Cyst with a mural nodule tumor of the brain

Abstract

The purpose of this article is to illustrate the imaging findings of lesions that present as cyst with a mural nodule tumor (CMNT). CMNT is a subtype pattern of intra-axial enhancement in central nervous system tumors, typical of a variety of brain neoplasms, including, as the most common, hemangioblastoma, pilocytic astrocytoma, ganglioglioma and pleomorphic xanthoastrocytoma and as less common tanycytic ependymoma, intraparenchymal schwannoma, desmoplastic infantile ganglioglioma and cystic metastasis. A retrospective design was chosen given the rarity of CMNT. Relevant cases were obtained retrospectively to review the different lesions that can present with the appearance of CMNT.

Current Clinical Brain Tumor Imaging

“…The combination of a cyst and solid nodule within a tumor suggests brain tumors such as ganglioglioma, pilocytic astrocytoma, pleomorphic xanthoastrocytoma, and, in the posterior fossa, hemangioblastoma. 17 Calcifications can be seen in oligodendrogliomas, ependymomas, and pineal tumors, among others. 18 Necrosis and hemorrhage are seen with higher grade gliomas, certain metastases, and rarely central nervous system (CNS) lymphoma in immunocompromised patients.…”

Pleomorphic xanthoastrocytoma in a case of tuberous sclerosis

“…[3,4] Pleomorphic xanthoastrocytomas typically appear as hypointense cystic masses with an enhancing mural nodule on T1-weighted MRI, hyperintense or mixed signal intensity on T2 weighted MRI with suppression of cyst content on FLAIR images. [5] Additionally, Raz et al also described the peculiar finding of enhancement of the adjacent meninges, which is seen in up to 70% of cases. [5] This tumor is of a low grade subtype, classified under WHO Grade 2 group of gliomas, and although malignant transformation into a higher grade or anaplastic variant is considered rare, histologically this tumor can be confused with Grade IV giant cell glioblastoma due to the findings of giant cells.…”

“…[5] Additionally, Raz et al also described the peculiar finding of enhancement of the adjacent meninges, which is seen in up to 70% of cases. [5] This tumor is of a low grade subtype, classified under WHO Grade 2 group of gliomas, and although malignant transformation into a higher grade or anaplastic variant is considered rare, histologically this tumor can be confused with Grade IV giant cell glioblastoma due to the findings of giant cells. Pleomorphic xanthoastrocytomas are somewhat uncommon and typically slow-growing, and cases which are completely excised show favorable prognosis.…”

MR and CT of Brain's Cava

“…The differential diagnosis for CSP includes the fluid midline alterations, such as craniopharyngioma (Figs 6 and 7), cyst of SP (Fig 8), absence of SP (Figs 9 and 10), neuroepithelial cyst (Fig 11), colloid cyst, simple cyst of CSP (Fig 12), cyst of the Cavum Veli Interpositi, parasitic cyst. In all these cases, the leaves of the SP would not be expected to be separated 29 …”

“…The CV is considered a normal variant that usually does not require surgical treatment. However some cases become symptomatic by causing obstruction of CSF flow through the foramen of Monro, leading to various symptoms including papilledema, headache, vomiting, loss of consciousness, and visual and sensorimotor disturbance caused by secondary increases in intra‐cranial pressure and hydrocephalus 29,30 . The CV may be present sometimes in congenital syndromes like the Sotos Syndrome 31 and an increased incidence of CV has been noted in patients with childhood‐onset schizophrenia and other affective disorders.…”