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65 year old male pre-op

Subependymoma

Benign rare CNS tumor

Composed of nests of ependymomal cells in a dense glial fibrillary matrix

WHO grade I

Usually occur in middle aged/ederly; metastasis primary ddx in the latter group

most found incidentally at autopsy or on imaging unrelated to indication for the exam

Symptoms, if any, from direct compression of the brain stem or d/t obstructive hydrocephalus

Imaging Characteristics

Typically intraventricular or periventricular

May be multiple

Lateral recess of 4th most common or lateral ventricle abutting septum

Isodense on CT

Isointense on T1, hyperintense on T2

distinguishing feature: No enhancement >60%

When large, may have cysts, Ca+2, or hemorrhage but atypical

Differential

central neurocytoma

ependymoma

colloid cyst (depending on location)

subependymal giant cell astrocytoma (if other signs of TS)

low grade intraventricular astrocytoma

metastasis

TX: usually follow-up or surgery if symptomatic