Concluded Case

A BIG MASS LESION IN A 3YRS OLD CHILD

3yrs old male with headache,nausea and gait disturbance since 2months getting worse by passing time, yesterday he lost his consciousness rushed to emergency where he was intubated and electively ventilated.O/E - PUPILS - B/L 8mm NRTL,GCS - 3/15.DIAGNOSIS AND MANAGEMENT PLAN?

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Concluded answer

large PNET, poor prognosis even after surgery as it is too much infiltrated, deep and poor gc

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Most likely a big glioma with secondary haemorrhage either inside the tumour or due to pressure erosion of a vessel with intraventricular extension of haemorrhage with secondary hydrocephalus. Although looks like glioma considering the site of tumour- but medullo- blastoma needs to be ruled out . Urgent External ventricular drainage is indicated along with ventilatory support, AED'S and supportive treatment

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Big heterogeneous midline mass involving the 3rd ventricle,bilateral thalamus ,pineal region ,corpus callisum with hemorrhagic areas and cystic lesions.Contrast MRI is not posted. Diastation of frontal horns of both lateral ventricles.Origin of the tumor is difficult to differentiate from the available films. Sagittal view shows well demarcated margin. DD- primitive neuroectodermal tumor,Germinoma,Germ cell neoplasm.Astrocytoma.menongioma .

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This patient was having braintumour &it suddenly bled resulting in intraventricular exetension. That may be gioma. Evd for attemting to reduce hydrocephalus &bleed 1st. Administer medicines to reduce icp&ventilate. Later surgical excision after explaining to parents her criticalstage.

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@Manorama Rajan mam,@Bhupesh Kumar sir,@Dr. Sivaram Reddy sir,@Dr. Abhijit V sir,@Padam Chand sir,@Dr. Pothireddy Srinivas Reddy sir,@Yashesh Dalal @Anand Kumar sir kindly opine

it's a PNET.. quite big. surgery but high risk poor prognosis

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Mass in brain stem region With hydrocephalus Opinion of paed neurologist

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@Dr. Deepak Bariya sir

@Manorama Rajan mam

large PNET, poor prognosis even after surgery as it is too much infiltrated, deep and poor gc

Choroid plexus carcinoma / PNET

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