Our patients have generally undergone US and/or MRI.
We have performed also CT in a few selected cases.
Case 1: B,
female patient presented to our Unit at the age of 10w, with macrocephalus.
We performed transfontanellar US (that depicted progressive hydrocephalus),
followed by cerebral MRI.
This imaging study revealed a highly vascularised mass that originated in the choroid plexus of the right lateral ventricle and important enlargement of the lateral ventricles.
Fig. 1
Fig. 1: B, 10w. Axial T2-weighted MR image shows marked hypointensity and flow voids within the right lateral ventricle mass attached to the choroid plexus in the trigone region.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania
Fig. 2
Fig. 2: B, 10w. Contrast-enhanced sagittal T1-weighted MR image shows a large, lobulated mass centered in the region of the choroid plexus glomus of the lateral ventricle.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania
Fig. 3
Fig. 3: B, 10w. Contrast-enhanced coronal T1-
weighted MR image shows intense homogeneous enhancement
of the mass.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania
The HP diagnosis was choroid plexus papilloma.
She underwent surgical ligation of the vascular pedicle and removal of the tumour,
without any adjuvant therapy. Follow-up postoperative studies with contrast enhanced MRI included the spine as to exclude the possibility of seeding from the choroid plexus papilloma.
We present the follow-up MDCT at the age of 4 years which showed no signs of relapse.
Fig. 4
Fig. 4: B, 4y, Follow-up MDCT, coronal MPR shows right-sided residual hygroma and persistent moderate lateral ventricle asymmetrical dilation.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania 2012
Neoplasms of the choroid plexus account for 0.4%–0.6% of all intracranial tumors,
2%–4% of pediatric brain tumors,
and 10%–20% of brain tumors in children younger than 1 year of age. Most choroid plexus tumors (about 80%) occur as the benign,
slowly growing choroid plexus papilloma,
a WHO grade I tumor with a favorable overall prognosis2. Choroid plexus tumors have long been associated with hydrocephalus and symptoms related to increased intracranial pressure3-5.
In most cases,
the increased intraventricular pressure is secondary to an increase in the production of CSF by the tumor4.
Histologic examination of choroid plexus papillomas reveals an appearance quite similar to that of normal nonneoplastic choroid plexus tissue.
Prominent fronds of fibrovascular connective tissue surrounded by columnar or cuboidal cells without significant mitotic activity are typical2.
Fig. 22
Fig. 22: Choroid plexus papilloma. Photomicrograph
(original magnification, 40; hematoxylin-eosin
stain) of a choroid plexus papilloma shows a distinctive
papillary pattern, with bland columnar to cuboidal cells
lining fibrovascular stalks.
References: Kelly K. Koeller, CAPT, MC, USN ● Glenn D. Sandberg, LTC, MC, USA (2002) Cerebral Intraventricular Neoplasms: Radiologic-Pathologic Correlation. From the Archives of the AFIP
Case 2: V,
7d old male patient from monitored twin-pregnancy,
in vitro fertilisation.
Screening ultrasound for cutaneous hemangiomatosis was performed. In our Department the screening of cutaneous hemangiomatosis includes transfontanellar and liver US.
Fig. 5
Fig. 5: V, 7d. Clinical appearance of cutaneous hemangiomatosis.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania 2012
The diagnosis was diffuse neonatal cutaneous and cerebral hemangiomatosis and treatment with Propranolol was initiated.
Fig. 6
Fig. 6: V, 7d. Convex probe - sagittal view US reveals multiple hyperechoic nodular lesions supra- and infratentorial.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania 2012
Fig. 7
Fig. 7: V, 7d. Liniar probe - trans mastoid view shows Color Doppler signal within the lesions.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania 2012
The patient developed IRDS and the imaging studies confirmed the progression of the cerebral lesions (both in number and dimensions),
as well as intracranial hemorrhage.
Fig. 8
Fig. 8: V, 7d. Follow-up coronal MPR MDCT at 1 month shows progressive disease: the lesions are more, larger and are bleeding.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania 2012
Fig. 9
Fig. 9: V, 7d. Sagittal MPR contrast-enhanced MDCT at 1 month shows increased enhancement of the lesions.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania 2012
Four months later the MDCT shows no signs of bleeding but reveals sequelae such as hydrocephalus and porencephalic cavities.
Fig. 10
Fig. 10: V, 7d. Follow-up MDCT at 4 months shows porencephalic cavities, posthemorrhagic hydrocephalus. No bleeding.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania 2012
Hemangioma is a common benign vascular neoplasm that closely resembles normal vessels and can be found in all organs of the human body.
Vascular lesions can be classified as infantile hemangiomas or vascular malformations on the basis of their natural history,
location, cellular turnover,
and histologic characteristics6. Hemangiomas are the most common tumor of infancy.
It is estimated that they occur in 1%–2% of the population in general and in up to 10% of white persons.
They occur more frequently in girls than in boys (3:1 ratio),
and their prevalence is higher in premature infants.
Hemangiomas are present at birth in 30%–40% of cases, with the remainder generally being appreciated in the first months of life.
More than one-half are located in the head and neck,
with the most common sites of involvement being the midcheek, upper lip,
and upper eyelid7.
Other common involved organ systems include: liver,
central nervous sistem,
intestine and lungs8.
Case 3: A,
13d old male patient from 38 GW monitored pregnancy,
natural birth,
BW=3900g,
AS 8.
At the age of 13 d the patient started having simple partial seizures with secondary generalization,
followed by postictal state including left - sided Todd's paralysis (a transient neurologic deficit,
usually weakness,
of the limb contralateral to the seizure focus).
Fig. 11
Fig. 11: A, 13d. MDCT shows a spontaneous hyperdense right frontal lesion, that was initially thought to be a intraparenchimatous haematoma.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania 2012
Fig. 12
Fig. 12: A, 13d. 1 month follow-up contrast-enhanced axial MDCT shows the low, inhomogenious enhancing frontal lobe lesion with tumoral appeareance. The diameter of the lesion is similar with the first examination. No perilesional edema is visualised.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania 2012
Fig. 13
Fig. 13: A, 13d. Contrast-enhanced sagittal T1 weighted shows lobulated, slightly enhancing frontal mass.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania
At the age of 4w the patient underwent surgery - coronal incision for right frontal approach - gross total removal under the microscope.
Fig. 14
Fig. 14: A, 13d. Surgical exposure of the tumor.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania 2012
The HP report was: oligodendroglioma.
Fig. 21
Fig. 21: A, 13d. HP report.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania
He was reevaluated 1 month later and the MRI showed no signs of residual tumor.
Fig. 15
Fig. 15: A, 13d. 4 months postoperative axial T1 weighted contrast enhanced MRI shows no residual lesion.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania
Oligodendroglial tumors account for 5-15% of gliomas.
Mean age is 42 years (grade II tumors) or 48 years (grade III tumors); only 6% occur in infancy/childhood.
Patients usually present with seizures.
This type of tumor can be pure or mixed with astrocytoma.
Usually arise from cerebral white matter,
but rarely invades or originates from dura or adenohypophysis.
Metastases are rare and usually to bone (75%),
cervical lymph nodes (50%),
lung or pleura (33%).
These are slow growing tumors with mean survival 5 years.
The treatment is based on surgery,
but combination chemotherapy is helpful9.
A number of studies have evaluated the prognostic significance of the Ki-67 (MIB-1) index.
In general,
higher proliferation rates (>3–5%),
significantly correlate with worse prognosis.
A study of 32 WHO grade II oligodendrogliomas found that Ki-67 labelling indices of >3% were indicative of a worse prognosis,
and a study of 89 oligodendroglioma patients documented a 5-year survival rate of 83% for patients whose oligodendroglioma had a MIB-1 labelling index of <5% but only 24% for patients with tumours displaying >5% MIB-1 positive cells.
Similar data have discriminated two groups of patients with significantly different survival times when using a cut-off value of 5% MIB-1 positive cells.
The value of measuring proliferation rates appears independent of patient age,
tumour site,
and histological grade10.
Case 4: A,
7d old male patient from unmonitored pregnancy,
presented with macrocephalus.
The patient had fatal outcome after only 6 weeks after birth.
Fig. 16
Fig. 16: A, 7d. Contrast enhanced axial MDCT shows cystic and solid, heterogeneous enhancing suprasellar mass and hydrocephalus.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania
Fig. 17
Fig. 17: A, 7d. Contrast-enhanced T1 weighted shows cystic and solid, heterogeneous enhancing suprasellar mass and hydrocephalus.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania
Fig. 18
Fig. 18: A, 7d. Follow-up at 6w axial T2 weighted MRI shows rapidly growth of the suprasellar tumour.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania
The HP report was mature teratoma.
By definition,
teratomas are composed of all three germ cell layers (ectoderm,
mesoderm,
and endoderm).
Incidence varies with age: 30-50% of congenital brain tumors,
2% of brain tumors in infants and children,
0.5% at all ages.
Congenital cases are usually fatal.
Some of the histologic features of fetal teratomas are unique,
compared with teratomas seen later in life.
Teratomas are histologically classified as either mature or immature1.
Mature teratomas have well differentiated tissue from all three germinal layers,
including neuroectoderm,
including epithelium that is solid,
cystic,
glandular or tubular,
cartilage or other mesenchymal elements,
glial and neuronal tissue.
Imature teratomas have less differentiated tissue from any of the three germinal layers; 50% with intracranial tumors die within one year.
Poor pregnosis: tissue resembling medulloepithelioma,
neuroblastoma,
retinoblastoma or ependymoblastoma.
The treatment in newborns is complete surgical excision (difficult)9.
Case 5: R,
preterm male neonate from 35 GW unmonitored pregnancy,
polyhydramnios,
C section,
BW=3200g,
AS 4/6.
Fig. 19
Fig. 19: R, preterm, 1d. Contrast enhanced axial MDCT shows an inhomogeneous enhancing nasopharyngeal mass.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania
Fig. 20
Fig. 20: R, preterm, 1d. Coronal contrast enhanced reformated MDCT shows the tumor extension to the skull base.
References: Department of Radiology, Emergency Hospital for Children M.S. Curie, Bucharest/ Romania
The HP report was nazal glioma.
Although the location of nasal glioma is not intracranial,
the lesion is composed of mature brain tissue isolated from the central nervous system.
Nasal gliomas occur near the root of the nose (where the cranial portion of the nose joins the forehead),
are composed of dysplastic glial tissue, and are congenital nonneoplastic lesions best categorized
as heterotopia.
A nasal glioma may be connected to the brain by a stalk of tissue in up to 15% of cases,
but the stalk does not contain a direct fluid-filled tract that communicates with the subarachnoid spaces.
Nasal gliomas are intranasal in 30% of cases,
extranasal in 60%,
and mixed in 10%7.
Treatment requires surgical excision.
Close follow-up of these patients is of paramount importance because of the possibility of postoperative CSF rhinorrhea and intracranial infectious complication.
If there is an intracranial extension that cannot be safely and adequately repaired via the initial extracranial approach,
a frontal craniotomy is recommended to prevent any complication.
Overall,
recurrence rates of 4 to 10% have been reported11.