30-year-old patient with visual impairment

Images

Doctor's Information

Name : Hamidreza
Family : Haghighatkhah
Affiliation :Radiology department,ShohadaTajrish Hospital,SBMU
Academic Degree : Associate professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Afarin Sadeghian

Case Section

Neuroradiology

Patient's Information

Gender : Male
Age : 30

Clinical Summary

30-year-old man presented with visual impairment

Imaging Findings

Axial, sagittal and coronal spin-echo T1-weighted(Fig.1) ,T2-weighted (Fig.2,3 and 4) and FLAIR(Fig.5) sequence images demonstrate a round supra sellar solid mass with small cystic components asarising from left-sided optic tract without evidence of restriction diffusion(Fig.6,7 and 8).

Differential Diagnosis

1-Tumoral lesions: 1.Chiasmatic/hypothalamic astrocytoma,2.Craniopharyngioma,3.Pituitary macroadenoma;2-Cellular infiltrates:1.LCH,2.Sarcoidosis,3.Lymphocytic hypophysitis;3-Other lesions:1.Hamartoma,2.Rathke's cleft cyst,3.Intracranial lipoma

Final Diagnosis

Optic tract glioma

Discussion (Related Text)

Optic pathway gliomas (OPGs) account for approximately 5% of all brain tumors and 10% to 15% of supratentorial tumors in children. The tumor can arise anywhere along the optic pathway, from just behind the globe to the occipital cortex. The diagnosis of OPG also covers cases of hypothalamic or chiasmatic glioma, in which it is difficult to distinguish the site of origin. In children, OPGs are almost always low-grade astrocytomas. Ten percent to 70% of children with OPG have neurofibromatosis (NF). NF-OPG is a separate entity from non–NF-OPG, with different imaging features and prognosis, thereby warranting a specific diagnostic, clinical, and therapeutic approach. The prognosis is reportedly much better in children with NF than in those without. In the patients with NF, the most common site of involvement was the orbital nerve. The tumor was smaller than in the non-NF patients, the original shape of the optic pathway was preserved, and cystic components were uncommon. In the non-NF group, the chiasm and hypothalamus were the most common sites of involvement, the tumor was mass like, and cystic components were frequently seen, as was extension beyond the optic pathways.

References

AJNR Am J Neuroradiology 22:1963–1969, November/December 2001