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ÿþCASE 3

69 year old female with history of known suprachiasmatic mass

Findings

T1 signal isointense, enhancing mass directly adjacent to the anterior 3rd ventricle in the region of the lamina terminalis

Differential

Chordoid Glioma

Meningioma (Chordoid Meningioma)

Chordoma

Central Neurocytoma

Craniopharyngioma

Pilocytic Astrocytoma

Ependymoma

Metastases

Chordoid Glioma

Well-circumscribed, solid, enhancing mass, which occasionally has a cystic component (19% of the reported cases)

Typically arises in the third ventricular region with frequent attachment to hypothalamic and suprasellar structures

Predominantly affects adults, median age 45 years; range, 12 70 years with a female predominance (female, 63%; male, 37%)

Clinical Presentation

Headache is the most common symptom reported by patients

Other clinical manifestations include:

Obstructive hydrocephalus

Visual disturbances secondary to compression of the optic chiasm

Signs of increased intracranial pressure

Endocrine disturbances such as amenorrhea, diabetes insipidus, syndrome of inappropriate antidiuretic hormone secretion, and hypothyroidism

Chordoid Glioma

Pathology

Treatment

Surgical resection of the lesion is considered the therapy of choice, even if it may result in an incomplete resection (50% of reported cases)

Only 3 patients were treated postoperatively with radiotherapy, 2 with ³-knife radiosurgery and 1 with radiosurgery

In these 3 patients, the tumor was subtotally excised; 2 of 3 were treated with adjuvant radiotherapy, and 1 of 3 died of recurrence 3 years after the initial diagnosis

The benefit of radiotherapy, of ³-knife radiosurgery, and of chemotherapy in the treatment of the partially excised chordoid gliomas is uncertain because of the small number of patients treated