Subependymal giant cell astrocytoma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D., Ifeoma Odukwe, M.D. [2], Sujit Routray, M.D. [3]

Overview

Subependymal giant cell astrocytoma must be differentiated from ependymoma, meningioma, tuberculoma, intraventricular hemorrhage, glioblastoma multiforme, primary CNS lymphoma, and cerebral metastases.

Differentiating Subependymal Giant Cell Astrocytoma from other Diseases

Diseases Clinical manifestations Para-clinical findings Gold
standard
Additional findings
Symptoms Physical examination
Lab Findings MRI Immunohistopathology
Head-
ache
Seizure Visual disturbance Constitutional Focal neurological deficit
Adult primary brain tumors
Glioblastoma multiforme
[1][2][3]
+ +/− +/− +
  • Pseudopalisading appearance
Oligodendroglioma
[4][5][6]
+ + +/− +
  • Chicken wire capillary pattern
  • Fried egg cell appearance
Meningioma
[7][8][9]
+ +/− +/− +
  • Well circumscribed
  • Extra-axial mass
  • Whorled spindle cell pattern
  • May be associated with NF-2
Hemangioblastoma
[10][11][12][13]
+ +/− +/− +
Pituitary adenoma
[14][15][3]
+ Bitemporal hemianopia
  • It is associated with MEN1 disease.
Schwannoma
[16][17][18][19]
+
  • Split-fat sign
  • Fascicular sign
  • Often have areas of hemosiderin
  • S100+
Primary CNS lymphoma
[20][21]
+ +/− +/− +
  • Single mass with ring enhancement
Childhood primary brain tumors
Pilocytic astrocytoma
[22][23][24]
+ +/− +/− +
Medulloblastoma
[25][26][27]
+ +/− +/− +
  • Homer wright rosettes
Ependymoma
[28][3]
+ +/− +/− +
  • Hydrocephalus
  • Causes an unusually persistent, continuous headache in children.
Craniopharyngioma
[29][30][31][3]
+ +/− + Bitemporal hemianopia +
Pinealoma
[32][33][34]
+ +/− +/− + vertical gaze palsy
  • May cause prinaud syndrome (vertical gaze palsy, pupillary light-near dissociation, lid retraction and convergence-retraction nystagmus
Vascular
AV malformation
[35][36][3]
+ + +/− +/−
Brain aneurysm
[37][38][39][40][41]
+ +/− +/− +/−
  • MRA and CTA
Infectious
Bacterial brain abscess
[42][43]
+ +/− +/− + +
  • Central hypodense signal and surrounding ring-enhancement in T1
  • Central hyperintense area surrounded by a well-defined hypointense capsule with surrounding edema in T2
  • History/ imaging
Tuberculosis
[44][3][45]
+ +/− +/− + +
  • Lab data/ Imaging
Toxoplasmosis
[46][47]
+ +/− +/− +
  • History/ imaging
Hydatid cyst
[48][3]
+ +/− +/− +/− +
  • Imaging
CNS cryptococcosis
[49]
+ +/− +/− + +
  • We may see numerous acutely branching septate hyphae
  • Lab data/ Imaging
CNS aspergillosis
[50]
+ +/− +/− + +
  • Multiple abscesses
  • Ring enhancement
  • Peripheral low signal intensity on T2
  • We may see numerous acutely branching septate hyphae
  • Lab data/ Imaging
Other
Subependymal giant cell astrocytoma
[51][52]
+ +/− +/− - +
  • T1 isointense and hypointense signal enhancement
  • T2 isointense and hyperintense signal enhancement
  • Homogenous postcontrast enhancement
  • Enlargement of ventricles
Brain metastasis
[53][3]
+ +/− +/− + +
  • Based on the primary cancer type we may have different immunohistopathology findings.
  • History/ imaging

ABBREVIATIONS

CNS=Central nervous system, AV=Arteriovenous, CSF=Cerebrospinal fluid, NF-2=Neurofibromatosis type 2, MEN-1=Multiple endocrine neoplasia, GFAP=Glial fibrillary acidic protein, HIV=Human immunodeficiency virus, BhCG=Human chorionic gonadotropin, ESR=Erythrocyte sedimentation rate, AFB=Acid fast bacilli, MRA=Magnetic resonance angiography, CTA=CT angiography

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