Hemangioblastoma in the Cerebellopontine Angle: Complete Resection Using the Transcondylar Fossa Approach.

Byung Hoo MOON ; Sang Kyu PARK ; Young Min HAN

Brain Tumor Research and Treatment.2014;2(2):128-131. doi:10.14791/btrt.2014.2.2.128

Hemangioblastomas (HBMs) in the cerebellopontine angle (CPA) have rarely been reported. When they are within the CPA, they may be misdiagnosed as vestibular schwannoma (VS) or cystic meningioma. Therefore, differential diagnosis is important for the safe treatment of the lesion. Large solid HBMs, similar to intracranial arteriovenous malformations (AVMs), are difficult to surgically remove from an eloquent area because of their location and hypervascularity. We report a case of an HBM in the CPA, which manifested as a hearing impairment or VS. Similar to AVM surgery, the tumor was widely opened and removed en bloc without a new neurological complication using the modified transcondylar fossa approach without resection of the jugular tubercle. Accurate diagnosis, pre-operative embolization, and a tailored approach were essential for the safe treatment of the HBM in the CPA.
Cerebellopontine Angle* ; Diagnosis ; Diagnosis, Differential ; Hearing Loss ; Hemangioblastoma* ; Intracranial Arteriovenous Malformations ; Meningioma ; Neuroma, Acoustic

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Extraneural Metastases of Glioblastoma without Simultaneous Central Nervous System Recurrence.

Wonki KIM ; Heon YOO ; Sang Hoon SHIN ; Ho Shin GWAK ; Seung Hoon LEE

Brain Tumor Research and Treatment.2014;2(2):124-127. doi:10.14791/btrt.2014.2.2.124

Glioblastoma multiforme (GBM) is well known as the most common malignant primary brain tumor. It could easily spread into the adjacent or distant brain tissue by infiltration, direct extension and cerebro-spinal fluid dissemination. The extranueural metastatic spread of GBM is relatively rare but it could have more progressive disease course. We report a 39-year-old man who had multiple bone metastases and malignant pleural effusion of the GBM without primary site recurrence.
Adult ; Brain ; Brain Neoplasms ; Central Nervous System* ; Glioblastoma* ; Humans ; Neoplasm Metastasis* ; Pleural Effusion ; Pleural Effusion, Malignant ; Recurrence* ; Spinal Neoplasms

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Hemorrhagic Recurrence in Diffuse Astrocytoma without Malignant Transformation.

Hyun Joo BAEK ; Seong Min KIM ; Seung Young CHUNG ; Moon Sun PARK

Brain Tumor Research and Treatment.2014;2(2):119-123. doi:10.14791/btrt.2014.2.2.119

Although uncommon, hemorrhage can be a complication of low grade glioma with an unfavorable prognosis such as transformation to higher grade glioma. To our knowledge, hemorrhagic recurrence of World Health Organization Grade II, diffuse astrocytoma without malignant transformation has not been reported. Thus, we report a case of diffuse astrocytoma with hemorrhagic recurrence without malignant transformation. The patient had undergone craniotomy and tumor removal 7 years previously. Annual follow-up MRIs had shown evidence of slow tumor recurrence. With the sudden onset of seizure, the patient was diagnosed as hemorrhagic recurrence and underwent second tumor removal highly suspecting malignant change into higher grade glioma. Histopathology confirmed diffuse astrocytoma without malignant changes. As the patient's postoperative condition was excellent, we plan to withhold chemotherapy and radiation therapy for use as a later treatment option.
Astrocytoma* ; Craniotomy ; Drug Therapy ; Follow-Up Studies ; Glioma ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Recurrence* ; Seizures ; World Health Organization

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Isolated Central Nervous System Relapse of Acute Lymphoblastic Leukemia.

Sang Hyun SUNG ; In Seok JANG

Brain Tumor Research and Treatment.2014;2(2):114-118. doi:10.14791/btrt.2014.2.2.114

Acute lymphoblastic leukemia (ALL) is the most common form of childhood cancer and may exhibit central nervous system (CNS) involvement. Advances in chemotherapy and effective CNS prophylaxis have significantly decreased the incidence of CNS relapse of ALL to 5-10%. Here, we report the case of a patient with isolated CNS relapse of standard risk group pre-B-cell type ALL in an 11-year-old girl, relapsed 3 years after successful completion of chemotherapy. An 11-year-old girl visited our hospital complaining of headache, dizziness, vomiting, and visual field defects. Neurological examination revealed left-side homonymous hemianopsia. Brain magnetic resonance imaging showed a large irregular dural-based sulcal hematoma in the right parietal and occipital lobes. Surgery to remove the hematoma revealed the existence of hematopoietic malignancy after pathologic evaluation. Bone marrow biopsy was subsequently performed but showed no evidence of malignancy.
Biopsy ; Bone Marrow ; Brain ; Central Nervous System* ; Child ; Dizziness ; Drug Therapy ; Female ; Headache ; Hematologic Neoplasms ; Hematoma ; Hemianopsia ; Humans ; Incidence ; Leukemia ; Magnetic Resonance Imaging ; Neurologic Examination ; Occipital Lobe ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Precursor Cells, B-Lymphoid ; Rabeprazole ; Recurrence* ; Visual Fields ; Vomiting

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Adult-Onset Sellar and Suprasellar Atypical Teratoid Rhabdoid Tumor Treated with a Multimodal Approach: A Case Report.

Hae Gi PARK ; Jong Hyung YOON ; Se Hoon KIM ; Kwan Ho CHO ; Hyeon Jin PARK ; Sun Ho KIM ; Eui Hyun KIM

Brain Tumor Research and Treatment.2014;2(2):108-113. doi:10.14791/btrt.2014.2.2.108

We report a very rare case of sellar and suprasellar atypical teratoid rhabdoid tumor (ATRT) in a 42-year-old female patient. The tumor was removed subtotally with a transsphenoidal approach. Histopathologic study showed rhabdoid cells with prominent nucleoli and abundant cytoplasm. Immunohistochemistry for INI1 was completely negative in the tumor cells, consistent with ATRT. After surgery, she received radiotherapy including spinal irradiation with proton beam therapy and subsequent chemotherapy, with no evidence of recurrence for more than 2 years. Up to date, this is the 8th case of an adult-onset ATRT in the sellar or suprasellar region. Despite its rarity, ATRTs should be considered in the differential diagnosis of an unclear malignant sellar or suprasellar lesion in adult patients and the treatment strategies for adult ATRT patients could be differentiated from those of pediatric ATRT patients.
Adult ; Cytoplasm ; Diagnosis, Differential ; Drug Therapy ; Female ; Humans ; Immunohistochemistry ; Proton Therapy ; Radiotherapy ; Recurrence ; Rhabdoid Tumor*

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Procarbazine, CCNU, and Vincristine Chemotherapy in Gliomatosis Cerebri.

Hyun Gon LEE ; Keun Soo LEE ; Won Hee LEE ; Sung Tae KIM

Brain Tumor Research and Treatment.2014;2(2):102-107. doi:10.14791/btrt.2014.2.2.102

A 49-year-old female patient was admitted due to memory disturbances. Magnetic resonance (MR) imaging suggested gliomatosis cerebri (GC), which had spread to both insular lobes, both frontal and basal ganglia and the brain stem. A stereotactic biopsy was performed at the high signal intensity area of the T2-weighted MR image, and the revealed a diffuse astrocytoma. Radiation therapy was judged not to be an appropriate treatment for the patient because of her cognitive impairment. A combinatorial chemotherapy regiment consisting of Procarbazine, CCNU, and Vincristine (PCV) was agreed upon after discussion. The patient underwent six cycles of PCV chemotherapy (a full dose was applied until the 3rd cycle, and dose then was reduced to 75% for the remaining cycles). Although the patient exhibited side effects such as bone marrow suppression and gastrointestinal symptoms, these were managed by medication. Over the 28 months following initiation of treatment, the high signal area in the right frontal and temporal lobes in the T2-weighted MR image decreased, and the patient's cognitive function [global deterioration scale (GDS) 4 points, mini-mental state examination (MMSE) 25 point] also improved (GDS 1 points, MMSE 29 points). PCV chemotherapy can therefore be an alternative therapeutic option for patients with GC who cannot be treated with radiation therapy or other chemotherapies.
Astrocytoma ; Basal Ganglia ; Biopsy ; Bone Marrow ; Brain Stem ; Drug Therapy* ; Female ; Humans ; Lomustine* ; Memory ; Middle Aged ; Neoplasms, Neuroepithelial* ; Procarbazine* ; Temporal Lobe ; Vincristine*

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Disseminated Hemangioblastoma of the Central Nervous System without Von Hippel-Lindau Disease.

Sun Yoon CHUNG ; Sin Soo JEUN ; Jae Hyun PARK

Brain Tumor Research and Treatment.2014;2(2):96-101. doi:10.14791/btrt.2014.2.2.96

Hemangioblastoma (HB) of the central nervous system may occur sporadically or in association with von Hippel-Lindau (VHL) disease. Disseminated HB means malignant spread of the original primary HB without local recurrence at surgically resected site. It has been rarely reported previously, and rarer especially without VHL gene mutation. We report a case of disseminated HB without VHL disease. A 59-year-old man underwent a surgery for total removal of a cerebellar HB. From five years after the surgery, multiple dissemination of HB was identified intracranially and he subsequently underwent cyberknife radiosurgery. The lesions got smaller temporarily, but they soon grew larger. Nine years after the initial surgery for cerebellar HB, he showed severe back pain. His magnetic resonance image of spine revealed intradural extramedullary mass at T6-7 level. Complete surgical removal of the mass was performed and the pathological diagnosis was identical to the previous one. He had no evidence of VHL disease. And there was no recurrence of the tumor at the site of the original operation. The exact mechanism of dissemination is unknown, but the surgeon should be cautious of tumor cell spillage during surgery and prudently consider the decision to perform ventriculo-peritoneal shunt. In addition, continuous follow-up for recurrence or dissemination is necessary for patients even who underwent complete removal of cerebellar HB.
Back Pain ; Central Nervous System* ; Diagnosis ; Hemangioblastoma* ; Humans ; Middle Aged ; Radiosurgery ; Recurrence ; Spine ; Ventriculoperitoneal Shunt ; von Hippel-Lindau Disease*

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A Case of Giant Skull Base Chondroma.

Juneyoung HEO ; Sung Jin CHO

Brain Tumor Research and Treatment.2014;2(2):92-95. doi:10.14791/btrt.2014.2.2.92

Intracranial chondroma is a rare benign tumor. Here, we present the case of a 29-year-old female who was afflicted with left eye blindness and ptosis. Brain computerized tomography and magnetic resonance imaging revealed the presence of a giant calcified mass accompanied by a solid mass in the middle and posterior fossa. A differential diagnosis regarding chordoma, chondrosarcoma, and other chondroid tumors based on radiologic information was inconclusive. The lesion was resected completely under a microscope using a combined pterional and subtemporal approach. The pathologic report confirmed the diagnosis of chondroma. No evidence of neurological worsening was observed. The tumor had a calcified mass with mature hyaline cartilage surrounded by a thick fibrous capsule. We dissected the periphery of the tumor mass and removed it via aspiration. It was readily distinguished from normal brain parenchymal tissue. The large calcified mass at the center of the tumor had relatively high vascularity, and a high-speed drill and various rongeurs were used to remove the tumor.
Adult ; Blindness ; Brain ; Chondroma* ; Chondrosarcoma ; Chordoma ; Cranial Fossa, Posterior ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Hyaline Cartilage ; Magnetic Resonance Imaging ; Skull Base Neoplasms ; Skull Base*

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