Brain Tumor Res Treat.  2017 Apr;5(1):24-29. 10.14791/btrt.2017.5.1.24.

Fourth Ventricular Lesions in Metastatic Gliomas: A Rare Predilection?

• Khan MN
• Poulin A
• Essig M

• KMID: 2378301
• DOI: http://doi.org/10.14791/btrt.2017.5.1.24

Abstract

Over the course of five years, a total of ten cases were collected of glioma patients in whom a distant lesion at the fourth ventricle was noted. A "˜distant lesion' was defined as a lesion with a normal appearing tissue bridge at imaging between the primary and secondary locations. Previous imaging of these patients was reviewed along with clinical history, course of therapy, and available histology. A review of the literature was performed with respect to present knowledge on patterns of glioma proliferation and dissemination. This case series is the first to describe the fourth ventricle as a location that may be prone to secondary lesions in glioma patients. Further investigation on this subject may yield deeper insights into the mechanisms by which glial tumors spread within the brain, with the hope of developing or improving therapeutic targets.

Keyword

Metastasis; Glioblastoma multiforme; Fourth ventricle; Cerebrospinal fluid; Magnetic resonance imaging; Pathogenesis

MeSH Terms

Brain
Cerebrospinal Fluid
Fourth Ventricle
Glioblastoma
Glioma*
Hope
Humans
Magnetic Resonance Imaging
Neoplasm Metastasis

Figure

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  Fig. 1 50-year-old male (patient #3) presented to emergency with ataxia and diplopia. Initial MRI examination reveals a T2 hyperintense lesion in the left front lobe with extension of abnormal signal intensity across midline (A) and enhancement on T1-weighted post-gadolinium images (B). Evaluation of the posterior fossa demonstrates a T2 hyperintense (C) enhancing (D) lesion involving the cerebellar vermis at the fourth ventricle, present at the time of initial examination. MRI, magnetic resonance imaging.

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  Fig. 2 53-year-old male with WHO grade III astrocytoma (patient #2). Initial MRI shows large right fronto-temporal FLAIR hyperintense (A) contrast-enhancing (B) lesion. Follow-up MRI obtained 3 years later reveals new abnormal FLAIR hyperintesity adjacent to the fourth ventricle (C). This lesion subsequently progressed with enlargement (D) and new enhancement (E), and eventually resulted in obstructive hydrocephalus (F). WHO, World Health Organization; MRI, magnetic resonance imaging; FLAIR, fluid attenuation inversion recovery.

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  Fig. 3 50-year-old male with WHO grade III astrocytoma (patient #10). Initial MRI examination demonstrates a FLAIR hyperintense (A) contrast-enhancing (B) lesion in the parasagittal posterior left frontal lobe. Follow-up examination after two years reveals no recurrent tumor at the resection site on FLAIR (C) or T1-weighted post-gadolinium images (D). However, at 26 months, there are new areas of subependymal FLAIR hyperintensity (E) and enhancement (F) in the lateral ventricles. Furthermore, there is a discrete focus of abnormal FLAIR hyperintensity (G) and enhancement (H) involving the posterior left pons, abutting the fourth ventricle. WHO, World Health Organization; MRI, magnetic resonance imaging; FLAIR, fluid attenuation inversion recovery.

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  Fig. 4 36-year-old male (patient #1) with WHO grade IV astrocytoma (glioblastoma multiforme). Initial MRI examination reveals a FLAIR hyperintense (A) contrast-enhancing (B) lesion in the right frontal lobe. Follow-up MRI examination demonstrated a FLAIR hyperintense (C) non-enhancing (D) lesion abutting the fourth ventricle which developed 35 months after the initial lesion. WHO, World Health Organization; MRI, magnetic resonance imaging; FLAIR, fluid attenuation inversion recovery.

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  Fig. 5 39-year-old male with WHO grade II astrocytoma. Initial MRI reveals a large lesion in the left temporal lobe demonstrating abnormal FLAIR hyperintensity (A). After two years, the patient develops a new left cerebellar FLAIR-hyperintense lesion (B), histologically grade II astrocytoma. This lesion progressively enlarged as seen on a subsequent examination (C). WHO, World Health Organization; MRI, magnetic resonance imaging; FLAIR, fluid attenuation inversion recovery.

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