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Neurology India, Vol. 58, No. 5, September-October, 2010, pp. 805-806 Letter to Editor Liponeurocytoma of lateral ventricle Ritu Pankaj1, Anupam Jindal2, Ashru K Banerjee1 1 Deparment of Lab Medicine Fortis Hospital Mohali, Mohali, Punjab, India Correspondence Address: Date of Acceptance: 21-Jul-2010 Code Number: ni10229 PMID: 21045527 DOI: 10.4103/0028-3886.72195 Sir, Cerebellar liponeurocytoma (LN) is a rare neoplasm showing neuronal, glial, and focal lipomatous differentiation [1] It is among the most frequent central nervous system (CNS) neuroepithelial tumors which show lipidization; however existence of such lipocytic differentiation within a central neurocytoma is very rare. [2] In this communication we report one more case of LN of lateral ventricle. We recently encountered a 35-year-old male who had presented to the neurosurgical department with complaints of intermittent severe headache associated with blurring of vision and diplopia of six months duration. His chief complaint was generalized weakness. Neurological examination revealed bilateral papilledema and bilateral sixth nerve palsy. Routine hematology and blood biochemistry were within normal limits. The magnetic resonance imaging (MRI) brain scan revealed an inhomogeneously enhancing large intraventricular mass filling the body and lateral horn of right ventricle. The mass measured 5x3x1 cm and showed areas of calcification. Patient underwent right frontal craniotomy, and complete tumor excision by mid frontal gyrus approach. Patient required a ventriculoperitoneal shunt on the tenth post-operative day. His subsequent recovery was satisfactory and at the time of discharge his Glasgow coma scale score was 14. On gross examination, the mass appeared well marginated, partly calcified and pinkish grey in color. Light microscopy revealed sheets of monomorphic cells with rounded nuclei and clear cytoplasm, resembling oligodendrocytes. There was a fine fibrillary background and several foci showed mature adipose tissue intimately mixed with other tumor cells. Fine capillaries were also seen between the groups of cells [Figure - 1]. Extensive secondary changes consisting of hemorrhage, hyalinization, and cystic degeneration were interspersed with areas showing hemosiderin pigment and calcification. Immuno-histochemically the tumor cells were positive for synaptophysin but the fat cells were negative. GFAP immunostaining showed a variable degree of positive staining. In some fields it was clearly related to trapped astrocytes, whereas in other fields this was more intimately related to the tumor. A diagnosis of central LN was made. The process of lipidization in this neoplasm is a subject of debate. While some authors describe it as true adipose metaplasia of neuroectodermal cells, [3] others suggest it to be simple lipidization of tumor cells. [4] Evidence of neuronal nature of neoplasm comes from the immunohistochemical profile which is positive for neuronal markers such as neuron-specific enolase, synaptophysin and chromogranin. [5] Topography plays an important role in neuropathology in differential diagnosis of morphologically similar lesions; however using a specific site limited term such as cerebellar liponeurocytoma restricts the use of tumor nomenclature at other sites. Our case showed glial, neuronal and lipomatous differentiation in a lesion which was located in lateral ventricle; therefore a less committal term such as central liponeurocytoma seemed more appropriate as it encompasses all neurocytic tumors with lipomatous differentiation irrespective of the location. The biological behavior of such tumors is quite unpredictable as shown by a recent publication where recurrence and malignant progression has been reported. [6] Long-term follow up studies of large number of cases will help to understand the biological behavior of this rare tumor. It further needs to be seen whether there is difference of biological behavior of tumor in cerebellar and extracerebellar location. Only five cases of liponeurocytoma (LN) of lateral ventricle have been reported until 2007 including one case in which one of us is a co-author. Acknowledgment We thank Director Fortis hospital Mohali and Dr Simi Bhatia, National Head, Histopathology, Super Religare Ltd, Mumbai for their assistance in immunohistochemistry of this case. References
Copyright 2010 - Neurology India The following images related to this document are available:Photo images[ni10229f1.jpg] |
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