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Digital Slide Seminar:

Dr Nor Haizura Abd Rani

Day 1

Case 1:

  • A 68-year-old female who is presented with left sided weakness and headache.

  • MRI brain: Right parietal mass 6.2x4.8x5.5cm with displacement / distortion of cortico spinal tract.

  • Clinical impression was given as right parietal high-grade glioma.

  • Tumor excision was done.

Case 2:

  • 49yo gentleman with altered behaviour and seizures for 2 months.

  • No raised intracranial pressure symptoms.

  • No fever, constitutional symptoms, or neurological deficit.

  • MRI brain: right frontal large enhancing predominantly cystic lesion, 7x4.4x4.4cm, compressing the right frontal horn of lateral ventricle, and crossing the midline, infiltrating the contralateral frontal lobe. Radiological impression: most likely right frontal lobe cystic astrocytoma.

  • Intraoperatively, noted yellowish solid cystic component.

Case 3:

  • 60 y.o Malay man presented with history of headache on and off for a year and left limb weakness for a week.

  • MRI Brain : A well-defined irregular intra-axial heterogenous tumor mass measuring 5.9x4.9x4.5cm. Isointense on T1W1, with hyperintense on T2 with minimal intralesional enhancement post-contrast.

  • Intra-operative: Greyish tumor with poor brain interface. Tumor is soft and highly vascularized.

Day 2

Case 1:

  • 39 yo Punjabi, male. Seizure and vomiting. GCS E4V5M6.

  • MRI brain: butterfly glioma (R>L).

  • Underwent right craniectomy and excision biopsy.

  • Intraop: tumour whitish pale in color, sticky tumour, xanthochromic fluid came out,

  • Poor irregular border, moderate vascularized.

Case 2:

  • 3-yo-girl known case of anaplastic ependymoma, WHO G3 of right parieto-temporal post surgical resection of tumour in 2019 and 2020, completed chemotherapy in 2020 radiotherapy in 2021.

  • Now presented with left sided hemiparesis, right craniectomy site bulging.

  • Recent MRI: enhancing solid lobulated lesion at medial aspect surgical cavity 1.2x1.9x2.3cm, lateral postero-superior aspect surgical cavity 1.7x1.5cm.

  • Done right re-craniectomy excision of tumor. Intraop: tumour solid cystic, mainly cystic. Cyst is multiloculated with yellowish fluid content. Small tumour nodule adjacent to choroid plexus, bounded laterally by temporal horn and medially by lateral ventricle.

  • Clinical imp: recurrent right temporal parietal anaplastic ependymoma.

Case 3:

  • 6-yo-boy. Had history of episodes of unsteady gait at age 5yo with frequent fall.

  • MRI brain and spine: well-defined midline posterior fossa mass with cystic component measured 3.9x2.6x2.9cm. Differentials: ependymona, medulloblastoma, ATRT, pilocytic astro, choroid plexus papilloma.

  • Intra op: poorly defined, attached at roof of 4th ventricle (contra dg radio)