Question:

The following is true regarding the intraventricular lesions:
1. An enhancing mass in the region of foramen of monro, associated with subependymal calcific nodules is suggestive of central neurocytoma.
2. A completely intraventricular mass near foramen of monro, with a heterogeneous signal and cyst formation is diagnostic of ependymoma.
3. A homogenously enhancing mass in the lateral ventricular trigone in a 45 year old female is strongly suggestive of meningioma.
4. An intensely enhancing mass in the lateral ventricle in a 2 year child is consistent with subependymal giant cell astrocytoma.
5. A heterogeneously enhancing lesion in the 4th ventricle in a young female is highly suggestive of a subependymoma.





Answer:

The correct answer for the question "The following is true regarding the intraventricular lesions:" is:

3. A homogenously enhancing mass in the lateral ventricular trigone in a 45 year old female is strongly suggestive of meningioma.



Explanation
1. An enhancing mass in the region of foramen of monro, associated with subependymal calcific nodules is almost pathognomonic of subependymal giant cell astrocytoma, which is seen in patients with tuberous sclerosis. [The subependymal giant cell astrocytomas are always located near the foramen of monro and intensely enhance. They are associated with ventricular wall calcifications as part of the stigmata of tuberous sclerosis which help in their differentiation.]

2. An intraventricular mass near foramen of monro, with a heterogeneous signal and cysts can represent a central neurocytoma as well as an ependymoma. Subependymal giant cell astrocytoma should show subependymal calcifications. [Both subependymoma and central neurocytoma tend to occur in the anterior portions of the lateral ventricles, but central neurocytoma is usually seen in a younger age group and shows a more heterogeneous isointense signal on T1, T2 MRI.]

3. Meningiomas appear as homogenous enhancing masses, commonly located in the lateral ventricular trigone in middle age females. [Meningiomas are usually seen in middle age patients especially females, they are frequently calcified and intensely enhance.]; [Meningioma resembles subependymoma in being homogenous.]

4. An intensely enhancing mass in the lateral ventricle in a 2 year child is highly suggestive of choroid plexus papilloma. [Unlike subependymoma, the choroid plexus papilloma occurs in young children in the region of the choroid plexus and it intensely enhances.]

5. A heterogeneously enhancing lesion in the 4th ventricle in a young female could represent an ependymoma as well as a subependymoma, however; subependymoma is a rare tumor and usually appears homogenous with no significant enhancement. [It accounts for less than 1% of all intracranial neoplasms.]; [It should be considered if we are encountering a complete intraventricular mass causing little or no edema, which is non-enhancing or minimally enhancing.]



From the manuscript:
A case of septum pellucidum subependymoma with a subtle imaging appearance simulating a cavum septum pellucidum
Radiology Case. 2013 Oct; 7(10):7- 16


This article belongs to the Neuro section.




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From the manuscript

A case of septum pellucidum subependymoma with a subtle imaging appearance simulating a cavum septum pellucidum

Free full text article: A case of septum pellucidum subependymoma with a subtle imaging appearance simulating a cavum septum pellucidum

Abstract
Subependymoma is a rare benign slowly growing tumor which usually appears as a well-defined lobulated entirely intraventricular mass, in the fourth or lateral ventricles. We report a case of subependymoma involving the septum pellucidum in a 28 year old female demonstrating a subtle and unusual radiological appearance. It showed very low attenuation on computed tomography, with very high signal on T2- and low signal on T1 weighted magnetic resonance images, merging with the ventricular wall, without definite focal mass. This appearance made the tumor difficult to differentiate from the cerebrospinal fluid and simulating a cavum septum pellucidum. The patient was treated by craniotomy and gross total resection of the mass.






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