PMC10118663_01
Patient 1. Magnetic resonance imaging findings: sagittal, coronal and axial images. A suprasellar ovoid mass with homogeneous enhancement after gadolinium administration is shown. (A) The sagittal T2 weighted image shows a suprasellar hyperintense ovoid mass with third ventricle extension. Note the normal pituitary gland in a normal sella (arrow). (B) The coronal T1 weighted image shows avid and homogeneous enhancement after gadolinium administration and ventricular asymmetry despite the septostomy and shunt. (C and D) The axial T1 weighted images with gadolinium show the involvement of the tumor in the interpeduncular cistern and the third ventricle. No hydrocephalus was detected due to the ventriculo-peritoneal shunt (asterisks).
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Immunohistochemical findings. (A) Hematoxylin and eosin stain (400x): small cells with circular and oval nucleus, with eosinophilic cytoplasm in a mucinous stroma. (B) Glial fibrillary acidic protein stain (100x): intense and diffuse reactivity for GFAP, in clusters and cords.
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The diagnosis of chordoid glioma was settled (Figure 2).
Patient 1. Postoperative and pre-radiotherapy magnetic resonance imaging findings. (A) The sagittal T2 weighted image showed remaining tumor at the third ventricle but without no significant mass effect. (B) The coronal T1 gadolinium weighted image showed the tumor inside the third ventricle but with ventricular symmetry. (C) The axial T1 gadolinium weighted image showed remnant tumor in the interpeduncular cistern. (D) The FLAIR sequence showed spontaneous brightness of the chordoid glioma.
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Eighteen months post-surgery, due to residual tumor of 10 per 19 mm (Figure 3), gamma knife radiosurgery was performed.
PMC10118663_02
Patient 2. Magnetic resonance imaging findings: sagittal and coronal images. A suprasellar mass with heterogeneous enhancement after gadolinium administration is shown, with hypothalamic involvement and hydrocephalus. (A) The sagittal T1 weighted image shows a suprasellar tumor with gadolinium enhancement compromising the interpeduncular cistern and the third ventricle. The normal pituitary gland is in a normal position (arrow). (B) The axial T2 weighted image shows spontaneous hyperintensity. (C) The coronal FLAIR shows tumor brightness and associated obstructive hydrocephalus.
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Mild supratentorial ventricular dilatation was detected (Figure 4).
Immunohistochemical findings. Positive cytoplasmic immunostaining for glial fibrillary acidic protein (400 X).
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Chordoid glioma was diagnosed (Figure 5).