Thread by @daniel_gewolb

Differential Diagnosis for cortically based masses

P-DOG 🐶

1️⃣Pleomorphic Xanthoastrocytoma (PXA)
2️⃣Dysembryoplastic neuroepithelial tumor (DNET)
3️⃣Oligodendroglioma
4️⃣Ganglioglioma
#Neurology #neurosurgery #peds #radres #neurotwitter @The_ASPNR @TheASNR #MedTwitter

1️⃣PXA

Originate in the subpial astrocytes typically in children and young adults often with a seizure history

Temporal lobe is most common

Imaging (variable):

▶️Classically appear as a cortically based mass with cyst and enhancing nodule and overlying DURAL TAIL or enhancing leptomeninges

▶️Calcifications are RARE

▶️Can look very similar to ganglioglioma though calcifications are rare in PXA and if you’re lucky enough to have a dural tail/enhancing leptomeninges then PXA is favored

▶️Companion case of another PXA below

2️⃣DNET

▶️Cortically based mass in children and young adults presenting with long-standing seizures

▶️Most frequently occurs in temporal and frontal lobes

Imaging:

▶️Classically presents as a well demarcated cortically based “BUBBLY” mass with HYPERINTENSE RIM AROUND CYSTS ON FLAIR

▶️Usually there is NO ENHANCEMENT (though can have punctate or ring enhancement). However, when enhancement is seen, consider the possibility of more aggressive tumors.

▶️Companion case below of another DNET

3️⃣Oligodendroglioma

▶️Cortically based mass mainly in ADULTS

▶️Location: FRONTAL and temporal lobes most common

Imaging:
▶️Classically presents as a gyriform cortical/subcortical based mass with GYRIFORM OR CLUMPED CALCIFICATIONS

▶️Consider this diagnosis in an ADULT WITH A CALCIFIED FRONTAL MASS

4️⃣Ganglioglioma

▶️Occurs in children and young adults

▶️Location: Temporal lobe (most common)

Imaging (variable and can look very similar to PXA):

▶️Classically presents as a cystic and solid mass in the temporal lobe in a child/young adult with seizures

▶️Presence of CALCIFICATIONS & LACK OF DURAL TAIL may help to differentiate from PXA

Companion case of another ganglioglioma

💡 Learning points/summary:

P-DOG 🐶

1️⃣PXA: Cyst w/ enhancing mural nodule with DURAL TAIL/leptomeningeal enhancement and NO CALCIFICATIONS

2️⃣DNET: BUBBLY well demarcated mass with NO ENHANCEMENT

3️⃣Oligodendroglioma: Gyriform mass in frontal lobe of an ADULT w/ CALCIFICATIONS

4️⃣Ganglioglioma: Cyst w/ enhancing nodule in temporal lobe w/ CALCIFICATIONS and NO DURAL TAIL