Deniz Kılıç

The majority of atypical teratoid/rhabdoid tumors (ATRTs) appear as heterogeneous masses with solid, cystic, necrotic components and calcification in the cerebral hemispheres; however, acute hemorrhagic onset is rare. The aim of this study is to describe a patient with an acute hemorrhagic supratentorial ATRT. A 4-year-old patient presented with right-sided weakness, nausea, vomiting, and loss of consciousness. Cranial magnetic resonance imaging revealed a large solid and cystic mass in the left posterior frontotemporal region with evidence of acute hemorrhage. The patient underwent urgent surgery, and gross total excision of the hemorrhagic tumor was achieved. A follow-up brain magnetic resonance imaging performed 2 months after surgery showed no evidence of tumor recurrence. Although hemorrhage is not uncommon in ATRT, massive acute hemorrhagic onset may obscure the underlying neoplasm; therefore, ATRT should be included in the differential diagnosis of spontaneous supratentorial hemorrhage in children.

It is not clear whether white-coat hypertension (WCH) is related to the development of left ventricular geometry changes in children. This retrospective, single-center study categorized patients into obese and normal-weight groups. The obese cohort comprised 72 with hypertension (48 male, 12.3 ± 3.2 years), 40 with white-coat hypertension (WCH; 29 male, 12.9 ± 2.8 years), and 31 normotensive controls (18 male, 11.9 ± 2.2 years). The normal-weight cohort included 62 with hypertension (40 male, 12.9 ± 3.9 years), 32 with WCH (21 male, 12.5 ± 3.3 years), and 89 normotensive controls (60 male, 13.0 ± 2.1 years). Echocardiography and ambulatory blood pressure monitoring were performed for all participants with WCH or hypertension. Abnormal left ventricular geometry was defined as the presence of concentric remodeling, concentric left ventricular hypertrophy, or eccentric left ventricular hypertrophy. The prevalence of abnormal left ventricular geometry demonstrated a significant, stepwise increase from the control group to the WCH and hypertension groups among normal-weight children (1%, 9.4%, and 25.8%, respectively; p < 0.001). This graded trend was absent in children with obesity, where the prevalence was elevated across all groups but did not increase progressively with the severity of the blood pressure phenotype (19.3%, 15%, and 45.8%, respectively; p = 0.002). These findings suggest that WCH may signify an intermediate cardiovascular risk state even in the absence of obesity. From a preventive medicine perspective, the identification of WCH in normal-weight children warrants periodic blood pressure monitoring. While our study clearly establishes the presence of this association in normal-weight youth, the specific nature of the interaction between WCH and obesity-whether additive or synergistic-warrants further investigation in larger, longitudinal cohorts.

Teratomas typically arise as midline lesions in the suprasellar and pineal regions. Pneumosinus dilatans is a rare condition characterized by the expansion of one or more of the paranasal sinuses and thinning of their bony walls with a normal covering mucosa. It usually involves the sphenoid and posterior ethmoid sinuses and has been associated with meningiomas and arachnoid cysts. Off-midline mature teratomas are uncommon, and no reports have described an association with pneumosinus dilatans. We present a rare association between an intracranial off-midline mature teratoma and pneumosinus dilatans in an 18-year-old male patient who presented with a second episode of a left-sided seizure, which has not yet been reported in the literature.

Functional or non-secretory ectopic pituitary neuroendocrine tumors (PitNET) can form around the sella turcica during the development of the adenohypophysis by differentiating and detaching from the pharyngeal roof. These tumors usually appear in the sphenoid sinus, clivus, cavernous sinus, infundibulum, and suprasellar cistern. Ectopic PitNETs typically display the characteristic magnetic resonance imaging findings of pituitary adenomas. However, preoperative diagnosis of PitNETs is usually challenging because of the variety of clinical and imaging presentations, locations, and sizes. Ectopic suprasellar PitNETs resemble mass lesions in the pituitary stalk. Ectopic cavernous sinus of PitNETs are typically microadenomas in the medial wall. Ectopic sphenoclival tumors are characterized by more aggressive tumor activity than the other ectopic PitNETs. Although ectopic PitNETs are exceedingly rare, they should be considered as a differential diagnosis for masses around the sella turcica. Treatment of the disease should be individualized and may include medical care, surgical resection, gamma-knife radiosurgery, and radiotherapy.

Aim We aimed to describe the computed tomography (CT) and magnetic resonance (MR) imaging findings of intracranial extra-axial chondroma. Material and methods We retrospectively evaluated the imaging findings of CT and MR examinations of six patients (three men and three women, aged 21–66 years) with histopathological diagnoses of intracranial extra-axial chondroma. Results Four tumors were located in the frontal region and two in the cavernous sinus. All the tumors showed low signals on diffusion-weighted images and high signals on apparent diffusion coefficient maps without restricted diffusion. There was no perifocal edema in all the tumors. Cavernous sinus chondromas were associated with bone erosion and anterior displacement of the internal carotid arteries, but without calcification. Calcification was present in all frontal chondromas. All the tumors revealed low signals on T1-weighted MR images. Frontal chondromas revealed mixed signals, but cavernous sinus chondromas were brightly hyperintense on T2-weighted MR images. No enhancement was detected in the two chondromas. An intense homogeneous enhancement was detected in a cavernous sinus chondroma. Conclusion The imaging appearances of frontal extra-axial chondromas and cavernous sinus chondromas may have different imaging appearances. Although there is a wide range of imaging findings, the absence of restricted diffusion, perifocal edema, enhancement, and presence of low signals on T1-weighted MR images in a well-circumscribed calcified extra-axial mass should suggest an intracranial chondroma.