Elsevier

Clinical Radiology

Volume 63, Issue 1, January 2008, Pages 80-91
Clinical Radiology

Intracranial ganglioglioma: clinicopathological and MRI findings in 16 patients

https://doi.org/10.1016/j.crad.2007.06.010Get rights and content

Aim

To record the clinical findings and magnetic resonance imaging (MRI) characteristics of intracranial gangliogliomas in 16 patients.

Materials and methods

Sixteen patients were imaged using unenhanced and contrast-enhanced MRI. Eight patients underwent unenhanced CT and of these, three underwent contrast-enhanced CT. Two radiologists read the images retrospectively. The images were studied with regard to location, size, margin, signal intensity, enhancement characteristics, cystic changes, and presence of calcifications. Clinical data, such as presenting signs and symptoms, physical findings, and medical histories, were collected. Histopathological and immunohistochemical studies were performed and analysed by two pathologists.

Results

In 12 cases the tumours were located in one of the cerebral hemispheres; in the other cases they were located in the brainstem, cerebellum, suprasellar area or the thalamus. The tumour dimension varied from 1–7 cm, with a mean of 3.6 cm ± 1.8 cm. The MRI features of ganglioglioma in the present cohort can be divided into three patterns: cystic (n = 2), cystic–solid (n = 6), and solid (n = 8). Solid lesions had a predilection for the temporal lobe; cystic and cystic–solid tumours had a wide anatomical distribution. Cystic lesions were significantly smaller than both cystic–solid and solid lesions (F = 4.28, P < 0.05). Cystic changes in the cystic-solid tumours showed one of the following patterns: those with walls showing contrast enhancement, those containing an enhancing nodule, or cysts without an obvious wall. The solid portion of cystic–solid gangliogliomas and the entire tumour in solid tumours showed homogeneous enhancement of variable degrees on T1-weighted (T1W) spin-echo (SE) images. Five tumours had mild or moderate oedema. In one patient two separate gangliogliomas were found, each lesion exhibiting different MRI features: solid and cystic–solid. One case of cortical ganglioglioma was found, causing bone erosion due to pressure. One tumour with chronic haemorrhage was found in the study.

Conclusion

MRI features of gangliogliomas are non-specific. A ganglioglioma should be suspected when a tumour shows the following features: (1) a solid lesion located in the temporal lobes with mild or no oedema and homogeneous enhancement on SE T1W images; or (2) a small cystic lesion or cystic–solid mixed mass with a wall enhancement or a markedly enhanced nodule. We report a patient with two separate gangliogliomas and a case with bone erosion.

Introduction

Ganglioglioma is a relatively uncommon tumour of the central nervous system (CNS), accounting for 0.4–0.9% of all intracranial neoplasms and 1–4% of paediatric CNS tumours.1, 2 It contains both mature neuronal and glial neoplastic elements. Gangliogliomas have been reported to arise in virtually any part of the brain,3 the most common site being the temporal lobes.4 Most gangliogliomas have a benign clinical course. Some low-grade gangliogliomas seem to behave aggressively and patients with anaplastic ganglioglioma have been reported.5 The favourable prognosis associated with ganglioglioma makes early recognition important for treatment and patient counselling.6

Section snippets

Materials and methods

A retrospective review of brain tumours in the pathology archives of our institution from the years 2000 to 2005 revealed 20 cases of ganglioglioma. Four of these patients were excluded from this study because of the absence of computed tomography (CT) or MRI data. This retrospective study was performed with the approval of the review board and ethics committee of our institution.

The patient group consisted of 16 patients (11 male and five female), with an age range of 12–53 years (mean 34.1 ± 

Clinical features

The clinical findings at the time of presentation and the patient history for all 16 patients are summarized in Table 1. Five patients presented with seizures and tics. Twelve cases were preoperatively misdiagnosed as gliomas, the remaining four cases were mistakenly diagnosed as astrocytoma, meningioma, haemangioblastoma, or germinoma.

Follow-up was measured from the date of surgery and ranged from 4–36 months. Follow-up data were not available in two patients, because they did not survive the

Discussion

The most common location for a ganglioglioma is the temporal lobe but this malignancy can be found in virtually any location of the brain or the spinal cord.6 Less frequent locations within the cerebral hemisphere are (in order of decreasing frequency): the frontal, parietal, and occipital lobes. Gangliogliomas arising in the pineal region, optical nerve, trigeminal nerve, ventricles, cerebellum, brain stem, thalamus, sella, or the cerebellopontine angle have also been reported.7, 8, 9, 10, 11,

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